Background
The notion of medical error may be defined as “a preventable adverse outcome that results from improper medical management (a mistake of commission) rather than from the progression of an illness resulting from lack of care (a mistake of omission)” (Kiymaz & Koç, 2018, p. 1161). The purpose of the present paper is to present an outline for a practicum project named “Effective system workflow to prevent medical errors and healthcare costs.” The ultimate goal of the project is to create a tangible workflow framework to mitigate the risks of medical errors and increased healthcare costs through the evaluation of current barriers to meaningful practice. The paper will consist of the goal and objectives outline, brief literature review, project methodology and evaluation approaches, and an approximate project timeline.
Goal Statement
While medical errors are frequently perceived as synonymous with professional competence, the aspects of workflow and hospital environment contribute significantly to the probability of error and the likelihood of its timely reporting. Hence, the goal of the present project is to assess the existing barriers to the errorless nursing practice and propose a tangible framework of workflow improvement to eliminate these barriers. The focus of the project primarily concerns the paradigm of medical errors and the patterns of their reporting and correction within the hospital environments. The population of the project will include nurses with at least one year of experience on the hospital premises, with the sample consisting of approximately 300 nurses.
Project Objectives
In order to meet the goal of the present project, the following two objectives are to be reached:
- To connect the paradigms of nursing workflow and medical error occurrence in order to define the barriers to safe practices;
- To develop an effective workflow framework among nurses that would mitigate the risk of committing a medical error significantly.
Once they are fulfilled, the overall field of nursing practice may benefit significantly from adopting new practices on preventing, identifying, reporting, and remediating medical errors in a productive environment.
Evidence-Based Review of Literature
A significant issue related to the management of medical errors is their perception in the professional community. The Code of Ethics presented by the American Nursing Association (ANA, 2015) states that while errors should be reduced and omitted, there is no explicit prohibition of making a mistake, as no one is immune to oversight. Moreover, there is an explicit indication that there are extreme cases for the fallacy to become punitive, and all the other cases of medical errors are to be reported, discussed, and corrected (ANA, 2015). The misinterpretation or ignorance of these recommendations leads to a vicious circle of making a mistake, underreporting it due to fear of being punished, and committing more medical errors in the future due to the lack of critical evaluation of the previous faults.
Thus, for instance, in the study conducted by Scott and Henneman (2017), the authors outlined some of the most common reasons for underreporting, including fear of consequences, undermining the significance of near fallacies, and the unawareness of the error reporting system within the facility. It would be reasonable to assume that such reasons derive from the lack of attention paid to error processing in hospitals and unproductive workflow. According to Araby et al. (2018), out of 36% of nurses who reported committing a medical error, almost half of the respondents committed the errors more than once. Moreover, the majority of the fallacies were caused by work overload and lack of training (Araby et al., 2018).
Similar results may be found in the study by Kiymaz and Koç (2018), with the overwhelming majority of nurses claiming workload, staff shortage, and exhaustion to be the most decisive precursors of committing an error. Additionally, such aspects as lack of nurse-physician communication and poor physical and mental health of nurses appear to contribute to the likelihood of medical error occurrence (Melnyk et al., 2018; Topcu et al., 2017). Hence, considering the aforementioned data, it may be concluded that there is a demand for outlining a workflow framework that would increase job satisfaction levels, improve interprofessional communication, ease the workload, and hence, reduce the risks of medical errors.
Methodology
The present project will use a cross-sectional survey as a primary source of data collection. The nurses will be recruited with the help of online media platforms specializing in nursing and a newsletter send-out to the nursing teams of the local hospitals. The survey will consist of approximately fifteen questions, including the respondents’ background information such as experience, age, physical and mental health status.
The second part will concern the information related directly to the medical errors and the Medical Error Tendency Scale, including the individual error incidence rate, the status of error reporting, and possible reasons that might have served as a precursor to a fallacy. The survey will be created and systematized with the help of SurveyMonkey online service. The IBM SPSS software will be used to analyze the data and create a frequency distribution regarding the barriers to medical error prevention. The development of the framework will be conducted with the help of working with focus groups that would respond to the initiated models of change to the workflow.
Resources
The physical resources required for the project will include the medical facilities to recruit the participants and the computer equipment necessary to gather and process primary data. The human resources, for their part, will address the population sample, the project manager, and volunteers to recruit the participants and collect and categorize the data. The technical resource required for the project includes the access to SurveyMonkey and IBM SPSS tools.
Formative and Summative Evaluations
The formative evaluation of the project will be conducted two weeks after the project initiation with the help of SurveyMonkey statistics analysis in order to improve the outcomes of the summative evaluation and reduce the anxiety levels (Gantt, 2013; Duers & Brown, 2009). The primary indicators to address will be the participant responsiveness rate and the number of participants included in the project so far, which will be tracked using a digital KPI database (Pellegrino, 2010). The number of eligible participants should be no less than fifty, and the responsiveness rates, including the respondents’ ability to respond to each question, should be no less than 90%.
In case the indicators fall behind, either the questionnaire structure or the recruitment tools will be modified depending on the issue identified (Black, 2010). Summative evaluation, for its part, will be conducted in two stages at the end of the project: an expert assessment and a field trial. The former stands for inviting a third-party researcher to study and evaluate the relevance and correctness of the project, whereas the latter concerns the introduction of a newly created framework to the nurses and the evaluation of their response to the change model.
Timeline
The timeline of the project will address eight major milestones: background research, groundwork (including survey design and recruitment initiation), data collection, formative assessment, data analysis, revision and framework outline, expert assessment, and field trial. The project timeline is divided into weeks, with the whole project taking 10-12 weeks from the initiation to completion stage.
References
American Nursing Association. (2015). Code of ethics for nurses with interpretive statements (Reprint). American Nursing Association.
Araby, E. M., Eldesouky, R. S. H., & Abed, H. A. (2018). Medical errors among nurses in the University Hospital of Benha, Egypt: Forms, underlying factors and reporting. Biomedical Journal, 7(4), 1-8. Web.
Black, P. (2010). Formative assessment. In P. Peterson, E. Baker, & B. McGaw (Eds.), International encyclopedia of education (3rd ed., pp. 359–364). Elsevier.
Duers, L. E., & Brown, N. (2009). An exploration of student nurses’ experiences of formative assessment. Nurse Education Today, 29(6), 654–659.
Gantt, L. T. (2013). The effect of preparation on anxiety and performance in summative simulations. Clinical Simulation in Nursing, 9(1), e25–e33.
Kiymaz, D., & Koç, Z. (2018). Identification of factors that affect the tendency towards and attitudes of emergency unit nurses to make medical errors. Journal of Clinical Nursing, 27(5-6), 1160-1169. Web.
Melnyk, B. M., Orsolini, L., Tan, A., Arslanian-Engoren, C., Melkus, G. D. E., Dunbar-Jacob, J., Rice, V. H., Millan, A., Dunbar, S. B., Braun, L. T., Wilbur, J. Chyun, D. A., Gawlik, K., & Lewis, L. M. (2018). A national study links nurses’ physical and mental health to medical errors and perceived worksite wellness. Journal of Occupational and Environmental Medicine, 60(2), 126-131. Web.
Pellegrino, J. W. (2010). Technology and formative assessment. In P. Peterson, E. Baker, & B. McGaw (Eds.), International encyclopedia of education (3rd ed., pp. 42–47). Elsevier.
Scott, S. S., & Henneman, E. (2017). Underreporting of medical errors. MedSurg Nursing, 26(3), 211-214.
Topcu, I., Türkmen, A. S., Sahiner, N. C., Savaser, S., & Sen, H. (2017). Physicians’ and nurses’ medical errors associated with communication failures. Journal of Pakistan Medical Association, 67(4), 600-604.