Capstone and Practicum: Medication Errors Change Proposal

One of the most recognized ways of improving human health in nursing is to ensure the proper administration of drugs. Drugs can either treat or prevent illness and thus, the subject of correct drug administration cannot be underestimated in healthcare. However, medication errors tend to occur in healthcare settings sometimes. Some of them occur accidentally, while others are the result of human negligence. For instance, if a nurse gives a drug to the wrong patient, he can never recover properly as the drug has other indications. Additionally, if a nurse reconstitutes a liquid drug and spills it, the patient receives not sufficient dose, which leads to minimal therapeutic effects of the drug on the patient. In both cases, patients may have to stay in the hospital for an extended period to recover completely. A change proposal that focuses on the background, problem statement, its purpose, PICOT statement, literature search strategy, literature review, necessary nursing theory, proposed implementation plan, and identification of potential barriers is thus necessary to recommend the utilization of the barcode technology to prevent medication errors.

Background

Many mistakes take place in healthcare, including medication errors. According to Cheragi et al. (2014), medication errors have contributed immensely to the increased healthcare costs and high mortality rates. Cheragi et al. (2014) further assert that finding out the most appropriate way of preventing medication errors can lead to improved healthcare delivery, which can further result in reduced healthcare costs and a short period of hospital stay. Various researchers have recommended the utilization of barcode technology as one of the significant measures for reducing medication errors. For example, Gann (2015) provides statistics, which show that barcode technology can reduce the errors associated with drug administration by 86%. Additionally, the technology can further reduce medication errors to approximately 66%, if used for one year. These statistics indicate that although medication errors can be a threat to the recipients of health care, utilization of the barcode technology can contribute immensely to solving the problem. Therefore, nurses should use the technology properly and employ sound judgment when administering drugs to avoid giving drugs in the wrong way.

Problem Statement

Although medication errors have continued occurring in healthcare settings, the problem is researchable, since several factors contribute to its existence. For instance, Cheragi et al. (2014) argue that medication errors not only occur during drug administration but also during dispensation and prescription of the drugs. According to Cheragi et al. (2014), medication errors occur daily, and they have accounted for significant mortalities not only in the United States but also in other countries. Bachhuber et al. (2016) further argue that medication errors are a threat to patient safety and they can delay the recovery period. Thus, a rigorous study of literature to assess the most useful approach to reducing medication errors can help in initiating a practical approach to solve the issue. Moreover, it can further improve patient safety and reduce the length of hospital stay.

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Purpose of the Change Proposal

The primary objective of this change proposal is to assess the impact of medication errors in healthcare settings and then identify an efficient method of reducing them. The proposed method is the use of barcode technology. as various researchers have associated it with reduced medication errors (Gann, 2015). For that reason, the current change proposal will identify the magnitude of medication errors and the extent to which the barcode technology can reduce them. Additionally, although this project focuses on the general reduction of medication errors in healthcare settings by different healthcare providers, its recommendations will focus on nursing care. Nurses spend the most time with the patients, and thus, they should assess the need for drugs and determine the required dosages.

PICOT Statement

The PICOT statement identifies the significant role that nurses and the barcode technology play in reducing medication errors in healthcare settings. Thus, the PICOT statement is “In surgical patients admitted to the surgical units, what outcome does the utilization of the barcode technology have compared to the non-barcode method on reducing the rate of medication errors in three months?” Bonkowski et al. (2013) argue that the barcode approach has managed to help healthcare providers reduce medication errors. As a result, its assessment in the surgical unit is fundamental in making relevant conclusions to improve drug administration.

Literature Search Strategy Employed

The first approach to ensuring a proper search of the literature was to consider some of the key words in the PICOT statement. The words used include ‘barcode technology,’ ‘medication errors,’ and ‘drug errors in surgical settings.’ The databases used were MEDLINE and CINAHL. The use of the terms ‘quantitative’ and ‘qualitative’ was useful as they helped in identifying most of the empirical evidence for this project. The inclusion criteria involved all studies that addressed medication errors and were conducted during the past five years prior to the time of the search. The exclusion criteria included all studies done more than five years ago. The table for the literature search results is on the appendix page.

Literature Review

The initial search of the literature focused on the impact of medication errors. However, a continued analysis of the capstone project incorporated the literature about the barcode technology. Consequently, the literature search has been divided into three themes that include impact of medication errors, effect of individual drug errors, and the effect of the barcode technology on reducing medication errors.

Impact of Medication Errors

Various researchers have identified the magnitude of medication errors in healthcare settings. For instance, Cheragi et al. (2014) view medication errors as a serious issue that can affect the health outcomes of the patient negatively. Additionally, Cheragi et al. (2014) provide statistics, which indicate that approximately 64.55% of nurses conduct medication errors in healthcare settings. Furthermore, Cheragi et al. (2014) argue that almost 28.11% of drugs are given in wrong dosages, and approximately 32.03 % of drugs are given at the time that is not indicated in the prescriptions. According to Aboshaiqah (2014, p.65), poor communication contributes to 65.4% of the medication errors. Further, Feleke, Mulatu, and Yesmaw (2015) assessed the magnitude of medication errors in Ethiopia and noticed that the incidence was 56.4%. All the researchers confirm that increased cases of medication errors have contributed significantly to the increased healthcare costs, high mortality rates, and longer the period of hospital stay. Therefore, it is necessary to reduce medication errors to curb the given effects.

Effect of Individual Drug Errors

Errors associated with some drugs have been found dangerous in healthcare settings. For instance, Bachhuber et al. (2016, p.687) provide statistics, which indicate that benzodiazepine overdose has increased the death rate of adults from 0.58 per 100,000 people to 3.7 per 100,000 people. Additionally, Desai et al. (2013) assert that medication errors associated with anticoagulants have resulted in increased mortality and further increased patient harm. The given studies provide reliable evidence, which healthcare providers should consider while planning to prevent medication errors.

Effect of the Barcode Technology

This technology has been associated with low rates of medication errors. According to Bonkowski et al. (2013), this approach can reduce them to 90.4%. Additionally, Hardmeier et al. (2014) contend that increased compliance with the barcode technology can guarantee proper administration of the drugs. It is caused by the fact that the technology helps nurses confirm patient identity and the required interventions. Finally, according to Ehteshami et al. (2014), the barcode technology is an efficient tool for ensuring patient safety during drug administration. This evidence, including the statistics, shows that the barcode technology is useful in reducing the errors associated with drugs in healthcare settings.

Applicable Change or Nursing Theory Utilized

The most appropriate nursing theory for ensuring the change is ‘From Novice to Expert.’ Patricia Benner invented this theory and described five levels of nursing experiences (as cited in Beta, & Lidaka, 2015). The first step, which is also the novice stage, means that a nurse has to learn the skill well. An advanced beginner is a nurse who is starting to master a skill. A competent nurse is above the advanced beginner but below a proficient nurse who has mastered the skill well. Finally, the expert nurse shows increased competence in handling any task with ease. This project aims at giving recommendations regarding the usage of barcode technology. It advocates for nurses to study and practice barcode technology so that they can become experts in their field. In so doing, they can minimize medication errors significantly.

Proposed Implementation Plan with Outcome Measures

The implementation of this project will first begin by teaching nurses how to utilize the barcode technology effectively. Nurses will then gain the skills and apply them during nursing care during drug administration. According to Beta and Lidaka (2015), the acquisition of skills and incorporating them into practice can facilitate the growth of a nurse from the novice level to the expert level, which can further improve the attitude of nurses towards any skill. Therefore, the first outcome measure of this plan is to assess the compliance of nurses with the technology. Additionally, Ehteshami et al. (2014) argue that proper medication administration can reduce the length of hospital stay and enhance patient safety. Therefore, the second outcome measure is to assess the satisfaction of patients with nursing care. This plan and outcome measures can further provide much insight into the efficacy of the barcode technology in patient care.

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Potential Barriers and How to Overcome Them

The first barrier to the success of this change is the time required to implement it. According to Pirinen et al. (2015), the technology requires nurses to spend some time verifying patient information before administering the drugs. However, common problems, such as increased workload and nursing shortage in the healthcare settings, can prevent nurses from doing the proper verification. The second barrier involves nursing leadership. If nursing leaders do not appreciate the importance of technology, their followers will not embrace it, as well. Therefore, two solutions to these barriers include encouraging the use of nursing care delivery models and increasing awareness of nurse leaders on the importance of the technology. Regarding the nursing care models, nurses can choose one nursing approach, such as primary nursing, which maximizes performance with few nurses as per Mattila et al. (2014). Then, if nurse leaders can encourage nurses to utilize the technology as they use the model, they can effectively reduce medication errors.

Conclusion

Medication errors contribute immensely to high mortalities and an extended period of hospital stay. Although these errors continue occurring in healthcare settings, barcode technology is useful in preventing them. Various researchers have noticed that the technology is relevant not only in guaranteeing patient safety but also in reducing healthcare costs. Therefore, nurses can be taught to use this technology and practice it severally to grow from novice to expert. The outcome measures to the success of the utilization of this technology include assessing compliance of nurses with it, and evaluating the satisfaction of patients as nurses use it. Although such barriers as increased workload exist in healthcare settings, proper leadership and utilization of appropriate nursing care delivery models, including primary nursing, can enhance the use of the barcode technology.