Discovery: topic and practice issue
The topic and the nursing practice issue related to this topic
As a nursing practice issue, improper drug administration may have different origins, from nurses’ understaffed and overworked conditions to their ignorance of proper procedures. Resolving the latter as a professional issue could be possible by initiating a change from a nurse’s level of employment.
The rationale for the topic selection. The scope of the issue/problem
Addressing this topic may be decisive in upholding patient-oriented practices. Thus, understanding appropriate safety measures preceding medication administration becomes relevant to creating a beneficial healthcare environment (Khalil, Bell, Chambers, Sheikh, & Avery, 2017). Furthermore, as an integral part of people’s health, primary care helps define the scope of the issue.
Summary: evidence to support the need for a change
The practice problem and the PICOT question
Nurses, who skip over necessary check-ups before medicine administration, may stimulate an increased number of medical errors. Thus, the PICOT question is:
P=Patients who are over 21 years old in primary care
I=Teach and integrate methods of adherence to procedures preceding medicine administration among nurses in a single unit of primary care
C=Results may be compared against those of units with no specialized training
O=The desired outcome is a decreased number of prescription-related medical errors
T=The results can be evaluated after six months
The main findings from the systematic review and the strength of the evidence
The review by Khalil et al. (2017) found that administrative and professional interventions do not affect patient outcomes in first-world primary care and cause no adverse effects. However, the strength of the evidence may be identified as mediocre. The similarity of the utilized studies and their results’ varying certainty supports this conclusion.
Evidence-based solutions for the trial project
Any proposal to reduce medical error in primary care should set low expectations and identify a susceptible professional group. Doing so could permit safeguarding the currently achieved levels of healthcare quality (Latimer, Hewitt, Stanbrough, & McAndrew, 2017). As such, an evidence-based solution could be primarily targeting nursing students for professional interventions.
Translation: Action Plan
Care standards, practice guidelines, or protocols to support the intervention planning
Professional communication lines need to be upheld among different levels of staff to help outline the plan’s necessity. Furthermore, doing so should incite the participants to adhere to specific safety tactics, which must be explained to them explicitly (Samra, Bottle, & Aylin, 2015). Practice guidelines that exist within a facility should be used to streamline the educational process to a single standard.
Stakeholders and their roles and responsibilities in the change process
- The Chief Nursing Officer (CNO) should help standardize the plan to the organizational requirements.
- The nurse manager should help form a unit that will participate in the plan.
- A charge nurse will be responsible for the formed unit and will help orient it toward appropriate safety methods.
- As the project leader, I will facilitate communication between other stakeholders and evaluate the results.
The nursing role in the change process
My role within the change process will be adapting the plan to the needs of the healthcare facility and its staff. Doing so will allow avoiding undermining the currently achieved healthcare quality levels.
Stakeholders by position titles
- Including the CNO allows making the project relevant facility-wide and secures its practical applicability.
- The nurse manager is crucial to creating a unit whose participation in the project will not impair the day-to-day healthcare process.
- A charge nurse, as a team leader, is indispensable for keeping the team focused on the set goal.
Type of cost analysis needed prior to a trial
Analyzing the cost of training staff on safety measures should be contrasted with the future cost of treating undetected medication errors. This process should involve the CNO and the charge nurse, as administrative and staff representatives, respectively.
Implementation
The process for gaining permission to plan and begin a trial
Procuring support from the CNO should be a crucial step to begin the trial, as their support will lend credibility to the project. No other group and committee may need to be formed.
The plan for educating the staff about the change process trial
The unit that will be formed by the nurse manager will be presented with training sessions. These first-week meetings will include theory discussions and case studies to help secure practical knowledge among participants.
The implementation timeline for the change process
Participants chosen by the nurse manager will receive initial formal training, followed by weekly progress reviews. In the final week, the participants may be interviewed to track their personal opinion regarding the trial’s effect on their professionalism.
The measurable outcomes based on the PICOT
The number of medical errors is the primary measurable outcome of the trial project. This number is comprised of hospital readmissions, emergency room (ER) visits, and mortality incidences (Khalil et al., 2017). Furthermore, the number of successful facility checkouts may also be used to analyze effectiveness. These measurable outcomes will be procured using nurses’ administrative paperwork.
Recording during the pilot change process
Westbrook et al. (2017) identify real-time surveillance of nurses as the best way to recognize changes, which may, however, put extra strain on the project and increase its costs. Thus, no additional forms may need to be used apart from existing administrative paperwork and the nurses’ final self-evaluative interview.
Resources available to staff during the change pilot
Apart from those resources that are already in use in primary care, staff will have access to educational resources that will keep them up-to-date with proper safety measures. This information will be available through the charge nurse.
Meetings of certain stakeholders throughout the trial
Monthly meetings of all stakeholders should be held to secure the trial’s continuity and its adherence to the interests of all involved groups.
Evaluation
Reporting the outcomes of the trial
The measurable outcome numbers will be compiled into an excel file and transformed into statistical charts following the end of the trial. These charts will be compared and contrasted against similar numbers that will be derived from the results of an uninvolved trial group. Therefore, the results of the carried out project will base themselves on a comparison of the two units’ results, which will then be assembled into a comprehensive report. Raw data will be included in the report to secure the study’s credibility.
The next steps for the use of the change process information
If the trial’s participants show better results than those of non-controlled groups, then these findings can be used for the planning of a facility-wide project focused on integrating knowledge regarding safety measures preceding medicine administration. Conversely, negative results can incite an analysis of the factors that may have influenced this outcome. Either result allows furthering the current breadth of knowledge regarding the effect of interventions on the provided quality of care.
References
Khalil, H., Bell, B., Chambers, H., Sheikh, A., & Avery, A. J. (2017). Professional, structural and organisational interventions in primary care for reducing medication errors. Cochrane Database of Systematic Reviews, (10), 1-145. Web.
Latimer, S., Hewitt, J., Stanbrough, R., & McAndrew, R. (2017). Reducing medication errors: Teaching strategies that increase nursing students’ awareness of medication errors and their prevention. Nurse Education Today, 52, 7-9. Web.
Samra, R., Bottle, A., & Aylin, P. (2015). Monitoring patient safety in primary care: An exploratory study using in-depth semistructured interviews. BMJ Open, 5(9), 1-7. Web.
Westbrook, J. I., Li, L., Hooper, T. D., Raban, M. Z., Middleton, S., & Lehnbom, E. C. (2017). Effectiveness of a ‘do not interrupt’ bundled intervention to reduce interruptions during medication administration: A cluster randomised controlled feasibility study. BMJ Quality & Safety, 26(9), 734-742. Web.