Assessment 4: Improvement Plan Tool Kit

This improvement plan tool kit is designed to help nurses implement the safety improvement plan to promote safe care between the nursing department and other departments regarding medication safety. The resource is sectioned into four themes: additional technology, error reporting system, staff training, and medication safety policies. Under these themes, at least three scholarly resources have been described in the form of annotated bibliography.

Annotated Bibliography

Additional Technologies: Barcode Medication Administration and Computerized Physician Order Entry

Abraham, J., Kitsiou, S., Meng, A., Burton, S., Vatani, H., & Kannampallil, T. (2020). Effects of CPOE-based medication ordering on outcomes: an overview of systematic reviews. BMJ Quality & Safety, 29(10), 1–2. https://doi.org/10.1136/bmjqs-2019-010436

This article reviews evidence from different secondary sources on the outcomes of using the computerized physic on order entry (CPOE) to prescribe medications. In this resource, the authors reviewed information from 118 systematic reviews on the outcomes of CPOE use on medication safety.

The use of CPOE was found to reduce medication errors but to different degrees. Human and other logistical factors were found to limit their effectiveness in decreasing medication errors. Therefore, this is a high-quality source for a practitioner nurse. This article supports the plan’s objective to reduce medication errors by at least half.

Jessurun, J. G., Hunfeld, N. G. M., Van Rosmalen, J., Van Dijk, M., & Van Den Bemt, P. M. L. A. (2021). Effect of automated unit dose dispensing with barcode scanning on medication administration errors: an uncontrolled before-and-after study. International Journal for Quality in Health Care, 33(4). https://doi.org/10.1093/intqhc/mzab142

In this resource, the authors researched the outcomes that using barcode scanning in medication dispensation can have on medication administration errors. This is a valuable resource for our plan implementation in that it sheds more light on the role of the barcode medication administration system in medication safety. In their prospective research, the authors found that BCMA in medication dispensing improves medication safety.

However, the article highlighted the need for compliance with this technology’s use to achieve results. Therefore, it remains revenant to the safety improvement plan because it reiterates the need for consistency in the use of this intervention.

Srinivasamurthy, S. K., Ashokkumar, R., Kodidela, S., Howard, S. C., Samer, C. F., & Chakradhara Rao, U. S. (2021). Impact of computerized physician order entry (CPOE) on the incidence of chemotherapy-related medication errors: a systematic review. European Journal of Clinical Pharmacology, 77(8), 1123–1131. https://doi.org/10.1007/s00228-021-03099-9

This article focused on CPOE use in reducing chemotherapy-related medication errors. In this article, the authors reviewed 11 articles but performed a meta-analysis on eight articles that were randomized controlled trials. The authors found an 81% reduction in medication errors related to chemotherapy. This article is relevant and valuable to the implementation of the plan to reduce medication errors. Practicing nurses, especially advanced practice nurses and independent practice nurses who have prescriptive authority, should consider this technology.

Thompson, K. M., Swanson, K. M., Cox, D. L., Kirchner, R. B., Russell, J. J., Wermers, R. A., Storlie, C. B., Johnson, M. G., & Naessens, J. M. (2018). Implementation of bar-code medication administration to reduce patient harm. Mayo Clinic Proceedings. Innovations, Quality & Outcomes, 2(4), 342–351. https://doi.org/10.1016/j.mayocpiqo.2018.09.001

In this article, the authors focused on the impact of BCMA on the rate of adverse medication effects that lead to patient harm. This resource focused on actual patient harm as the potential point for action to improve patient safety. This prospective research tracked confounding factors such as adherence to BCMA use and found a 55.5% reduction in actual patient harm when this technology was used.

When the adherence factor was not considered, the rate of reduction was 43.5%. Therefore, this article is a piece of critical evidence for justification for implementation and adherence to the plan to improve safety. This resource’s value to the plan is suggested in the prospective methodology and the steps in which the research was executed.

Error Reporting System

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 (Basel, Switzerland), 8(9), 46. https://doi.org/10.3390/medicines8090046

This review article focused on error reporting culture, error incidence rates, and strategies to improve medication error reporting systems. The authors of this article reviewed 60 articles principally for the United States and the United Kingdom on medication error reporting systems.

This article is valuable to a nurse as it outlines the necessary strategies to improve the error reporting system by involving nurses and conducting root causes. However, this resource advocated for making a safe reporting system that would protect the report as well as the patient. Whether acting as the reporter or the overseer of the reprising, the nurse needs to be active in identifying these errors and reporting them to promote early preventive action and prevent future errors from occurring.

Tillman, D. (2019). Simulation as an educational strategy to increase medication error identification in licensed practical nurses. Journal of Comprehensive Nursing Research and Care, 4(2). https://doi.org/10.33790/jcnrc1100151

This article focused on educating licensed practice nurses to improve education error identification and reporting. The authors used a simulated education system to improve nurses’ competencies in medication error identification and reporting. Nurses’ education promotes safe practice and confidence in care, thus better care outcomes.

The nurses need to stay abreast of evidence-based practices regarding medication safety continually. Therefore, this article is an integral part of the safety improvement plan as it reinforces the nurse’s role in the plan. Educational competencies would improve knowledge, skills, and attitude in the identification of medication errors to prevent future similar errors and promote action to lessen the damage from the error.

Zhou, S., Kang, H., Yao, B., & Gong, Y. (2018a). An automated pipeline for analyzing medication event reports in clinical settings. BMC Medical Informatics and Decision Making, 18(Suppl 5), 113. https://doi.org/10.1186/s12911-018-0687-6

In this resource, Zhou and colleagues have reiterated the additional workload that medication error reporting and analysis have on nurses. However, using an automated approach would improve outcomes by reducing this workload.

Nevertheless, nurses still have an active role in the identification and reporting of these errors in the automated process because these systems will rely on the input data from incidents that nurse report. This resource is vital to the implementation of the plan because it actualizes how to achieve one of the plan interventions, error reporting. To a nurse, it enlightens them on their role in the error reporting system and the need for active participation.

Zhou, S., Kang, H., Yao, B., & Gong, Y. (2018b). Analyzing medication error reports in clinical settings: An automated pipeline approach. AMIA Annual Symposium Proceedings, 2018, 1611–1620. https://www.ncbi.nlm.nih.gov/pubmed/30815207

In a subsequent study, Zhou and colleagues analyzed the error report using the automated approach. These authors applied this technological approach in the error reporting and analysis system to demonstrate, using research, how it can be beneficial to reduce clinicians’ workload and provide measurable outcomes of medication error prevention interventions.

This technology offers a viable input into the nursing process for nurses to evaluate their care quality and safety improvement. Providing regular analyzed feedback to users enables them to understand how they are performing in preventing patient harm at the population level. Therefore, timely feedback can always be applied to evaluate the safety improvement plan outcomes.

Staff Training

Browne, F., Hannigan, B., & Harden, J. (2021). A realist evaluation of a safe medication administration education program. Nurse Education Today, 97(104685), 104685. https://doi.org/10.1016/j.nedt.2020.104685

Continuous nursing education has been used to maintain and update nurse professional skills in other practice areas. This article focused on the outcomes of a continuing nursing education program on patient medication safety and the process of knowledge transfer to actual practice.

Successful and safe practices reflect the effectiveness of the safety program and its replicability in other practice settings. This article is valuable to the safety improvement plan and team because it outlines the stage of implementation of a medication safety and administration education program to improve patient safety. It also presents an effective evaluation of these programs.

Farzi, K., Mohammadipour, F., Toulabi, T., Heidarizadeh, K., & Heydari, 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

This article presents a piece of research evidence about the outcomes of a learning strategy that involved 57 nurses in an Iranian hospital. The authors of this article evaluated the effects of this learning strategy on medication error rates. The article presented a significantly lower rate of medication errors after the blended learning and training.

This article is helpful in the implementation of the safety improvement plan because it can help in strategies for continuous nursing education programs. The strategy presented in this resource is relatively inexpensive and would outline cost-effective intervention in actualizing our plan to improve medication safety. This intervention would help nurses keep abreast of current medication safety practices.

Musharyanti, L., Haryanti, F., & Claramita, M. (2021). Improving nursing students’ medication safety knowledge and skills on using the 4C/ID learning model. Journal of Multidisciplinary Healthcare, 14, 287–295. https://doi.org/10.2147/JMDH.S293917

Many hospitals have adopted the art of encouraging learning, training, and reflecting on medication safety among nurses as a strategy to improve patient safety. This article assesses the outcomes of implementing a medication safety learning model to improve knowledge and skills. The authors in this study found that up to 70% of nurses in the study setting had never received patient safety instructions from the institution.

This resource is also valuable to the implementation of the safety improvement plan because it identifies one of the gaps that the plan would need to fill among nurses. To the nursing team, it outlines a methodology for improving the team’s knowledge and skills to promote safe practices among nurses. This article found that the learning approach improves the nurses’ knowledge and skills in medication administration safety.

Medication Safety Policies

Chui, M. A., Pohjanoksa-Mäntylä, M., & Snyder, M. E. (2019). Improving medication safety in varied health systems. Research in Social & Administrative Pharmacy: RSAP, 15(7), 811–812. https://doi.org/10.1016/j.sapharm.2019.04.012

In this article, the authors review various policies and strategies that have been applied to improve medication in varied settings. One outstanding theme from this review is strengthening systems through policies to implement strategies. Implementing our safety improvement plan. At the organizational level, policies ensure adherence to strategies and interventions put in place to improve patient safety.

Nurses will benefit from the content of this article because it conveys the need organization–specific policies to ensure that nurses adhere to a safety culture. Thus, nurses will need to participate in medication safety policymaking and implement these policies in their respective units.

Paparella, S. F. (2018). Alignment with the ISMP 2018-2019 targeted medication safety best practices for hospitals. Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association, 44(2), 191–194. https://doi.org/10.1016/j.jen.2017.11.014

This article begins by acknowledging that these errors still occur despite the implementation of technology and other interventions to prevent medication errors. The institution for safe medication practices (ISMP) analyzed various preventable medication-related events.

This article recommends various policy changes and best practices that will require actualization by various practitioners. The value of this resource in the medication safety improvement plan is the emphasis on organizational policies to regulate the practice. Another theme discussed is the new sources of error that still occur, thus the need for vigilance.

Shamsuddin, A., Jeffries, M., Sheikh, A., Laing, L., Salema, N.-E., Avery, A. J., Chuter, A., Waring, J., & Keers, R. N. (2021). Strategies supporting sustainable prescribing safety improvement interventions in English primary care: a qualitative study. BJGP Open, 5(5), BJGPO.2021.0109. https://doi.org/10.3399/BJGPO.2021.0109

Policies also regulate how healthcare use implemented technologies. Policy deviations are one of the reasons for failure to achieve desired outcomes when using interventions such as technologies. This article analyzed technology in light of influencing policy factors and the role of policymakers.

The authors argue that to ensure that prescribers and nurses adhere to protocols of prescribing to reduce medication errors, organization policies need to be aligned with best practices. One of the roles of the nurses in the safety improvement plan was to adhere to organization policies, including set protocols for safety. This article reinforces this role and presents additional information to support the need for technology use adherence.

Conclusion

This annotated bibliography presents a tool kit for nurses to improve medication safety in their practice. The tool kit includes four themes: additional technology, an error reporting system, staff training, and medication safety policies. The additional technology theme includes information on the use of barcode medication administration and computerized physician order entry to reduce medication errors.

The error reporting system theme discusses the benefits of using a standardized system to report errors. The staff training theme emphasizes the importance of ongoing training for medication safety. The medication safety policies theme highlights the need for clear policies and procedures to improve medication safety.

References

Zhou, S., Kang, H., Yao, B., & Gong, Y. (2018b). Analyzing medication error reports in clinical settings: An automated pipeline approach. AMIA Annual Symposium Proceedings, 2018, 1611–1620. https://www.ncbi.nlm.nih.gov/pubmed/30815207

Assessment 4 Instructions: Improvement Plan Tool Kit

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 compelling 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 \"public\" 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. www.canadian-nurse.com/articles/issues/2011/october-2011/a-collaborative-ap
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 compelling 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