NURS 6052 Module 3 Assignment Evidence-Based Project

NURS 6052 Module 3 Assignment

Evidence-Based Project, Part 2: Advanced Levels of Inquiry and Systemic Reviews

Student Name

NURS6052

Walden University

Professor Name

Date

Slide 1:

The focus of the presentation Medication administration errors (MAEs) through a systematic review of literature in order to focus on non-punitive reporting systems and educational interventions as potential solutions.

Slide 2:

Objectives 

Examine medication administration errors  

Analyze non-punitive solutions  

Evaluate educational interventions  

Apply PICO(T) framework  

Improve medication safety  

Medication administration errors (MAEs) are a critical patient safety element in nursing practice, typically due to system failure, inadequate training, or retaliatory reporting environments. The evidence-based project explores MAEs through systematic literature review, with emphasis on the non-punitive reporting systems and educational interventions as feasible alternatives. Using the PICO(T) strategy, it critically appraises peer-reviewed articles from databases like PubMed, CINAHL, Scopus, and Web of Science to determine feasible error-reduction strategies. Through analysis of high-level evidence, the appraisal demonstrates how organizational change and education for nurses are effective ways of improving medication safety within acute care.

Slide 3:

Clinical Issue

Medication administration error (MAE) 

Key issue in patient safety and nursing practice

Medication administration: core of nursing

Clinical Issue of Interest: Medication Administration Errors in Nursing Practice

Medication administration error (MAE) is a key issue in patient safety and nursing practice. These errors occur where there is a divergence from the planned medication regimen, e.g., wrong drug, wrong dosage, inappropriate route, or incorrect timing. MAEs have important patient outcomes such as length of stay in hospital, healthcare costs, and patient harm and even death (Jessurun et al., 2022). The major implications involved, the knowledge of the underlying causes, reporting barriers, and minimizing these errors via interventions to improve the quality of clinical care. Medication administration lies at the core of nursing; therefore, nurses are key stakeholders that must be engaged in addressing this issue.

The incidence of MAEs has been widely reported in a wide range of settings across the world. Research has been carried out by Tariq et al. (2024), which has identified some of the reasons including communication breakdowns, suboptimal training, interruptions during medication rounds, and system breakdowns as critical among the main reasons behind such errors. Additionally, underreporting of MAEs continues to be a problem due to fear of blame, legal repercussions, or disciplinary action. Solution to this complex issue necessitates systemic intervention by way of education, redesign of the system, and establishment of safety and transparency culture. Hence, identification of evidence-based practices to reduce MAEs is imperative in terms of improving nursing practice and patient wellbeing.

Slide 4:

PICO(T) Question 

In registered nurses working in acute care hospitals (P), how does the implementation of non-punitive error reporting systems and targeted educational programs (I), compared to current punitive error management practices and limited educational support (C), affect medication administration error rates and nurse compliance with reporting protocols (O) over a 6–12 month period (T)?

Development of the PICO(T) Question

To structure my clinical inquiry around medication administration errors, I formulated a PICO(T) question that focuses on the intervention of interest, its impact, and the context in which it applies. The acronym PICO(T) stands for Population, Intervention, Comparison, Outcome, and Timeframe. In this case:

Population (P): Registered nurses working in acute care hospitals.

Intervention (I): Implementation of non-punitive error reporting systems and targeted educational programs.

Comparison (C): Current practices involving punitive error management and limited educational support.

Outcome (O): Reduction in medication administration errors and improved nurse compliance with error reporting protocols.

Timeframe (T): Over a period of 6–12 months following implementation.

The PICO(T) question was developed following a critical review of the literature and consideration of gaps in existing practice. By focusing on interventions like non-punitive reporting and education, my aim is to study methods that not only reduce errors but also encourage an active safety culture in nurses. My PICO(T) question will form the crux of my evidence-based project and guide my search for relevant studies and systematic reviews during the course.

Slide 5:

Research Databases 

PubMed biomedical focus

CINAHL nursing specialty 

Scopus interdisciplinary coverage 

Web of Science citations 

Comprehensive evidence base 

Research Databases Used for Literature Search

To perform a careful and extensive search for peer-reviewed journal articles on medication administration mistakes, I searched four main databases offered by the Walden Library: PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, and Web of Science. These databases offer individual advantages and links to wide sets of scholarly resources relevant to nursing and healthcare studies. PubMed, administered by the U.S. National Library of Medicine, is a valuable resource for biomedical literature (Jin et al., 2024). The database contains millions of citations for MEDLINE, life science journals, and electronic books, and hence is appropriate for identifying high-quality studies on medication safety, nursing practices, and patient outcomes. Its sophisticated filters for searching allow identification of systematic reviews, meta-analyses, and other filtered evidence types required to answer clinical questions with the highest level of scientific precision.

CINAHL is tailored specifically for nursing and allied health professionals, with access to a big database of nursing literature, conference proceedings, and evidence-based care sheets. Since the aim of this project was nursing practice and the administration of drugs, CINAHL provided targeted literature directly addressing the clinical issue at hand. Its robust indexing system facilitates precise searching with controlled vocabulary terms such as CINAHL Headings, enhancing the quality and the relevance of retrieved articles.

Scopus is a vast abstract and citation database of peer-reviewed literature, encompassing all the major disciplines like health sciences, social sciences, and humanities. Scopus excels in cross-disciplinary research and offers tracking, analysis, and visualization features for research trends (Baas et al., 2020). Scopus’s extensive coverage supports identifying landmark and path-breaking research on medication error and prevention measures. Finally, Web of Science provides multidisciplinary coverage and robust citation mapping capabilities, which allow authors to track how ideas evolve over a period of time and determine seminal studies in a field. Powerful Boolean searching and availability of high-impact journals are provided by this database, which prove useful when searching for systematic reviews and meta-analyses that aggregate results from many different studies. With the use of these databases, I presented a systematic and thorough method of looking for the best existing evidence about medication administration errors within nursing practice.

Slide 6:

Systematic Reviews (1/2) 

Afaya, A., Konlan, K. D., & Kim Do, H. (2021). Improving patient safety through identifying barriers to reporting medication administration errors among nurses: An integrative review. BMC Health Services Research, 21(1), 1–10. https://doi.org/10.1186/s12913-021-07187-5 

Brabcová, I., Hajduchová, H., Tóthová, V., Chloubová, I., Červený, M., Prokešová, R., Malý, J., Vlček, J., Doseděl, M., Malá-Ládová, K., Tesař, O., & O’Hara, S. (2023). Reasons for medication administration errors, barriers to reporting them and the number of reported medication administration errors from the perspective of nurses: A cross-sectional survey. Nurse Education in Practice, 70(1), 103642. https://doi.org/10.1016/j.nepr.2023.103642 

Slide 7:

Systematic Reviews and High-Level Evidence Articles Identified

Using keywords from my PICO(T) question, i.e., medication administration error, nursing, non-punitive reporting, education, and systematic review, I was successful to identify four peer-reviewed articles on the meta-analysis or systematic review level. The four articles provide high-level evidence addressing various issues of medication administration errors, i.e., causes, reporting barriers, and potential interventions.

Afaya, A., Konlan, K. D., & Kim Do, H. (2021). Improving patient safety through identifying barriers to reporting medication administration errors among nurses: An integrative review. BMC Health Services Research, 21(1), 1–10. https://doi.org/10.1186/s12913-021-07187-5 

The integrative review integrates evidence from a number of studies to examine organizational and individual barriers that discourage nurses from reporting medication errors. Authors cite fear of retaliation, lack of confidentiality, and poor institutional policies as key barriers to reporting. This review is most closely analogous to the comparison component of my PICO(T) question, that is, existing punitive vs. non-punitive systems.

Brabcová, I., Hajduchová, H., Tóthová, V., Chloubová, I., Červený, M., Prokešová, R., Malý, J., Vlček, J., Doseděl, M., Malá-Ládová, K., Tesař, O., & O’Hara, S. (2023). Reasons for medication administration errors, barriers to reporting them and the number of reported medication administration errors from the perspective of nurses: A cross-sectional survey. Nurse Education in Practice, 70(1), 103642. https://doi.org/10.1016/j.nepr.2023.103642 

Although the paper is a cross-sectional study rather than a systematic review, it is high-level quantitative data that explores both the reason for MAEs and reluctance to report them. The extremely large sample size (n=1,205) and standardized survey instrument provide it with good validity and reliability. It deals with the intervention element of the PICO(T) question by emphasizing the need for improved training and supportive cultures to reduce errors.

Slide 8:

Systematic Reviews (2/2)

Fathy, A. S. M., Khalil, N. S., Abd-elbaky, M. M., & Taha, N. (2020). Nurse’s knowledge and practice regarding medication errors in critical care units: Descriptive study. Minia Scientific Nursing Journal, 008(1), 111–120. https://doi.org/10.21608/msnj.2020.188051 

Tsegaye, D., Alem, G., Tessema, Z., & Alebachew, W. (2020). Medication administration errors and associated factors among nurses. International Journal of General Medicine, 13(13), 1621–1632. https://doi.org/10.2147/ijgm.s289452 

Fathy, A. S. M., Khalil, N. S., Abd-elbaky, M. M., & Taha, N. (2020). Nurse’s knowledge and practice regarding medication errors in critical care units: Descriptive study. Minia Scientific Nursing Journal, 008(1), 111–120. https://doi.org/10.21608/msnj.2020.188051 

This is descriptive research evaluating the knowledge and current practices of nurses on medication errors in critical care settings. It illustrates significant knowledge deficits and inconsistent practice, especially among recent graduates. Although the design is descriptive, the results support the necessity for targeted education, an intervention central to my PICO(T) question.

Tsegaye, D., Alem, G., Tessema, Z., & Alebachew, W. (2020). Medication administration errors and associated factors among nurses. International Journal of General Medicine, 13(13), 1621–1632. https://doi.org/10.2147/ijgm.s289452 

Cross-sectional study of prevalence and risk factors for MAEs in Ethiopian referral centers identifies common causes such as inadequate training, heavy workload, and interruptions during medication rounds. This is not a systematic review but employs effective primary data to address the population and outcome aspects of the PICO(T) question.

Slide 9:

Levels of Evidence and Strengths of Systematic Reviews

Afaya et al. (2021) is an integrative review (Level I)

Other Three are Cross-sectional studies (Level III) 

Large sample strengths

Standardized instruments 

Statistical validity 

Levels of Evidence and Strengths of Systematic Reviews

Of the four articles examined, Afaya et al. (2021) is an integrative review (Level I evidence) and three others are descriptive or cross-sectional studies (Level III evidence). Although there are no meta-analyses among the selected articles, collectively, they present solid empirical evidence for the nature, etiology, and solution to medication administration errors in nursing practice. Systematic reviews, like the integrative review of Afaya et al. (2021), are the most superior form of evidence (Level I) since they use strict methods to synthesize data from numerous studies in a thorough manner. Systematic reviews reduce bias via preselected inclusion/exclusion criteria, quality appraisal of included studies, and explicit data synthesis methods. For example, Afaya et al. utilized the Mixed Methods Appraisal Tool (MMAT) to evaluate the quality of studies included in order to only utilize high-quality evidence to inform their conclusions. The strength of systematic reviews is that they can provide an overview of the literature overall, distinguish patterns, and offer recommendations based on cumulative evidence rather than isolated findings.

Cross-sectional studies, which are lower in the hierarchy of evidence, still have valid contributions, especially if conducted on large samples and using validated instruments. Brabcová et al. (2023) are an excellent case in that they conducted a survey of over 1,200 nurses using a validated instrument. That they used statistical techniques such as Pearson correlation and CHAID analysis lends support to the internal validity of their findings. Similarly, Tsegaye et al. (2020) used binary logistic regression to identify independent predictors of MAEs to make more robust generalizations about causal associations.

Slide 10:

Conclusion 

Punitive culture harms 

Education reduces errors 

System redesign needed 

Higher evidence required 

Safety culture imperative 

Findings of the systematic review support that medication administration errors continue to occur despite punitive reporting cultures, lack of knowledge, and workflow system problems in the system. Although integrative reviews and cross-sectional studies yield helpful information regarding the causes and interventions for MAE, more senior evidence is required to define best practice. The study emphasizes the importance of the implementation of non-punitive reporting systems along with targeted education interventions to enhance medication safety, thus ensuring improved patient outcomes and openness of nursing practice.

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