NURSFPX 4020 Improvement Plan Tool Kit Essay

Medication errors are among the common healthcare problems resulting in preventable injuries, deaths, and disabilities to patients (Bukoh & Siah, 2020). Reducing medication errors requires the use of evidence-based practice knowledge to guide the adoption of the appropriate prevention plan and improve medication safety. The four main themes for this in-service presentation included bedside shift handover, medication reconciliation, interdisciplinary collaboration, and electronic documentation and communication. This paper will present an annotated bibliography of twelve resources that explain the four themes identified for the safety improvement plan.

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Shift Handover and Communication

Bukoh, M. X., & Siah, C.-J. R. (2020). A systematic review on the structured handover interventions between nurses in improving patient safety outcomes. Journal of Nursing Management, 28(3), 744–755. https://doi.org/10.1111/jonm.12936

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Errors occurring during shift handover as a result of poor communication contribute to various causes of medication errors. Nurses communicate with others during shift reporting, however, gaps in communication without following a standardized communication means risk increasing errors. This article is a systematic review and meta-analysis discussing the effectiveness of structured handover intervention in improving patient safety. Various structured handover interventions include but are not limited to SBAR (situation, background, assessment, recommendations), STICC (situation, task, intent, concern, calibrate), and ICCCO (identification of patient, clinical history, clinical status, care plan, outcomes). These structured handover interventions can be delivered verbally, through documentation, written, or recorded. They aim at improving communication between nurses and enhancing patient safety. Findings from this article indicated a reduction in medication errors, patient complications, and general adverse events when using structured handover. This article is relevant in emphasizing the need for change in bedside shift reporting and the effectiveness of a standardized handover to enhance continuity of care and reduce handover errors. The article also provides high-level evidence supporting the improvement of patient safety.

Usher, R., Cronin, S. N., & York, N. L. (2018). Evaluating the influence of a standardized bedside handoff process in a medical-surgical unit. Journal of Continuing Education in Nursing, 49(4), 157–163. https://doi.org/10.3928/00220124-20180320-05

Standardized bedside handover is a practice that has been studied by many researchers. Despite nurses understanding the importance of bedside shift reporting, the quality of reporting is wanting impairs the continuity of care and ultimately reduces the quality of care a patient receives. This article evaluates the influence of standardized bedside shift reporting in the medical-surgical unit. This article focused on addressing the influence of various standardized interventions including the use of SBAR, a web-based education program, and competency checklist tool. Utilization of the standardized handoff report aims at enhancing communication between nurses that is necessary for continuity of care. according to this article, using standardized handover intervention resulted in an improvement in communication between nurses and a reduction in hand off time. The contents of this article are useful in enhancing change in bedside shift reporting and integrating effective communication in the process. Therefore, nurses can adopt and use standardized handover interventions to improve patient safety and reduce medication errors.

Jeong, H.-J., & Park, E.-Y. (2022). Patient-nurse partnerships to prevent medication errors: A concept development using the hybrid method. International Journal of Environmental Research and Public Health, 19(9), 5378. https://doi.org/10.3390/ijerph19095378

Shift handover offers an opportunity for incoming and outgoing nurses to communicate and share information necessary for continuity of care. Unlike traditional shift reporting in nursing stations, bedside shit reporting allows nurses and patients to interact during the process. Bedside shift reporting has various advantages including early assessment, direct visualization, and focus on a single patient. Nurse-patient interactions help in reducing patient complications and improving patient safety. This article focuses on emphasizing the need of improving the professional relationship between patients and nurses aimed at improving the dynamics of bedside reporting. Enhanced patient-nurse relationship enhances trust, communication, cooperation, respect, and sharing. Additionally, involving patients in their care makes them feel appreciated and they are likely to adhere to treatment and cooperate with nurses ultimately improving the quality of care. This article is useful in emphasizing the need for active engagement of patients during bedside shift reporting. To influence care and enhance the quality of care, nurses should appreciate the vital role of patients in their care to improve safety.

Interdisciplinary collaboration and Medication Safety

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, 2042098620968309. https://doi.org/10.1177/2042098620968309

Medication errors can occur at any point of management of medication management. This can range from prescription, dispensing, and administration where nurses, physicians, and pharmacists are included. Enhancing collaboration between different caregivers has been the focus of various research. This article compares the effectiveness of different interventions in reducing prescribing, dispensing, and administration of medication errors. Various databases including MEDLINE, Cochrane, CINAHL, and EMBASE among others provided elaborate knowledge for this systematic review. The interventions reviewed included prescriber education, computed medication reconciliation, pharmacist-led medication reconciliation, computerized physician order entry (CPOE), medication reconciliation by the mentor, and automated drug distribution. These interventions can be used singly or combined can help in reducing medication errors. The importance of interdisciplinary collaboration cannot be over-emphasized for its immense contribution. Interdisciplinary collaboration enhances communication between health professionals in the clinical area. The success of the implementation reduces disparities while improving patient safety.

Manias, E. (2018). Effects of interdisciplinary collaboration in hospitals on medication errors: an integrative review. Expert Opinion on Drug Safety, 17(3), 259–275. https://doi.org/10.1080/14740338.2018.1424830

Breakdown in communication at any point of care is among the common causes of medication errors in healthcare. Overcoming communication barriers in healthcare is a priority for reducing errors. This article is an integrative review that aimed at examining the influence of interdisciplinary collaboration on medication errors. Interdisciplinary collaboration is an important means of facilitating communication between healthcare providers. This article identified five different areas of an interdisciplinary collaboration involving medication errors. They include communication using tools such as guidelines, protocols, and communication logs; pharmacists’ participation in care teams; collaborative workshops and conferences; the complexity of role differentiation and environment; and collaborative medication review on admission and discharge. According to the author, Manias, enhanced interdisciplinary collaboration through effective communication improves knowledge, an essential component of enhanced decision-making. Medication errors can be reduced through interdisciplinary collaboration in the five different areas mentioned in this article. This article is useful as it provides extensive knowledge about the five different areas of interdisciplinary collaboration. Therefore, nurses and other healthcare providers should beware of the different opportunities for interdisciplinary collaboration and utilize them to enhance patient safety. Patient care is the responsibility of every healthcare provider.

Johansen, J. S., Havnes, K., Halvorsen, K. H., Haustreis, S., Skaue, L. W., Kamycheva, E., Mathiesen, L., Viktil, K. K., Granås, A. G., & Garcia, B. H. (2018). Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (IMMENSE study): study protocol for a randomized controlled trial. BMJ Open, 8(1), e020106. https://doi.org/10.1136/bmjopen-2017-020106

The increasing aging population accompanied by morbidity and the need for pharmacotherapy increases the risk of drug-related problems (DRP). DRP may arise from inappropriate prescription, adverse drug reactions, wrong administration, drug interactions, and the need for monitoring. The presence of communication barriers, fragmentation of care, frequent transitions, and multiple prescribers are risks for the occurrence of DRP among the elderly. This article evaluates the effectiveness of an integrated medication management (IMM) model on medication safety. IMM is based on interdisciplinary collaboration where nurses, physicians, pharmacists, and patients cooperate to optimize medication therapy by preventing DRPs. IMM integrates various services including medication reconciliation, patient counseling, medication review, dissemination of correct medication information at major points of care such as admission and discharge, and post-discharge calls. The study results showed the effectiveness of IMM in improving patient safety. IMM improves communication between healthcare providers, and reduction in hospital stays, reduction in readmissions, and reduction in drug-related problems as supported by research in Northern Ireland and Sweden. This article is useful in understanding how IMM can be integrated into primary healthcare to prevent adverse drug reactions and medication errors among the elderly and the general population.

Sessions, L. C., Nemeth, L. S., Catchpole, K., & Kelechi, T. J. (2019). Nurses’ perceptions of high-alert medication administration safety: A qualitative descriptive study. Journal of Advanced Nursing, 75(12), 3654–3667. https://doi.org/10.1111/jan.14173

Various causes of medication errors including communication breakdown, human problems, staffing patterns and workflow, inadequate policies, and patient-related issues are barriers to safe medication. In addition, the presence of high-alert medications including antithrombotics, insulin, antibiotics, anesthetics, and opioids can cause patient harm. Little is known about the nurses` perception of these medications. This article presents a qualitative study to determine nurses’ perceptions of support and barriers to high-alert medication (HAM) administration safety. This article presents three major themes contributing to safety administration HAM: collaboration, nursing competence and engagement, and organizational culture of safety. Risk factors for medication errors identified include increased workload, acuity, and distractions. This article is useful as it emphasizes the importance of intra- and interprofessional collaboration, patient incorporation, and nursing engagement in the administration of HAM. Reduction in errors of administration of HAM improves patient outcomes and reduces complications, morbidity, and mortality.

Medication Reconciliation and Medication Safety.

Frament, J., Hall, R. K., & Manley, H. J. (2020). Medication reconciliation: The foundation of medication safety for patients requiring dialysis. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 76(6), 868–876. https://doi.org/10.1053/j.ajkd.2020.07.021

Medication reconciliation is a process of collecting medication information through history and reviewing all documentation to identify the medications taken and avoid duplication of medications. Medication reconciliation identifies medication list discrepancies and helps in the creation of an accurate medication list that provides clinicians with valuable information during the care of patients. The issue of medication reconciliation is important in patients with various comorbidities taking several medications. For instance, patients with kidney failure requiring dialysis are at increased risk of suffering from drug adverse events due to polypharmacy, altered medication pharmacokinetics and pharmacodynamics, and multiple chronic conditions. This article addresses the importance of medication reconciliation in improving patient safety in patients requiring dialysis. The use of medication reconciliation positively affects patient care as it helps in identifying the medications patient is receiving, the medication that has caused adverse events, and medications requiring review. Nurses and other healthcare providers should adopt medication reconciliation as a safety improvement plan.

Prey, J. E., Polubriaginof, F., Grossman, L. V., Masterson Creber, R., Tsapepas, D., Perotte, R., Qian, M., Restaino, S., Bakken, S., Hripcsak, G., Efird, L., Underwood, J., & Vawdrey, D. K. (2018). Engaging hospital patients in the medication reconciliation process using tablet computers. Journal of the American Medical Informatics Association: JAMIA, 25(11), 1460–1469. https://doi.org/10.1093/jamia/ocy115

The information on the roles of patients in medication reconciliation beyond verbal participation is limited. Limited participation of patients leads to unintentional discrepancies. This article addresses the effect of using an electronic home medication review tool on medication safety. Patients were randomized to use an electronic medication review tool before and after hospital admission. The effect of the tool on medication safety and its usefulness was assessed. The findings demonstrated a high willingness of patients engagement in medication reconciliation that enabled patients to identify any medication discrepancies missed by clinicians. This article is useful as it provides a high level of evidence regarding the importance of incorporating patients to improve patient safety. The presence of electronic devices helps in reducing the gap in patient involvement in medication reconciliation.

Redmond, P., Grimes, T. C., McDonnell, R., Boland, F., Hughes, C., & Fahey, T. (2018). Impact of medication reconciliation for improving transitions of care. Cochrane Database of Systematic Reviews, 8(8), CD010791. https://doi.org/10.1002/14651858.CD010791.pub2

Points of transition of care act as a source of various medication of discrepancies that can result in medication errors. This article presents a systematic review of randomized control trial articles discussing the effects of medication reconciliation on medication discrepancies during care transitions. Twenty-five randomized articles were identified and reviewed. The authors compared information from articles where medication reconciliation was used versus where it wasn’t used. This article provides a high level of evidence from 25 randomized control trials involving 6995 patients. This article described the impact of medication reconciliation on the number of medication discrepancies per patient medication, re-hospitalization, preventable adverse effects, and a composite measure of hospital utilization. Despite the minimal effects of medical reconciliation on various outcomes, nurses and other healthcare providers should adopt and practice medication reconciliation during care transitions to improve patient safety and reduce adverse effects.

Electronic Documentation and Medication Safety

Gates, P. J., Hardie, R.-A., Raban, M. Z., Li, L., & Westbrook, J. I. (2021). How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis. Journal of the American Medical Informatics Association: JAMIA, 28(1), 167–176. https://doi.org/10.1093/jamia/ocaa230

The need to reduce medication errors has led to increased use of technology in the process of patient care. The use of electronic medication systems (EMS) has been proposed and used in various settings. This article is a systematic review and meta-analysis evaluating the impact of EMS on medication errors. The review compared information from articles that incorporated EMS versus those that didn’t use it. Peer-reviewed articles were retrieved from reputable sources including PubMed, Scopus, CINAHL, and Embase. Two researchers independently reviewed the article that met the inclusion criteria while excluding others. The quality of studies was also reviewed and documented. Most studies included were classified as moderate with few strong and weak. Findings from the articles affirmed the importance of EMS in reducing prescribing error rates. This article provides high-level evidence on the implementation of EMS on improving patient safety and reducing medication errors. The information is effective and can be used in the development of the safety improvement plan.

Hess, E., Palmer, S. E., Stivers, A., & Amerine, L. B. (2020). Impact of an electronic health record transition on chemotherapy error reporting. Journal of Oncology Pharmacy Practice: Official Publication of the International Society of Oncology Pharmacy Practitioners, 26(4), 787–793. https://doi.org/10.1177/1078155219870590

Incident reporting systems are a critical component of patient safety that allows healthcare providers to report any errors incurred. These systems help in risk identification and trends. This article evaluates the utilization of incident reporting systems as a new electronic health record in medication error reporting. This study involves a pre- and post-analysis conducted by reviewing medication errors reported via the voluntary incident reporting system. Error reports included the category of a medication error, the date of the error, harm severity, patient location at the time of the error, involved medications, medication summary, contributing factors, and a narrative summary. These systems discovered that most medication errors occurred during the prescription and dispensing phase. ‘Wrong dose’ was the leading error followed by ‘overdose’, ‘missing dose’, and finally ‘order incorrect’. The institution was able to understand the trends in medication errors as well as enable the institution to develop future improvement goals. This article is useful in understanding the importance of using an incident reporting system in mitigating medication errors. Implementing an incident reporting system improves patient safety and should form part of this improvement plan. However, combining incident reporting systems with proactive risk identification approaches enhances system-focused improvements to improve the safety of patients.

Conclusion

This article presented an annotated bibliography of 12 scholarly resources providing extensive evidence that can be used to implement a safety improvement plan. The information presented will help in understanding the importance of medication reconciliation techniques, bedside handover, electronic documentation and communication, and interprofessional collaboration in the medication safety plan. Decisions to adopt any of the interventions will be based on the feasibility and appropriateness of the intervention in reducing medication errors.

References

Johansen, J. S., Havnes, K., Halvorsen, K. H., Haustreis, S., Skaue, L. W., Kamycheva, E., Mathiesen, L., Viktil, K. K., Granås, A. G., & Garcia, B. H. (2018). Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (IMMENSE study): study protocol for a randomised controlled trial. BMJ Open, 8(1), e020106. https://doi.org/10.1136/bmjopen-2017-020106

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For this assessment, you will develop a Word document or an online resource repository of at least 12 annotated professional or scholarly resources that you consider critical for the audience of your safety improvement plan, pertaining to medication administration, to understand or implement to ensure the success of the plan.

Communication in the health care environment consists of an information-sharing experience whether through oral or written messages (Chard & Makary, 2015). As health care organizations and nurses strive to create a culture of safety and quality care, the importance of interprofessional collaboration, the development of tool kits, and the use of wikis become more relevant and vital. In addition to the dissemination of information and evidence-based findings and the development of tool kits, continuous support for and availability of such resources are critical. Among the most popular methods to promote ongoing dialogue and information sharing are blogs, wikis, websites, and social media. Nurses know how to support people in time of need or crisis and how to support one another in the workplace; wikis in particular enable nurses to continue that support beyond the work environment. Here they can be free to share their unique perspectives, educate others, and promote health care wellness at local and global levels (Kaminski, 2016).

You are encouraged to complete the Determining the Relevance and Usefulness of Resources activity prior to developing the repository. This activity will help you determine which resources or research will be most relevant to address a particular need. This may be useful as you consider how to explain the purpose and relevance of the resources you are assembling for your tool kit. The activity is for your own practice and self-assessment, and demonstrates course engagement.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 1: Analyze the elements of a successful quality improvement initiative.
Analyze usefulness of resources for role group responsible for implementing quality and safety improvements with medication administration.
Competency 2: Analyze factors that lead to patient safety risks.
Analyze the value of resources to reduce patient safety risk or improve quality with medication administration.
Competency 3: Identify organizational interventions to promote patient safety.
Identify necessary resources to support the implementation and sustainability of a safety improvement initiative focusing on medication administration.
Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.
Present reasons and relevant situations for resource tool kit to be used by its target audience.
Communicate resource tool kit in a clear, logically structured, and professional manner that applies current APA style and formatting.
References
Chard, R., & Makary, M. A. (2015). Transfer-of-care communication: Nursing best practices. AORN Journal, 102(4), 329â€“342.

Kaminski, J. (2016). Why all nurses can/should be authors. Canadian Journal of Nursing Informatics, 11(4), 1â€“7.

Professional Context

Nurses are often asked to implement processes, concepts, or practicesâ€”sometimes with little preparatory communication or education. One way to encourage sustainability of quality and process improvements is to assemble an accessible, user-friendly tool kit for knowledge and process documentation. Creating a resource repository or tool kit is also an excellent way to follow up an educational or in-service session, as it can help to reinforce attendees’ new knowledge as well as the understanding of its value. By practicing creating a simple online tool kit, you can develop valuable technology skills to improve your competence and efficacy. This technology is easy to use, and resources are available to guide you.

Scenario

For this assessment, consider taking one of these two approaches:

Build on the work done in your first three assessments and create an online tool kit or resource repository that will help the audience of your in-service understand the research behind your safety improvement plan pertaining to medication administration and put the plan into action.
Locate a safety improvement plan (your current organization, the Institution for Healthcare Improvement, or a publicly available safety improvement initiative) pertaining to medication administration and create an online tool kit or resource repository that will help an audience understand the research behind the safety improvement plan and how to put the plan into action.
Preparation

Google Sites is recommended for this assessment; the tools are free to use and should offer you a blend of flexibility and simplicity as you create your online tool kit. Please note that this requires a Google account; use your Gmail or GoogleDocs login, or create an account following the directions under the “Create Account” menu.

Refer to the following links to help you get started with Google Sites:

G Suite Learning Center. (n.d.). Get started with Sites. https://gsuite.google.com/learning-center/products/sites/get-started/#!/
Google. (n.d.). Sites. https://sites.google.com
Google. (n.d.). Sites help. https://support.google.com/sites/?hl=en#topic=
Instructions

Using Google Sites, assemble an online resource tool kit containing at least 12 annotated resources that you consider critical to the success of your safety improvement initiative. These resources should enable nurses and others to implement and maintain the safety improvement you have developed.

It is recommended that you focus on the 3 or 4 most critical categories or themes with respect to your safety improvement initiative pertaining to medication administration. For example, for an initiative that concerns improving workplace safety for practitioners, you might choose broad themes such as general organizational safety and quality best practices; environmental safety and quality risks; individual strategies to improve personal and team safety; and process best practices for reporting and improving environmental safety issues.

Following the recommended scheme, you would collect 3 resources on average for each of the 4 categories focusing on safety with medication administration. Each resource listing should include the following:

An APA-formatted citation of the resource with a working link.
A description of the information, skills, or tools provided by the resource.
A brief explanation of how the resource can help nurses better understand or implement the safety improvement initiative pertaining to medication administration.
A description of how nurses can use this resource and when its use may be appropriate.
Remember that you must make your site â€˜publicâ€™ so that your faculty can access it. Check out the Google Sites resources for more information.

Here is an example entry:

Merret, A., Thomas, P., Stephens, A., Moghabghab, R., & Gruneir, M. (2011). A collaborative approach to fall prevention. Canadian Nurse, 107(8), 24â€“29.
This article presents the Geriatric Emergency Management-Falls Intervention Team (GEM-FIT) project. It shows how a collaborative nurse lead project can be implemented and used to improve collaboration and interdisciplinary teamwork, as well as improve the delivery of health care services. This resource is likely more useful to nurses as a resource for strategies and models for assembling and participating in an interdisciplinary team than for specific fall-prevention strategies. It is suggested that this resource be reviewed prior to creating an interdisciplinary team for a collaborative project in a health care setting.
Additionally, be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.

Identify necessary resources to support the implementation and continued sustainability of a safety improvement initiative pertaining to medication administration.
Analyze the usefulness of resources to the role group responsible for implementing quality and safety improvements focusing on medication administration.
Analyze the value of resources to reduce patient safety risk related to medication administration.
Present reasons and relevant situations for use of resource tool kit by its target audience.
Communicate in a clear, logically structured, and professional manner that applies current APA style and formatting.
Example Assessment: You may use the following example to give you an idea of what a Proficient or higher rating on the scoring guide would look like but keep in mind that your tool kit will focus on promoting safety with medication administration. Note that you do not have to submit your bibliography in addition to the Google Site; the example bibliography is merely for your reference.

Assessment 4 Example [PDF].
To submit your online tool kit assessment, paste the link to your Google Site in the assessment submission box.

Example Google Site: You may use the example Google Site, Resources for Safety and Improvement Measures in Geropsychiatric Care, to give you an idea of what a Proficient or higher rating on the scoring guide would look like for this assessment but keep in mind that your tool kit will focus on promoting safety with medication administration.

Note: If you experience technical or other challenges in completing this assessment, please contact your faculty member.

Additional Requirements

APA formatting: References and citations are formatted according to current APA style

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