RUA: Evidence-Based Practice Change Group Project

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Analyzing Published Research: Preventing Medication Errors

Njiole Nwogu

Chamberlain University College of Nursing

NR449: Evidence Based Practice

Professor April Boney

October 2, 2022

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Analyzing Published Research: Preventing Medication Errors

Medication administration errors (MAEs) are avoidable incidents that could cause a

patient to be injured while the medication is in the hands of a healthcare worker, patient, or user

(Tariq et al., 2018). Medication errors account for over 29% of all prescription drug-related

accidents, 1.2 million injuries annually and are responsible for between 7,000 and 9,000 deaths

per year in the United States (Tariq et al., 2022). More than $40 billion is spent annually on

treating people who have been injured by MAEs. (Tariq et al., 2022).

Problem

MAEs also cause emotional and physical distress, discontentment, and a loss of faith in

the healthcare system (Tariq et al., 2022). When MAEs occur, quality care is hampered which

could have a detrimental impact on treatment outcomes. This is unethical and hazardous,

consequently, various strategies have been examined for their efficacy in preventing MAEs. This

has been the focus of our group's work.

One method used in preventing medication errors is the use of barcode medication

administration (BCMA) as stated by Fuller (2019). PICOT poses a clinical question to

investigate this inquiry which is, “In hospitalized adult patients, does the use of BCMA

compared to not using BCMA impact medication errors?” Two articles, (Macias et al., 2018;

Naidu & Alicia, 2019) met the search strategy criteria to provide evidence that will best answer

this PICOT question as it relates to the project topic. The purpose of this paper is to analyze

these two research articles for evidence in answering the PICOT question and support the group

work as it relates to the impact of BCMA usage in preventing medication errors.

Synthesis of Literature

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To start the literature review, an evidence matrix table in the appendix shows a data

summary as part of evidence from the two studies. Both articles are reviewed to examine the

effectiveness of using BCMA in preventing MAEs in hospitalized adults. The critical review

focuses on the variables, methods of carrying out the individual studies, participants, including

sampling and the sample size, instrumentation, and the implication of the findings to future

work.

Variables

Both studies focused on BCMA in preventing MAEs. In the study by Macias et al.

(2018), the independent variable was the use of BMCA. The same case was with the study by

Naidu & Alicia (2019), but with both BCMA and e-MAR being considered. The dependent

variable measured was the rate of MAEs for Macias et al. (2018), they also evaluated the severity

and type of the medication errors. Naidu & Alicia (2019) also measured BCMA usage outcomes

and clinical practices related to MAEs as the dependent variable.

Methods

Macias et al. (2018) adopted a quantitative study method using an experimental and

randomized control trial (RCT) design involving between group pre-/post-intervention approach.

They relied on primary data from the observation and measurement of data obtained from the

intervention and control groups before and after the interventions had been carried out. On the

other hand, Naidu & Alicia (2019) concluded the research topic using a systematic review. Eight

studies met the researchers’ study criteria which included an observational study, a pre- and post-

intervention study, a descriptive-analytical study, a case-control study, three literature reviews,

and a mixed-method design study. Some of the articles used quantitative methods and others

used either mixed or qualitative methods to examine the nurses’ perspective on BCMA usage.

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Participants

Macias et al. (2018), involved patients with oncological cancer as participants. In total,

715 patients (n = 715) were selected following convenience sampling at an oncology university

hospital in Spain. Among the 715 patients, 627 were randomly assigned to the intervention group

(N = 627), while eighty-eight patients (N = 88) were assigned to the control group.

For Naidu & Alicia (2019), the primary studies the investigators reviewed followed the

right approaches for sampling and recruiting participants (patients, nurses, or other healthcare

professionals) who took part in the studies. The observational study involved 3 blinded

observers, the descriptive-analytical study, 242 nurses, the case-control study, 59 nurses while

one of the three literature reviews evaluated BCMA implementation in a hospital with 260 beds.

Instruments

The key variables measured were the extent to which the BCMA was applied as an

intervention and how MAEs were measured as the outcomes. In the research by Macias et al.

(2018), observation was applied as the main instrument in collecting data about MAEs. This was

gathered for both the intervention and control groups, before and after the BMCA intervention. A

total of 1,994 observations were made by a group of trained Pharmacists, students, and a nurse.

Observers were taught to identify and categorize errors, and a formal observational protocol was

developed as a result aiding in validity. Though the inter-rater reliability measures in Macias et

al. (2018) studies was not obtained, the data results are reliable based on a confidence interval of

95%, 91% power study, a sample size of 1,994 observations and a 4.2% error rate.

The primary sources analyzed by Naidu and Alicia (2019) utilized various instruments

such as self-designed questionnaires, checklists, observation, and interviews. These instruments

all aligned with the objectives of the research and therefore gives it reliability and validity

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Findings providing Evidence to Support Clinical Problem

Both (Macias et al., 2018; Naidu & Alicia, 2019) provide evidence that BCMA usage is

effective in minimizing medication errors compared to not using them. The study by Macias et

al. (2019) is also proposing improvements to this technology. Nadia & Alicia (2019) found that

some nurses are not comfortable with these systems due to a lack of understanding and training,

suggesting that these technologies would have a good impact on MAEs if they were used in

conjunction with the right coaching, workflow, guidelines, as well as direction and support.

Implications for future work

Since findings from the reviewed articles provide evidence that BCMA usage prevents

MAEs, this innovation can be replicated and implemented generally, but not without issues. Two

questions to further guide the group work are, (1) how will the implementation of BMCA impact

the nurses’ roles, including their everyday work processes and workflow? (2) How will

organizations overcome the issue of lack of technical support to ease the implementation of

BCMA usage in preventing MAEs?

Conclusion

The issue of MAEs is a major problem in healthcare owing to the huge number of

injuries, deaths, emotional and financial impact on patients. Both studies (Macias et al., 2018;

Naidu & Alicia, 2019) were analyzed and provide evidence that using BCMA prevents MAEs in

hospitalized adult patients. This evidence answers the PICOT question and supports the group

project about preventing MAEs. Starting with the matrix table, the analysis of the articles

progressed with focus on the synthesis of literature, however, two questions to guide future work

on the group project still need to be addressed for successful implementation of BCAM usage.

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References

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

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

https://doi.org/10.7939/r3-0q22-k166

Houser, J. (2016). Nursing Research: Reading, Using and Creating Evidence: Reading, Using

and Creating Evidence. Jones & Bartlett Learning.

Macias, M., Bernabeu-Andreu, F. A., Arribas, I., Navarro, F., & Baldominos, G. (2018, January).

Impact of a Barcode Medication Administration System on Patient Safety. In Oncology

Nursing Forum (Vol. 45, No. 1). http://doi.org/10.1188/18.ONF.E1-E13

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

electronic medication administration record system in clinical practice for an effective

medication administration process. Health, 11(05), 511.

http://doi.org/10.4236/health.2019.115044

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

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

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Appendices

Appendix A

EVIDENCE MATRIX TABLE

Articl

e

Referenc es

Purpos e

Hypoth esis

Study Question(s)

Variables Independent

(I) Dependent(

D)

Study Design

Sampl e Size

& Selecti

on

Data Collectio

n Methods

Major Finding( s)

1 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

To examine the effect of barcode medication administration (BCMA) on the rates of errors in the administration of medications among patients in an onco-hematology hospital, as well as establish the types of medication errors in that facility.

I-the administration of medication using a BCMA. D-the rates of medication administration errors (MAEs). Severity, type, and error incidence data were also gathered.

A quantitative study method with experimental/randomiz ed controlled trial (RCT) design involving a between-groups pre- /post-intervention study.

A total of 715 patients (n = 715). (Intervention group) were 627 (N = 627). (Control group) was 88 (N = 88),). A convenience sample was selected from an oncology day unit at a university hospital in Spain.

Observation of MAEs was the major method of collecting data. Observation was by trained pharmacists, students and one nurse.

The key findings of this study were that adopting the BCMA technique aids in lowering the severity and incidence of MAEs. Thus, a BCMA can be adopted as a useful system to increase the time nurses spend with patients directly and aid in improving

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medication administration 's five rights.

2 Naidu, M., & Alicia, Y. L. Y. (2019). Impact of barcode medication administration and electronic medication administration record system in clinical practice for an effective medication administration process. Health, 11(05), 511

To evaluate the usage and effect of BMCA and e-MAR on nurses’ administration of medications, clinical practices, and other outcomes.

I- the use of BMCA and e-MAR system, D- the nurses' administration of medications and BCMA usage outcomes.

A systematic review design with mixed method design

Eight research studies that met criteria using the correct research search strategies

A narrative synthesis of secondary data that used, questionnaire s, checklists, observation, and interviews

The combination of BCMA and e-MAR played a huge role in improving the levels of efficiency. BCMAS system is espoused as having the capacity to improve patient safety and reduce overall medication errors. Thus, adopting this technology can play a huge role in reducing the incidents of MAEs.