M6007 Health Administration

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M6007 Health Administration

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M6007 Health Administration

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Course Code: M6007
University: Monash University

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Country: Australia

Question: 
In this assignment the student is required to identify an aspect of nursing that you believe could be improved through EBP. You are required to explain and describe how you would go about doing it using the steps of the EBP process. 
Answer: 

Introduction:
Evidence based practice (EBP) is the approach to identify best practice evidence that provides optimal care to patient and combine the evidence with clinical skills and patient values to deliver care. The main purpose of the paper is to look into the issue of medication errors and use the steps of the EBP process to identify the strong evidence that can prevent medication errors (DiCenso, Guyatt & Ciliska, 2014). Medication error can be defined as the preventable events that have the capability of causing or leading to inappropriate medication use affecting the health of the patients (Salmasi et al., 2015). Occurrence of these events may be due to professional practices or healthcare products, different types of procedures as well as systems that might include improper prescribing, order communication as well as product labeling. The paper looks at the consequence of medication errors and ways to prevent it in practice setting using the EBP process.
Rational for medication error as a practice issue:
The medication errors have threatening effects on the health of the patient and the family members. It results in preventable deaths, long stays in the hospitals, readmissions of the patients, poor quality health of the patient and suffering. It also leads to loss of trust and respect among the healthcare members and the patients that also affect the reputation of the healthcare sectors and overflow of healthcare resources. Nanji et al. (2016) had stated that it also has negative impacts on the professionals where they suffer from feelings of guilt and fear about the events. They fear of losing their license that would affect their career. They also feel guilty of making the patients suffer more that affect their morale as well as their self-confidence. They get involved in different types of legal obligations that affect the career of the professionals and the brand reputation of the healthcare center (Parry, Barribal & While, 2015).
Preventing medication errors following the steps of the EBP process:
To prevent medication errors and promote patient safety, identifying the best interventions that can prevent medication is critical. The six steps of the EBP process can guide in identifying the best evidence to prevent medication errors. These are as follows:
Development of clinical question:
The first step a to search for strongest evidence related to practice issue according to the EBP process is to frame a clinically guiding research question that can help to retrieve relevant research literatures on the topic. PICO question can provide a pathway to search for relevant evidence (Hall & Roussel, 2016). The PICO question related to medication error prevention includes the following:
Is computerized medication order entry (intervention) effective in preventing medication errors (outcome) in medicine ward (population)?
Retrieving evidence from the right source:
Several medical and health care databases like Medline, CINAHL and PubMed can help to search for best evidence that prevent medication errors in clinical setting. Use of keywords from the clinical question helps to proceed with the search for relevant research literatures (Hall & Roussel, 2016). The search terms that can be used for the above clinical question includes computerized medication order entry, medication errors or medicine, medication error prevention and reducing medication errors. The search term helped to retrieve various interventions that has been implemented to reduce medication errors.
Critical evaluation of the selected evidence:
The review of research evidence revealed CPOE as an effective intervention to prevent medication errors. This could be identified by the analysis of research outcome and determining the credibility, validity and reliability of the research evidence. The articles that gave idea about the effectiveness of CPOE included the study by Slight et al. (2015). Slight et al. (2015) evaluated the impact of CPOE by prospective time series analysis and medication errors related outcome was evaluated before and after the implementation of the intervention. The study findings revealed significant reduction in non-missed-dose medication errors and reduction was found in both intensive and general care units. The reliability of the evidence was confirmed by the review of validated tools to collect data and characteristics of the CPOE system.  The strength of the data collection process was that type of medication errors was clearly defined and the medication error was detected by means of drug dispensing and administration analysis to promote transparency. To confirm the validity of the research evidence, other articles related to CPOE outcome was analyzed. The finding of the study was found to be consistent with the research by Radley et al. (2013) as that study also confirmed that CPOE can significantly reduce frequency of medication errors in acute-care setting.
Integration of research evidence with client value clinical skills
As the critical appraisal of research evidence and comparison with other research articles confirmed use of CPOE as an effective intervention to reduce medication errors, the next step was to assess whether the intervention can be applied with current clinical expertise. To support nurses to use CPOE in medicine wards, providing them training in efficient use of the system is necessary. In addition, as per patient’s values, it will be essential to protect the confidentiality of patient’s information while recording medication related allergies.
Reflection and analysis of outcome:
To evaluate whether CPOE can prevent medication error in the medicine ward, the strategy that can be employed by nursing staff is to record medication error rate before and after using CPOE. This may to evaluate the success of the intervention.
Dissemination of the evidence:
If desired results are obtained, then the utility of the intervention can be communicated to other clinical team members and staffs in the medicine (Hall & Roussel, 2016).
Conclusion:
From the above discussion, it becomes clear that medication error is one of the most threatening events that not only affects the quality of life of the patents but also affects the the reputation of healthcare centers.  The discussion regarding the utilization of the steps of the EBP process to identify the best practice evidence to prevent medication errors defines the importance of EBP in promoting practice improvement. The discussion proves use of CPOE as an effective step to reduce medication error related events and promote safety of patients in clinical settings.
References:
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences.
Hall, H. R., & Roussel, L. A. (2016). Evidence-based practice. Jones & Bartlett Publishers.
Slight, S. P., Eguale, T., Amato, M. G., Seger, A. C., Whitney, D. L., Bates, D. W., & Schiff, G. D. (2015). The vulnerabilities of computerized physician order entry systems: a qualitative study. Journal of the American Medical Informatics Association, 23(2), 311-316.
Radley, D. C., Wasserman, M. R., Olsho, L. E., Shoemaker, S. J., Spranca, M. D., & Bradshaw, B. (2013). Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal of the American Medical Informatics Association, 20(3), 470-476.
Nanji, K. C., Patel, A., Shaikh, S., Seger, D. L., & Bates, D. W. (2016). Evaluation of perioperative medication errors and adverse drug events. Anesthesiology: The Journal of the American Society of Anesthesiologists, 124(1), 25-34.
Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse medication administration error: A narrative review. International journal of nursing studies, 52(1), 403-420.
Salmasi, S., Khan, T. M., Hong, Y. H., Ming, L. C., & Wong, T. W. (2015). Medication errors in the Southeast Asian countries: A systematic review. PLoS One, 10(9), e0136545.

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