RUA: Evidence-Based Practice Change Group Project

1

Preventing Medication Errors

Njiole Nwogu

Chamberlain University College of Nursing

NR449: Evidence Based Practice

Professor April Boney

September 12, 2022

2

Clinical Question

Medication errors are preventable occurrences that may result in the incorrect use of

medication or patient injury while the medication is in the possession of a healthcare provider,

patient, or consumer (Tariq et al., 2018). Medication errors cause between 7,000 and 9,000 annual

deaths in the United States, it also causes injuries to over 1.2 million individuals annually and are

to blame for over 29% of prescription drug-related injuries in hospitalized patients (Tariq et al.,

2022). Each year, the overall cost of caring for patients with medication-related errors surpasses

$40 billion, patients suffer psychologically and physically because of drug errors in addition to the

financial burden (Tariq et al., 2022). Patient dissatisfaction and a loss of faith in the healthcare

system are further negative outcomes of medication errors (Tariq et al., 2022).

Patients depend on medication for their health and anticipate that they will be provided the

right medications for their needs. Therefore, when mistakes happen, good care is disrupted and

there is a chance of injury, which could result in negative patient outcomes. This is extremely

harmful and dangerous, both from an ethical and a practical point of view. Consequently, there has

been an exploration of different interventions and their effectiveness in preventing medication

errors and this is the focus of our group’s work.

The use of Barcode medication administration (BCMA) and electronic medication

administration system (e-MAR) is stated as one way of preventing medication errors (Fuller,

2019). To aid in investigating this research, PICOT presents a clinical question and seeks an

answer. The PICOT question formulated is “In hospitalized adult patients, what is the effectiveness

of using BCMA and e-MAR in preventing medication errors compared to not using them within

twelve weeks?” The population is hospitalized adult patients, the intervention is the use of BCMA

and e-MAR. A comparison is made between the technological approaches employed by the BCMA

3

and e-MAR and those that do not use them, keeping patients' safety at the forefront. The outcome

of the medication process is to enhance patient health and treatment quality by lowering or

preventing medication errors. The purpose of this paper was to explore and describe the research

strategies used to examine and identify two most relevant articles that relate to preventing

medication errors and provide evaluation for BCMA and e-MAR usage outcomes in preventing

medication errors. These two articles will best answer the PICOT question.

Levels of Evidence

The initial examination of a research study in terms of which approach was used, the type,

and duration of the study helps to evaluate the level of evidence (Houser, 2018). The type of

question being asked in this research is an intervention question, to know the effectiveness of

BCMA and e-MAR compared to none in preventing medication errors. A randomized controlled

trial (RCT) using a mixed method approach that combines quantitative and qualitative methods

would be the best type of evidence for this study or to address the question (Houser, 2018). It

includes describing the quantifiable state of the study and the subjective reaction to it. Statistics

are the aim of quantitative study design which is the primary method. This could check hypotheses

for categorizing connections or evaluating the impact of measures on findings. To understand the

importance and meaning of occurrences, a qualitative approach is also integrated. Based on the

time frame, the approach would be cross-sectional, and it is prospective, using primary data

(Houser, 2018). It may also be stated that this would be an experimental investigation where the

cause and effect of the effectiveness of BCMA and e-MAR are studied. In this case there is a

random assignment of subjects to groups, highly controlled conditions are used during experiments

and results are analyzed quantitatively (Houser, 2018).

4

Search Strategy

Starting with CINAHL in the chamberlain library and continuing with the PubMed and

Google Scholar databases the search for the most relevant articles relating to the topic was initiated.

The first step was to identify the search concepts which are linked to the PICOT question. Search

terms such as: (a) Barcode medication administration system (BCMA), (b) electronic medication

administration (e-MAR), and (c) medication errors were adopted because they best described the

concept. The Boolean operators “AND” and “OR” were utilized to connect the chosen search terms

to narrow and broaden the search respectively. These databases featured different article types,

Google Scholar listed 20,400 findings, compared to CINAHL's 469 and PubMed175 results. To

make the search more extensive, one of the terms was switched to preventing medication errors

so that relevant articles are not overlooked based on terminology. The next step was to use the

filtering tools to narrow the search to more focused results from the wide variation options. The

search was restricted to the publishing period from 2018 to 2022, set the language to English, the

peer reviewed filter and full text were also applied.

The selected databases presented fewer findings, CINAHL had just eight results, whereas

Google Scholar had roughly 1000 and PubMed reduced to 14 with the application of the full text

filter. Not all the findings on the Google Scholar were academic, these findings were dispersed

and rendered it challenging to identify the trustworthy ones. The CINAHL database links every

paper in the findings and provides filters that users may use to focus their search. To assess the

authenticity of each article, it also displays the publisher, qualifications, and writers directly

beneath the result. Manually searching reference lists from crucial papers identified key literature.

5

By screening the articles based on the relevant results and level of evidence, two articles

were identified, one from the CINAHL database and the other from Google scholar database.

Criteria for screening also included, the design, method of study, sample size, results, and general

findings in relation to the question and how it applies to the nursing practice. The first article “The

impact of Barcode administration system on patient safety” is a randomized controlled study with

a 715-sample size. This article used a quantitative method and provided measurable statistical

analysis which is strong evidence for testing the effectiveness of the intervention. The second

article “Impact of bar-code medication administration and electronic medication administration

record system in clinical practice for an effective medication administration process” is a

systematic review. This sort of literature is often regarded as the strongest level of evidence

because several studies are evaluated on how well they answer the research question and reviewed

to show the most effective methods or outcomes related to the question. It is a mixed method

design with no potential for bias. For both articles, the conclusions match the data results and will

be beneficial to patient care therefore good choices for the most relevant articles to answer the

PICOT question and guide the team project.

Conclusion

The first step of this research search strategy paper was formulating a PICOT question

relating to the project topic. Two primary source articles were identified as evidence to answer the

PICOT question. The research search strategy has been fully described and analyzed and included

the criteria and refinement decisions. Both articles relate to the group topic and will best answer

the PICOT question, “In hospitalized adult patients, what is the effectiveness of using BCMA and

e-MAR in preventing medication errors compared to not using them within twelve weeks?

6

References

Fuller, A. (2019). Electronic Medication Administration Records and Barcode Medication

Administration to Support Safe Medication Practices in Long-term Care Facilities.

https://era.library.ualberta.ca/items/5f13a1b6-a1e2-4f13-8b1d-7ea531d24c42

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Burlington,

MA: Jones & Bartlett Learning.

Macias, Bernabeu-Andreu, F. A., Arribas, I., Navarro, F., & Baldominos, G. (2018). Impact of a

Barcode Medication Administration System on Patient Safety. Oncology Nursing

Forum, 45(1), E1–E13. https://doi.org/10.1188/18.ONF.E1-E13

Naidu, M., & Alicia, Y. L. Y. (2019). Impact of bar-code medication administration and

electronic medication administration record system in clinical practice for an effective

medication administration process. Health, 11(05), 511. https://www.scirp.org/html/6-

8204580_92509.htm

Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2022). Medication dispensing errors and

prevention. https://www.ncbi.nlm.nih.gov/books/NBK519065/