Assignment: Background of the Change Proposal

Assignment: Background of the Change Proposal

Assignment: Background of the Change Proposal

In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

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Develop a 2,500-4,000 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

1. Background
2. Clinical problem statement.
3. Purpose of the change proposal in relation to providing patient care in the changing health care system.
4. PICOT question.
5. Literature search strategy employed.
6. Evaluation of the literature.
7. Applicable change or nursing theory utilized.
8. Proposed implementation plan with outcome measures.
9. Discussion of how evidence-based practice was used in creating the intervention plan.
10. Plan for evaluating the proposed nursing intervention.
11. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
12. Appendix section, for evaluation tools and educational materials, etc. are created.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Rubric Criteria

Total160 points

Criterion				4. Acceptable	5. Target
Format/Documentation Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.				5.7 points Appropriate format and documentation are used with only minor errors.	6.4 points No errors in formatting or documentation are present.
Use of Evidence-Based Practice in Intervention Plan (B) Use of Evidence-Based Practice in Intervention Plan (C1.4)				14.24 points Use of evidence-based practice in intervention plan is presented. Minor aspects are unclear or require support.	16 points Use of evidence-based practice in intervention plan is clearly and logically presented. Relevant support and rationale are evident.
Mechanics of Writing Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.				8.54 points Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.	9.6 points Writer is clearly in command of standard, written, academic English.
Evaluation of Literature Evaluation of Literature				7.12 points Evaluation of literature is presented. Minor aspects are unclear or require support.	8 points Evaluation of literature is clearly and logically presented. Relevant support and rationale are evident.
Plan for Evaluating Proposed Nursing Intervention Plan for Evaluating Proposed Nursing Intervention				7.12 points Plan for evaluating proposed nursing intervention is presented. Minor aspects are unclear or require support.	8 points Plan for evaluating proposed nursing intervention is clearly and logically presented. Relevant support and rationale are evident.
Purpose of Change Proposal (B) Purpose of Change Proposal (C2.2)				7.12 points Purpose of the change proposal in relation to providing patient care in the changing health care system is presented. Minor aspects are unclear or require support.	8 points Purpose of the change proposal in relation to providing patient care in the changing health care system is logically presented. Relevant support and rationale are evident.
Background Background				7.12 points Background of clinical problem are presented. Minor aspects are unclear or require support.	8 points Background of clinical problem are clearly and logically presented. Relevant support and rationale are evident.
Potential Barriers and Plan to Overcome Barriers Potential Barriers and Plan to Overcome Barriers				7.12 points Potential barriers and plan to overcome barriers are presented. Minor aspects are unclear or require support.	8 points Potential barriers and plan to overcome barriers are clearly and logically presented. Relevant support and rationale are evident.
Change or Nursing Theory Change or Nursing Theory				7.12 points Change or nursing theory is presented. Minor aspects are unclear or require support.	8 points Change or nursing theory is logically presented. Relevant support and rationale are evident.
PICOT Question PICOT Question				7.12 points Topic and criteria are presented. Minor aspects are unclear or require support.	8 points Topic and criteria are clearly and logically presented. Relevant support and rationale are evident.
Evidence Selects and integrates evidence to support and advance position/purpose; considers other perspectives.				8.54 points Relevant evidence that includes other perspectives is used.	9.6 points Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered.
Development, Structure, and Conclusion Advances position or purpose throughout writing; conclusion aligns to and evolves from development.				9.97 points The thesis, position, or purpose is advanced in most aspects. Ideas clearly build on each other. Conclusion aligns to the development of the purpose.	11.2 points The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.
Literature Search Literature Search				7.12 points Topic and criteria are presented. Minor aspects are unclear or require support.	8 points Topic and criteria are clearly and logically presented. Relevant support and rationale are evident.
Revisions Incorporated as Directed by Instructor Revisions Incorporated as Directed by Instructor				7.12 points The key aspects were revised. The revision generally improves the accuracy and clarity of the project.	8 points All revisions are incorporated. The revision greatly improves the accuracy and clarity of the project.
Thesis Development and Purpose Communicates reason for writing and demonstrates awareness of audience.				9.97 points The thesis, position, or purpose is adequately presented. An awareness of the appropriate audience is demonstrated.	11.2 points The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.
Implementation Plan and Outcome Measures Implementation Plan and Outcome Measures				14.24 points Implementation plan and outcome measures are presented. Minor aspects are unclear or require support.	16 points Implementation plan and outcome measures are clearly and logically presented. Relevant support and rationale are evident.
Clinical Problem Statement Clinical Problem Statement				7.12 points Clinical problem statement is presented. Minor aspects are unclear or require support.	8 points Clinical problem statement is clearly and logically presented. Relevant support and rationale are evident.

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Background of the Change Proposal

The current healthcare systems focus on adhering to the four bioethical principles that entail benefiting patients (beneficence), preventing and avoiding harm (non-maleficence), allowing patients to influence care decisions and practices (autonomy), and ensuring social justice, fairness, and impartiality. Despite the overarching call to comply with these ethical principles, the inevitable adverse events compromise patient safety by leading to deaths, injuries, compromised quality of life, prolonged hospitalization, and increased care costs. Medication errors (MEs) are among adverse events whose occurrence leads to multiple detrimental consequences on patients, families, healthcare professionals, and organizations. Mutair et al. (2021) define medication errors as “unintentional mistakes either by omission or commission” (p. 2). This definition informs the perception that medical-related mistakes are inevitable despite individual and organizational interventions for ensuring medication safety. However, it is possible to debunk this belief by focusing on personal and institutional antecedents of medication mistakes.

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Nurses are responsible for ensuring medication safety by adhering to the “rights” of medication administration, including the right patient, route, dosage, documentation, drug, and time. Amidst this daunting responsibility, they spend about 40% of their time administering medications (Wondmieneh et al., 2020). Although spending enough time administering medications is a profound strategy for ensuring accuracy and safety, errors can occur in other medication use stages and processes, including during prescribing, transcribing, and dispensing.

The prevalence of medication mistakes during these processes narrows down to individual and organizational risk factors. According to Wondmieneh et al. (2020), the primary predictors of medication errors include work experience, interruptions when administering medications, an absence of clinical guidelines, and a lack of adequate training and education on medication safety. In emergency departments, healthcare professionals are susceptible to perpetrating errors of omission or commission due to contextual antecedents, such as time pressures, burnout, nursing staff shortages, ineffective communication and delegation of tasks, disruptions, and a high number of patients requiring emergency care (Di Simone et al., 2018). As a result, this paper proposes evidence-based interventions for preventing medication errors in the emergency department by leveraging information from scholarly literature.

Clinical Problem Statement

Medication errors in the emergency department (ED) pose a significant health and safety threat by increasing the likelihood of premature deaths, injuries, comorbidities, prolonged hospitalization, readmissions, increased care costs, and legal implications, including lawsuits and licensure revocation. While discussing medication errors as a profound clinical problem, it is essential to assess their consequences and burden from global and national lenses. According to Di Simone et al. (2018), a report by the Institute of Medicine (IOM) predicts that between 44000 and 98000 patients succumb to medication-related errors annually. Although the IOM report provides alarming statistics regarding the contribution of medication mistakes in increasing global mortality rates, the report seems to underestimate the actual effect of these adverse events.

For instance, a more recent report by the US Department of Health and Human Services (DHSS) reports that medication errors account for about 180000 deaths among hospitalized patients (Mutair et al., 2021). Regarding the economic burden, Farzi et al. (2020) contend that the United States government incurs approximately $42 billion in the cost of medication errors annually. This massive burden exacerbates unsustainable healthcare expenditures that result in fragmented, ineffective, and expensive healthcare services.

Regardless of the diversities in various reports about the burden of medication errors, it is valid to argue that they are among the leading causes of global mortalities and increased care costs. A high prevalence of medication mistakes in the emergency department (ED)is overly discouraging, considering the time nurses spend administering medications. The previously identified individual and organizational antecedents exacerbate the situation by depriving nurses of knowledge and awareness of safer medication management processes and cultivating unsupportive workplace culture. For example, limited experience in clinical practice alongside communication breakdowns, an absence of clinical guidelines, time pressure, and inadequate training compromise the safety of medication management interventions and processes. Unless health organizations implement evidence-based practices, medication errors will continue to inflict massive economic, psychological, and procedural burdens on patients, families, healthcare professionals, and health institutions.

The proposed incorporation of training and education programs for nurses obtains support from the current scholarly literature. Farzi et al. (2020) state that insufficient knowledge and awareness of medication management processes is a primary cause of medication errors. Equally, Abukhader & Abukhader (2020) underscore educational programs or a training curriculum as ideal for improving nurses’ awareness of medication safety protocols and preventing medication mistakes. Consequently, healthcare organizations should consider this intervention and address barriers to nursing training programs to avoid medication errors.

The Purpose of the Change Proposal

The primary objective of this change proposal is to validate the plausibility of preventing and avoiding medication errors through training and educating nurses on safer medication administration, communication, and follow-up. As noted in a plethora of current scholarly literature, insufficient knowledge of medication management processes alongside burnout, communication breakdown, limited experience in clinical practice, time pressure, and the absence of practice guidelines perpetrate medication mistakes. Although healthcare organizations implement a diversity of strategies to prevent and avoid medication mistakes, training and educating nurses results in multiple benefits, including increasing their awareness and knowledge of medication management, enhancing their communication and reporting competencies, bolstering their understanding of mechanisms to using medication management technologies like automated drug distribution systems and barcoding technology, and strengthening their competency of conducting root cause analysis and identifying near misses. As a result, it is valid to contend that a comprehensive training and education program for nurses can complete other evidence-based interventions for preventing medication mistakes.

PICOT Question

The PICO(T) framework provides ideal opportunities for nurse researchers to develop foreground questions and cultivate a culture of inquiry. According to Melnyk & Fineout-Overholt (2019), creating a culture of investigation is the initial step in implementing evidence-based practice because it enables researchers to identify clinical issues, question current practices, and establish priorities that prompt the utilization of external evidence sources. As a result, the PICOT format provides a platform for identifying clinical problems (P), defining potential interventions for solving the problem (I), comparing alternatives and substitutes (C), determining the desired outcomes (O), and setting timeframes for evaluation interventions (T). In the context of this change proposal, it is possible to breakdown the issue of exploration into the following parts of the PICO(T) format:

P: Emergency department

I: Educating and training nurses

C: Other interventions like incorporating advanced technologies, effective communication, and medication labeling

O: Preventing medication errors

These focus areas narrow down to the PICO(T) question; In the emergency department (ED) (P), does training and educating nurses on safer medication (I), compared to other interventions (C), prevent medication errors (O)?

Literature Search Strategy Employed

After developing a foreground question using the PICO(T) framework, it is essential to select external evidence sources consistent with the topic of exploration and that provide evidence-based interventions for solving the identified problem. It is crucial to note that the PICOT format significantly improves the mechanisms for selecting ideal evidence sources from a diversity of library and electronic databases. According to Melnyk & Fineout-Overholt (2019), developing a PICOT question forms the basis of literature search strategies by providing researchers with target keywords, subtitles, and subject headings that allow them to filter research. Amid the plausibility of searching for relevant evidence sources using the PICOT statement, I used various keywords and subject headings to locate academic studies aligned with my clinical question. These keywords, subtitles, and subject headings include medication errors in emergency departments (EDs), medication safety education, medication safety training, preventing medication errors, training sessions for medication safety, and strategies for preventing medication errors. Also, I used risk factors for medication errors as a subject heading to identify scholarly articles that explain the individual and organizational antecedents for medication mistakes.

Besides leveraging keywords, subtitles, and subject headings to filter research options and identify relevant external evidence sources, I used publication dates as an inclusion criterion by considering journal articles published within the last five years. Further, I navigated reputable electronic databases, such as PubMed, CINAHL, Springer, PLOS ONE, and PMC, to identify scholarly articles for answering the PICOT question. Finally, I considered the studies’ designs and level of evidence before selecting journal articles for review. In this sense, I mainly included clinical trials, systematic reviews, quasi-experimental studies, cross-sectional studies, and descriptive studies. The objective of considering these inclusion criteria was to identify relevant, current, authoritative, accurate, and purposeful evidence sources.

Evaluation of the Literature

The literature search practice yielded various scholarly articles that provide insights into various strategies for preventing medication errors in different clinical settings. In a quasi-experimental study involving 57 clinical nurses in Iran, Farzi et al. (2020) contend that an asynchronous blended learning program delivered through e-learning can improve nurses’ performance and reduce medication errors. Further, the study revealed that applying technology when educating and training nurses on medication safety enhances the knowledge and skills of clinicians and enhances the quality of education programs. In a second study, Abukhader & Abukhader (2020) conducted a quasi-experimental study in intensive care units of four hospitals in Ramallah city in Palestine to assess the effectiveness of an education program of medication safety on the knowledge and awareness of critical care nurses. The study revealed that educating and training nurses on medication safety improves clinicians’ understanding of intravenous medication mistakes (Abukhader & Abukhader, 2020). These scholarly articles provide insights that are consistent with the PICOT question. They are current, peer-reviewed, and consolidate valid and generalizable findings.

While the two academic journal articles elaborate on the effectiveness of training and educating nurses on medication safety, other identified evidence sources focus on a contingency plan for preventing medication errors. Di Simone et al. (2018) recommend specific training sessions, setting work limits, addressing disruptive events like technological problems during administration and noise, and improving nurses’ behaviors and attitudes as proven interventions for preventing and avoiding medication errors. On the other hand, Wondmieneh et al. (2020) highlight training in medication safety, providing clinical guidelines for safe medication management practices, developing reporting systems, and eliminating workplace stressors like burnout, heavy workload, time pressures, and disruptions as ideal considerations for ensuring medication safety and avoiding errors. Thirdly, a systematic review of literature by Manias et al. (2020) identifies computerized physician order entry (CPOE), prescriber training, an automated drug distribution system, and pharmacist-led medication reconciliation as effective measures for preventing mistakes.

Finally, Kiani et al. (2020) provide two themes for ensuring medication safety; acting professional and presenting technical strategies. Professionalism in medication management includes reading and double-checking drug labels, participating in continuous training on medication management and handling, and being aware of legal problems associated with medication mistakes. On the other hand, presenting technical strategies entails differentiating high-risk medications, separating medications, finding solutions to medication errors, and using expert clinicians to administer medications. Although the reviewed scholarly articles exhibit a diversity of findings and recommendations, they anonymously support the rationale for educating and training nurses on medication safety as a tool for preventing medication errors.

Applicable Change or Nursing Theory Utilized

Developing and implementing education and training programs for nurses are advanced interventions for preventing medication errors in the emergency department. As a result, the organization should address the underlying impediments to these elements of change and quality improvement initiatives. An ideal nursing theory for facilitating change and supporting quality improvement programs is Kotter’s eight-step change management model. According to Carman et al. (2019), this change management approach contains three crucial tenets that accommodate the eight steps of change initiation, implementation, evaluation, and sustenance. The three primary principles of Kotter’s change theory are creating a climate for change, empowering and enabling the whole organization to implement and assimilate change, and sustaining change by anchoring new approaches to the institutional culture. These steps are vital in facilitating communication, improving employee involvement in the change process, and modeling the organizational culture to accommodate new practices and change interventions.

Proposed Implementation Plan with Outcome Measures

The proposed implementation plan adheres to all stages of the project’s lifecycle, including proper planning and budgeting, process initiation, implementation, and sustenance. During the implementation phase, nurse educators will train and educate nurses on medication safety and interventions to prevent medication errors; the implementation team will frequently monitor and evaluate processes and results, disseminate findings to the organizational leaders, and utilize findings to improve educational and training sessions. Further, leaders will address baseline variations and other unanticipated issues by ensuring adequate resource allocation and staffing. The outcome measures for the intervention plan include improving nurses’ knowledge and awareness of medication safety, improving accuracy in calculating medication dosage, reducing incidences of medication errors, and improving nurses’ confidence, behaviors, and attitudes when administering medications.

Discussion of How Evidence-Based Practice was Used in Creating the Intervention Plan

Evidence-based practice (EBP) entails using the best available evidence to improve care and inform clinical decisions. According to Hailemariam et al. (2019), the emergence of EBP as a tool for improving health practices and decisions created a significant shift from passive and uncontrolled diffusion of interventions to the active, research-based, and structured approach of implementing and sustaining quality improvement interventions.

In the context of an intervention plan for preventing medication errors by educating and training nurses on medication safety, evidence-based practice (EBP) influenced the development of this initiative by enabling the selection and review of current scholarly articles. In this sense, the reviewed five scientific studies provide various recommendations for improving medication safety. These recommendations include educating prescribers, implementing advanced technologies like barcoding technology, addressing workplace disruptions and stressors, improving communication and reporting mechanisms, and practicing expert-led medication reconciliation. Incorporating these suggestions can enhance the viability of the intervention plan and provide the necessary empirical backing to the proposed quality improvement program.

Plan for Evaluating the Proposed Nursing Intervention

The primary purpose of evaluating the intervention plan is to establish the consistency between the proposed approaches and the desired outcomes. Throughout the project’s lifecycle, frequent monitoring and evaluations can unearth processes, outcomes, impacts, and unanticipated baseline variations. Since the intervention plan encompasses educational and training programs for nurses, it would be essential to evaluate their effectiveness, outcomes, and impacts using Kirkpatrick’s evaluation model. Hydari et al. (2019) argue that Kirkpatrick’s model assesses the effectiveness of training programs by focusing on four levels: trainee’s response to the program, learners’ learning outcomes and increase in knowledge, attitude, and skills, learners’ behavioral changes, and the overall results of the training program. It is possible to assess these aspects by implementing formative and summative evaluations (Appendix 1).

Potential Barriers to Plan Interventions and Solutions

The anticipated barriers to the effective implementation of educational and training programs for nurses include resource constraints, operation disruptions due to the need to attend educational sessions, time pressures, nursing staff shortages, and functionality issues of learning and simulation technologies. These challenges may result in delays and compromise the overall effectiveness of the plan interventions in preventing medication errors. As a result, the organizations can address them by allocating adequate resources for learning equipment, proper staffing, frequent monitoring to identify unanticipated challenges, and regular evaluation of technological modalities used in learning and simulating medication management processes. Equally, proper scheduling can address the problem of disruptions of operations and nursing staff shortages that emanate when nurses attend educational sessions.

Conclusion

Medication errors in the emergency department (ED) have multiple ramifications, including deaths, injuries, disabilities, and increased care costs. The current literature supports the plausibility of preventing medication errors by educating and training nurses on medication safety. Although external evidence sources provide other ideal strategies for improving medication safety, they present training and educational programs as ideal for improving nurses’ knowledge and awareness of safer medication management processes. When implementing this plan intervention, it is vital to develop an evaluation plan to identify the project process, outcomes, and impacts.

Appendix 1: An Evaluation Plan for the Nursing Intervention

Method	Tools	Sample question(s)	Sample data
Surveys	Questionnaire	Are the sessions accurate? Complete? What should change?	Identify opinions and report.
	Interview
Observation	Course in action	Do learning materials and technology facilitate interactive learning?	Eliminate technical problems facing technologies
			Implementation of effective instructional strategies
Reviews	Experts and end-users	Are goals accurate and current? What needs to change?	Determine if goals and instructional strategies are congruent
Extant data	Performance measures	Is the course usable, timely, and successful? What needs to change?	Identify learner’s proficiency in goal, ease of use, etc.
	Navigation devices and technology issues
	Prevention of medication errors
	Calculation of medication dosage

References

Abukhader, I., & Abukhader, K. (2020). Effect of medication safety education program on intensive care nurses’ knowledge regarding medication errors. Journal of Biosciences and Medicines, 08(06), 135–147. https://doi.org/10.4236/jbm.2020.86013

Di Simone, E., Giannetta, N., Auddino, F., Cicotto, A., Grilli, D., & Di Muzio, M. (2018). Medication errors in the emergency department: Knowledge, attitude, behavior, and training needs of nurses. Indian Journal of Critical Care Medicine, 22(5), 346–352. https://doi.org/10.4103/ijccm.ijccm_63_18

Farzi, K., Toulabi, T., Heidarizadeh, K., Heydari, F., & Mohammadipour, F. (2020). The effect of blended learning on the rate of medication administration errors of nurses in medical wards. Iranian Journal of Nursing and Midwifery Research, 25(6), 527–532. https://doi.org/10.4103/ijnmr.ijnmr_188_20

Hailemariam, M., Bustos, T., Montgomery, B., Barajas, R., Evans, L. B., & Drahota, A. (2019). Evidence-based intervention sustainability strategies: a systematic review. Implementation Science, 14(1). https://doi.org/10.1186/s13012-019-0910-6

Heydari, M. R., Taghva, F., Amini, M., & Delavari, S. (2019). Using Kirkpatrick’s model to measure the effect of new teaching and learning methods workshop for health care staff. BMC Research Notes, 12(1). https://doi.org/10.1186/s13104-019-4421-y

Kiani, F., Salar, A., & Rezaee, N. (2020). Preventing the medication errors in hospitals: A qualitative study. International Journal of Africa Nursing Sciences, 13(1). https://doi.org/10.1016/j.ijans.2020.100235

Manias, E., Kusljic, S., & Wu, A. (2020). Interventions to reduce medication errors in adult medical and surgical settings: A systematic review. Therapeutic Advances in Drug Safety, 11, 1–29. https://doi.org/10.1177/2042098620968309

Melnyk, B., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

Mutair, A. A., Alhumaid, S., Shamsan, A., Zaidi, A. R. Z., Mohaini, M. A., Al Mutairi, A., Rabaan, A. A., Awad, M., & Al-Omari, A. (2021). The effective strategies to avoid medication errors and improve reporting systems. Medicines, 8(9), 1–12. https://doi.org/10.3390/medicines8090046

Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020). Medication administration errors and contributing factors among nurses: A cross-sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC Nursing, 19(1), 1–9. https://doi.org/10.1186/s12912-020-0397-0