The practice problem selected for this project is that insufficient nurse staffing leads to medication errors. A medication error is a preventable occurrence in the hands of a healthcare provider leading to or causing inappropriate medication use, potentially resulting in patient harm. Medication errors in healthcare environments may occur due to a number of reasons, but understaffing is a leading work cause that results in such errors.
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Understaffing can lead to workload pressures, interruptions, poor standardization of procedures and protocols, and limited periods (World Health Organization, 2017). Meanwhile, medication administration to patients is a highly detailed and critical process, which requires focus and attention. Without an appropriate level of staffing to complete all necessary tasks, nurses are forced to juggle responsibilities alongside medication distribution.
The question of medication errors is an important issue in terms of healthcare delivery because giving medication is a vital part of providing care and the healing process. Patients rely on medication for their health and expect medical professionals to provide them with appropriate drugs for their well-being. Therefore, when a medication error occurs, it disrupts proper care and it can potentially cause harm leading to adverse patient outcomes.
This scenario is highly detrimental and dangerous both ethically and practically. Medication errors in hospital environments are prevalent, with 46.5% of patients receiving at least one wrongful drug, and 12.8% experiencing an adverse event (World Health Organization, 2016). Medication error remained at the top of the perceived and data-recorded patient adverse events in cases of understaffing. Medication errors accounted for 36.9% of errors among nurses in the course of undertaking their duties (Kang, Kim, & Lee, 2016).
Healthcare facilities with a higher percentage of nurses and a lower ratio of patients report a few cases of medication errors. On the other hand, healthcare facilities with high nurse workloads due to understaffing report an increase of 1.23 times in medication errors (Kang et al., 2016). Problems of nurse staffing continuously remain a top reason given by medical professionals as a contributing factor to medication administration errors. This is due to nurses being disrupted in their tasks to perform other duties, making transcription-related errors, and a lack of information or guidance on medication and patients since there is a constant rotation of nurses among wards (Hammoudi, Ismaile, & Yahya, 2017).
Therefore, based on the information presented in this section, it is clear that medication errors, due to the insufficient nursing workforce, are a major nursing practice problem that can address through evidence-based practice change.
- P- Population and problem – Nurse understaffing resulting in medication error leading to patient adverse events.
- I- Intervention – Improve staffing and nursing rotations to provide proper time and conditions for medication administration.
- C- Comparison – Maintain current level of staffing which is inadequate.
- O- Outcome – Decreased instances of recorded medication errors as well as patient adverse events, which occur due to drug mistakes.
- T- Time frame – 8 weeks to see maximum outcomes
In nurse employees (P), what is the effect of improving staffing level (I), on medication errors and drug-related adverse outcome rates (O), compared with maintaining current understaffing levels (C), within 8 weeks (T)?
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The key stakeholders in this EBP change project include nurses and the hospital’s management. The role of the management is that it will be required to approve the project and fund its implementation. Nurses will be the implementers of this change project as they are the targets of the process.
Watson’s caring theory can be potentially applied to this EBP project. Medication administration is part of the care process, and it is a critical nursing practice. Practicing some of the principles outlined in the theory such as remaining calm under stress, focusing before beginning the process of medication administration, and respecting co-workers’ attention and privacy when they are busy with medications can be applied in practice as strategies in addition to the intervention to reduce distraction and poor communication, which normally leads to errors.
The available literature shows that nursing understaffing is one of the major issues that contribute significantly to medication errors. In a study to assess factors contributing to medication errors, Hammoudi et al. (2017) found that errors are committed due to communication and staff issues. Understaffing primarily increased workload and disrupted staff rotation schedules. The authors emphasize the importance of teamwork and communication skills in medicine distribution to avoid such errors.
In another study, Stewart et al. (2018) concluded that healthcare provision is a complex mix of social and professional roles, emotions, resources, and environmental factors whereby doctors rely on pharmacists to correct medication errors. In the process, nurses lack recognition, and thus they face significant stress due to the lack of adequate staffing, which increases the probability of making medication errors.
Yang, Hung, and Chen (2015) conducted a study to assess the application of nursing staffing models on patient safety and reduction of costs. They found that the use of different models, where nursing aides help RNs, has mixed outcomes, with fewer medication errors but increased costs and other adverse events when 76% of the staff were RNs. These results point to the fact that nurse understaffing is directly related to high rates of medication errors.
Beeber, Zimmerman, Madeline Mitchell, and Reed (2018) sought to assess the quality of health services and safety in assisted living facilities and staff delegation policies in place. The results of their studies showed that state-level policies of delegation improve services by including more medication technicians that either administer or assist with medication, thus reducing medication errors as it was handled by qualified staff. In another study, Blignaut, Coetzee, Klopper, and Ellis (2017) found 296 errors were made in 1847 medication administration and the majority of them were related to wrong-time and wrong-dose. The errors were associated with patient identification protocols and excessive workload.
In their study, Chua, Lee, Peralta, and Lim (2019) carried out a structured evaluation process for medication errors and found out that few cases of medication errors were reported, even with a higher number of patients, if there were enough nurses with a positive perception of the single-checking protocol system. Joolaee, Shali, Hooshmand, Rahimi, and Haghani (2016) sought to determine the connection between medication errors and the work environment and the results of their study established a negative relationship between the environment and medication errors.
The environment in this context is used to mean, among other factors, the nurse to patient ratio in a healthcare setting. The common errors associated with poor work environments include the lack of on-time administration of drugs, poor measures, and non-compliance with the administration protocols.
Cho, Chin, Kim, and Hong (2015) argue that a large number of patients per nurse result in a greater incidence of wrong medication administration in time or dosage. However, a better work environment has an inverse relationship with adverse events. For instance, sufficient nurse staffing will ensure that nurses are not overworked and thus they are less likely to make poor decisions, hence improved patient outcomes through the avoidance of medication errors.
In addition, total nursing staff hours of care and RN hours are negatively associated with the quality of care provided (Dabney & Kalisch, 2015). Some of the problems associated with long RN working hours include missed timelines including medication administration. In their study, Godshall and Riehl (2018) found that nurses opine that using automatic disposal systems (ADS) is safe and can be applied to eliminate medication errors. Therefore, the available literature as presented in this section shows a strong correlation between nursing understaffing and increased rates of medication errors, which validates the need for this EBP change project.
Data Collection Methods
After the implementation of the EBP change process, the project will be evaluated after 8 weeks to assess any outcomes. The data collected in this case will be the occurrence of medication errors due to nursing decisions. Data will be extracted from the hospital’s health records indicating the rate of medication errors during the 8 weeks of implementing the change process.
Data will be analyzed using SPSS 22 to compare the rates of medication errors before and during the EBP change process.
It is expected that medication errors during the 8 weeks of implementing the EBP will be reduced significantly. There will be enough nurses to meet all the staffing needs and ensure a reasonable nurse-patient ratio for better decision-making and provision of quality care. Therefore, it is expected that nurses will not be overworked, which implies that their care delivery will be efficient.
Beeber, A. S., Zimmerman, S., Madeline Mitchell, C., & Reed, D. (2018). Staffing and service availability in assisted living: The importance of nurse delegation policies. Journal of the American Geriatrics Society, 66(11), 1-9. Web.
Blignaut, A. J., Coetzee, S. K., Klopper, H. C., & Ellis, S. M. (2017). Medication administration errors and related deviations from safe practice: an observational study. Journal of Clinical Nursing, 26(21-22), 3610-3623. Web.
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Cho, E., Chan, D. L., Kim, S., & Hong, O. (2015). The relationships of nurse staffing level and work environment with patient adverse events. Journal of Nursing Scholarship, 48(1), 74-82. Web.
Chua, G. P., Lee, K. H., Peralta, G. D., & Lim, J. (2019). Medication safety: A need to relook at double-checking medicines? Asia-Pacific Journal of Oncology Nursing, 6(3), 246-252. Web.
Dabney, B. W., & Kalisch, B. J. (2015). Nurse staffing levels and patient-reported missed nursing care. Journal of Nursing Care Quality, 30(4), 306-312. Web.
Godshall, M., & Riehl, M. (2018). Preventing medication errors in the information age. Nursing, 48(9), 56-58. Web.
Hammoudi, B. M., Ismaile, S., & Abu Yahya, O. (2017). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian Journal of Caring Sciences, 32(3), 1-9. Web.
Joolaee, S., Shali, M., Hooshmand, A., Rahimi, S., & Haghani, H. (2016). The relationship between medication errors and nurses’ work environment. Surgical Nursing Journal, 4(4), 27-34.
Kang, J. -H., Kim, C. -W., & Lee, S.-Y. (2016). Nurse-perceived patient adverse events depend on nursing workload. Osong Public Health and Research Perspectives, 7(1), 56-62. Web.
Stewart, D., Thomas, B., MacLure, K., Pallivalapila, A., El Kassem, W., Awaisu, A., … Al Hail, M. (2018). Perspectives of healthcare professionals in Qatar on causes of medication errors: A mixed methods study of safety culture. PLOS One, 13(9), 1-17. Web.
World Health Organization. (2016). Medication errors. Web.
Yang, P. -H., Hung, C. -H., & Chen, Y. -C. (2015). The impact of three nursing staffing models on nursing outcomes. Journal of Advanced Nursing, 71(8), 1847-1856. Web.