Abstract
The purpose of this assignment is to create a final PICOT question for your DPI Project to be approved by the college. As per topic Improving Patient Outcomes by Reducing Avoidable Interruptions During Medication Administrations. Brief description of background problem will explain the life-threatening consequences of wrongly dosed medication due to short or less training provided to nursing staff.
The purpose statement describes the project design, effected population, variables to be studied, and the geographic location. Detailed description of modifications, available resources, stakeholder’s contributions and clinical outcomes of interventions also discussed in purpose statement. Medication error is common and extensive topic during patient care.
The purpose of this quantitative, quasi-experimental project was to determine if or to what degree the implementation of improving patient outcomes and patient satisfaction by reducing avoidable interruptions during medication administrations (intervention) would impact patient needs before medication administration (what) when compared to no intervention among the adult inpatient medical/surgical population (population) patients in a medication administration (setting, i.e., primary care clinic, ER, OR).
Ethnic considerations are enforced during patient care as vital part of training; Theoretical considerations are based in major framework of the project. Data collection methods includes interviews, questioner and can be statistical during final stages of project.
Introduction to the Project
Administration of medicinal products is an essential element of critical care nursing tasks. The nurse takes care of safe quality care when drugs are administered; however, there are mistakes. Safe drug management is a critical improvement area, and this project is an example of successful measures aimed at reducing interruptions that may be avoided. In the acute care environment, the nurse is in charge of delivering patients with safe medicines.
The administration of medicines is a primary nursing duty and may cause financial and human damage. The research says 10% of preventable adverse events were administered mistakes of medicine, and 2% of hospitalized patients were administered preventable medication. Hospital admission costs are approximately $5,000, and the annual mortality of patients due to drug mistakes is about 7,000 (Institute of Medicine, 2000).
Due to the significance administration has on the healthcare delivery process, it is crucial to examine the problems occurring during it. This work will focus on examining the role specific interventions have on reducing interruptions and improving patient outcomes, as well as satisfaction. The quantitative, quasi-experimental project as a whole will use both existing and gathered data to arrive at new knowledge in the sphere of nursing. By gathering patient data and reviewing prior studies on the subject of nursing interruptions, the most effective method of intervention will be discovered and substantiated by research.
Background of the Project
A nurse’s work in a hospital has always been connected with micro management and a variety of tasks to perform. Assisting physicians in their work, overlooking patients, administering various forms of treatment and giving injections – all of these and more are what an average nurse has to do on a daily basis. The large amount of tasks, as well as the nature of the work itself lends itself to interruptions and some amount of mismanagement. With a large number of people gathered in the same space, in a setting where attention of specialists is always needed, cases of being interrupted during work are prevalent.
However, when a nurse is up to the task of administering drugs, this tendency presents a serious problem. Interruptions are known from research to cause higher rates of medical mistakes, as well as decrease overall patient satisfaction. According to (World Health Organization, 2015), patient care can be life threatening condition for patient in any setting due to wrong medication in any patient setting. Another major problem is financial burden on health care facilities due to medication errors. This can prolong hospitalization, can leave lifelong physiological or psychological effects on patients. Focus is eliminating medication error to provide safe medical care due to recording of high number of incidents due to wrong medication administration.
Need of this project initiates due to high number of recorded medication errors in nursing homes, inpatient care and outpatient settings as well. Since last decade, extensive research and training been performed to encounter this major setback in health care facility. This medical error can be happening in any setting. Westbrook et al. (2010) observed that 98 nurses perform 4,271 pharmaceutical services for 720 patients via two large hospitals in Sydney, Australia.
They assumed that medications disruptions enhanced mistakes. In 53 percent of drug administrations, interruptions were recorded, and 80 percent of administration contained certain types of mistakes. Currently, the body of research regarding medical drug administration errors, their effects and prevention is significant, but no specific solution has been found to most unanimously solve the problem.
Problem Statement
After thorough literature research, unit evaluation, observations, and investigations, it is apparent that interruptions have a detrimental influence on drug management. Discontinued workflows, nurse satisfaction, and safe administration of medicines have been proven to reduce. The documentary and the first papers on the medical and operative trauma unit carried out by the pupil of the DNP are sponsored. DNP students can positively affect patient satisfaction by lowering handling time spent on preventable interruptions and increasing patient outcomes through drug failure prevention.
Interruptions negatively influence medicines management following thorough literature evaluation, unit assessment, observations, and surveys. Discontinued workflows, and safe administration of medicines have been proven to reduce. It is unknown if or to what degree implementing anti-interruption programs to reduce avoidable interruptions during medication administrations would improve patient satisfaction and self-measured wellness than current practice among the adult inpatient medical/surgical patients. The project will have the ability to measure the effectiveness of such an approach using evidence.
Purpose of the Project
The purpose of this project is to determine if or to what degree the implementation of anti-interruption programs (intervention) will improve patient satisfaction and self-measured wellness by reducing avoidable interruptions during medication administrations would impact patient needs before medication administration (what) when compared to no intervention among the adult inpatient medical/surgical population (population) patients in a medication administration (setting, i.e., primary care clinic, ER, OR). The main goal of this project is to ensure that institutions implement the high-quality measures to provide safe patient care.
The design for this project is quasi-experimental and the methodology used is quantitative analysis. The work centers on a patient experiences, as they are the population that is most affected both by nurse interruption and medical errors. Through this project, medical professionals will obtain a framework for improving their work capacity, organization and performance in hopes of providing better standards of care. This project will ensure that the field of medicine is competent in terms of ensuring the welfare of the patients. Successful complete of project will results in giving risk free inpatient care for nursing home patients where DPI project will go forward.
Clinical Questions
- Is the use of anti-interruption programs effective at reducing interruptions?
- Is the use of anti-interruption programs effective at improving patient satisfaction/self-accessed wellness?
- How severely do medical errors and interruptions during drug administration affect patient satisfaction/self-accessed wellness?
The aforementioned questions are used to evaluate the effects of drug administration mistakes and interruptions can have on patients, which in turn justifies and contextualizes the need for an intervention. The effectiveness of anti-interruption programs will also be measured, as it pertains to the patients of hospitals and their condition.
Independent variables
Medical errors, medical interruptions, anti-interruption programs.
Dependent variables
Patient satisfaction, patient self-accessed wellness.
The actions of the hospital staff (i.e medical errors, medical interruptions, anti-interruption programs) act as independent variables, which affect the condition and state of concerned patients. Therefore, both patient satisfaction and wellness are dependent variables.
Advancing Scientific Knowledge
By directly addressing the problem of medical mistakes, this work will reflect on the effects of some of the current practices, hopefully leading to changes in medical practice. The creation of this paper is aimed at improving the quality of patient care and the reduction of the number of interruptions. Positively, less interruption will lead to better patient outcomes and satisfaction. When nursing staff are overworked or interrupted repeatedly, they hardly communicate and might ignore the doctor’s prescription of the patients’ treatment Kliger, J., Blegen, M., Gootee, D., & O’Neil, E. (2009).
The patient ends up receiving the wrong medication or no medication at all. Without proper treatment the patients will end up worsening or even losing their lives. With adequate medication knowledge and medication reconciliation, patients will receive appropriate treatment thus improving their health and increasing their chances of survival. This project will relate with other research in that it shows the relationship between decrease interruption for nursing staff reduce medication errors. Competency is the expected value of this task as it will be a source of information for other projects too. Training for EMR and other medication administration program should also be part of training. Data entry with individual treatment plan can be helpful for nursing staff to stay aware of patient’s medication allergies and contradictions.
Significance of the Project
This project will serve as an addition and an analysis of works prior to it, both incorporating existing data on the subject and providing its own research into the common pool of knowledge. The work will produce results pertaining to the effects medical mistakes in drug administration due to interruption have on patients, their outlook and health. Medication errors can results in life threatening complication for patient and can lead to death or any other physical or psychological irreversible effects.
In order to reduce this commonly occur error during patient care whether its inpatient or outpatient, nursing staff should be given adequate time to administer right dose according to patient prescription. This project aiming medication administration with safety and positive clinical outcomes. Another focus on timely management in case of uninviting event due to wrong medication administration. Adequate training to administer right medication for nursing staff can reduce financial burden from health care industry due to long hospitalization and legal issues.
Another Focus convenient administration if there should arise an occurrence of uninviting occasion because of wrongdoing, Satisfactory preparing to direct right prescription for nursing staff can diminish monetary weight from medical services industry because of long hospitalization and legitimate issues. In any case, there is a gap in the research on the grounds that different articles offer blended discoveries in regard to the adequacy of the proposed intercession. Since the current evidence-based interventions remarks on the conceivable adequacy of medication administration without interruption is recommended.
The DPI project fruition is additionally critical for various partners. First and foremost, clinicians, attendants, and other medical services experts can observer fundamental advantages since the venture offers a chance to propel the nature of care identifying with more established patients (Kliger, J., Blegen, M., Gootee, D., & O’Neil, E. (2009). While these individuals normally experience the ill effects of decayed medical issue, it is sensible to furnish them with further developed consideration, and the venture attempts to adapt to it. It is normal that the outcomes will further develop the clinical site practice in light of the fact that the undertaking can uncover proficient, viable applications. Besides, the undertaking can be advantageous for the entire medical services industry. Kliger, J., Blegen, M., Gootee, D., & O’Neil, E. (2009).
Concede the monetary weight of this issue, implying that its counteraction can make the clinical framework more practical. At last, there is an obvious association between the task and worked on general wellbeing. The reasoning behind this assertion is that the venture can foster explicit rules for medical services experts to guarantee that patients are less liable to medication error.. It means that the DPI undertaking can adequately shield more patient care from getting wrong medication.
Rationale for Methodology
A quantitative study method is effective for the purposes of this work, due to the types of data that will be gathered and the goals of the project as a whole. Quantitative methodology is well-suited for analyzing and accessing data already gathered by other sources, and the present body of research on the topic of medical interruptions, their prevention and effects. Since the main clinical question of this work pertains to the effects of nurse interruption during drug administration, the rates of interruption, their correlation with medical errors and patient feedback will all be necessary to gather.
The type of data is numerical in nature, therefore lending itself to quantitative methods. By taking the results of existing work and applying a quantitative method to them, the objective impact of independent variables can be found. This method is also well suited for gathering data from patients in the form of both calls and questionnaires.
Nature of the Project Design
The DPI project uses a quasi-experimental design to answer the clinical question. The reason for selecting this approach is the necessity of applying the intervention ( reduce unavoidable stresses during medication pass) and identifying whether it leads to improved outcomes (reduced medication error ). In particular, the quasi-experimental style lends itself well to using both existing and new data, as well as to the process of applying certain changes to an observed environment.
Thus, the given design is relevant because it allows for assessing the intervention’s effectiveness for quasi-experimental and comparison groups. Siedlecki (2020) also admits that case studies, descriptive, and correlational designs are not appropriate since they are less practical compared to the selected approach. Thus, it is necessary to stipulate that the quasi-experimental design is ideally aligned with the quantitative methodology.
It is reasonable to provide a detailed explanation of the project design. Since the project is the implementation of evidence-based practice (EBP), it follows a before and after design. Consequently, the project sample should be divided into two groups. The before group includes those patients who receive the standard of care that is turning and repositioning every four hours. As for the after group, it consists of those participants who are subject to 2-hourly turning and repositioning. The project implies that it is necessary to collect and analyze the data regarding the number of pressure injuries that developed in the two groups.
This approach denotes that it is required to identify the medication errors incidence within each of the groups and compare the obtained data to determine whether there is an improvement following the proposed intervention. An appropriate statistical test is necessary to identify whether the changes are statistically significant and directly connected to the intervention. An anti-interruption strategy involves the use of change strategies to reduce the number of interruptions a nurse will experience during drug administration. The three observations of drug administration times before and after implementation were observed (two mornings and one afternoon).
Definition of Terms
The DPI project is a scholarly paper, and this fact justifies the use of specific vocabulary. That is why the given section presents key terms and offers definitions for them to ensure that readers can correctly understand the meaning of every word and word combination. These terms are defined in lay words and in the context in which they appear in the paper. The following terms are used operationally in this project:
- Medical Errors – Medical errors can be defined as any preventable negative/serious effect of nursing care or medical treatment, regardless of whether any harm was actually done to the patient (Westbrook et al., 2010).
- Medical Interruptions – Interruptions can be defined as non-emergent problems arising during the process of drug administration process (Westbrook et al., 2010).
- Anti-Interruption Programs – a variety of measures aimed at reducing the frequency and impact of interruptions on nursing work, primarily coming from hospital management and leadership (Capasso, 2012).
- Patient Satisfaction – Personal opinion of the patient regarding the quality, timeliness, adequacy and other aspects of nursing drug administration (Prakash, 2010).
- Patient Self-Accessed Wellness – A person’s perception of their health and wellbeing (Prakash, 2010).
Assumptions
Assumptions pertain to certain sentiments that are accepted as the truth, on the merit of both the author and those that will read their work.
- It is assumed that the participants were truthful in their interviews and other collected material, as well as did not intentionally distort the truth. This assumption is made knowing that such conduct was asked of them, and they were not financially incentivized to act in another manner.
- It is assumed that the statistics gathered and discussed in this work accurately reflect rates of medical errors due to interruptions, as well as their occurrence in hospitals, as the data was gathered from other medical journals and credible sources.
Limitations
Limitations for the project are influences or factors outside the author’s control, something that is unable to be changed or affected. The limitations of this study are methodological, limiting its scope, the potential range of participants and the range of available data.
- The participants of this study are only English speakers, as this is the language of the study itself
- Quality improvement only has access to publicly available data and records
- Lack of support or funding limited the time scale, scope, and the potential sample size of this work, as with proper financing, analysis of more data could be accomplished
Delimitations
Delimitations are deliberate choices limiting the size or methods of the work made by its author.
The sample size is limited to the San Francisco Bay area, as the size of the work needs to be feasible to be performed by a single individual, as well as analyzed and put into context.
Data will be collected over phone calls and polling methods.
Summary and Organization of the Remainder of the Project
Chapter 1 primarily discusses some of the most important aspects of the work, including its design, methodology, used terms, purposes and goals. As noted previously, this project seeks to address an important problem in nursing and drug administration. Medication errors are a huge issue in the medical services industry, implying that a useful intercession is important to resolve the issue. Proof from academic and EBP exhibits that the undertaking can progress logical information on the grounds that the current guidelines offers clashing aftereffects of patient safety and positive clinical outcomes (Cuttler, S. (2014). This venture is extremely important to the goal of improving patient experiences in a medical setting, as well as finding most effective solutions to the emergent problems in nursing. It is beneficial to both health providers and their clients.
Chapter 1 significantly remarks on the methodological part of the task. As indicated by Ching, J., Long, C., Williams, B., & Blackmore, C. (2013). legitimize utilizing a quantitative methodology, while Ching, J., Long, C., Williams, B., & Blackmore, C. (2013). clarify that it is sensible to utilize a semi trial plan. Then, at that point, the key terms are characterized to guarantee that anybody perusing the DPI task can precisely comprehend the ideas being talked about.
Chapter 2 will overview the current literature on reducing medical errors and intrruptions during care, the effect they can have on the patients and other considerations relevant to the clinical questions of the work. Chapter 3 will present a detailed description of the project methods and procedures, commenting on the sample, data collection, data analysis, and other methodological affairs. Finally, Chapter 4 will introduce a graphic summary of the project results, while their discussion and interpretation will be offered in Chapter 5.
References
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Capasso, V., Johnson, M., & Strauss, M. B. (2012). Improving the medicine administration process by reducing interruptions. Journal Of Healthcare Management, 57(6), 384-390.
Ching, J., Long, C., Williams, B., & Blackmore, C. (2013). Using lean to improve medication administration safety: In search of the “perfect dose.” Joint Commission Journal On Quality And Patient Safety, 39(5), 195-204.
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Cuttler, S. (2014). Collaborative Alliance for Nursing Outcomes: Medication Error Reduction Plan Report.
Institute of Medicine. (2000). To Err Is Human: Building a Safer Health Care System. Washington, DC: National Academy Press.
Kliger, J., Blegen, M., Gootee, D., & O’Neil, E. (2009). Empowering frontline nurses: A structured intervention enables nurses to improve medication administration accuracy. Joint Commission Journal On Quality & Patient Safety, 35(12), 604-612.
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Pape, T. M. (2013). The effect of a five-part intervention to decrease omitted medications. Nursing Forum, 48(3), 211-222. Web.
Prakash, B. (2010). Patient satisfaction. Journal of Cutaneous and Aesthetic Surgery, 3(3), 151. Web.
Smith, C. B., & Williams-Jones, P. (2012). Tips to reduce dangerous interruptions by healthcare staff. Nursing2020, 42(11), 65-67.
Westbrook, J., Woods, A., Rob, M., Dunsmuir, W., & Day, R. (2010). Association of interruptions with an increased risk and severity of medication administration errors. Archives Of Internal Medicine, 170(8), 683-690. Web.
Westbrook, J.I., Ampt, A., Kearney, L., & Rob, M.I. (2008) All in a day’s work: an observational study to quantify how and with whom doctors on hospital wards spend their time. Medical Journal of Australia, 188(9), 506-509.
I, (Fareeha A SipraE), verify that I have completed (10) practice hours in association with the goals and objectives for this course. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.