Write a Literature review for Effectiveness of ‘Do not interrupt’ interventions during medication administration.
Hospitals in Australia administer thousands of medication to old aged patients where various errors take place (Keers 2013). Interruptions increases fatality and impact on patients especially those who are aged. Random errors of medication administration have been continuously evaluated by researchers so that interruptions can be reduced while preparation of medication. Medication administration errors (MAE) could significantly reduce impacts by 36% on emergency department patients. These errors in health care are generally committed by nurses unknowingly have often led to several serious consequences on patients (Sasangohar 2014). The current scope of analysis evaluates critically methods that can reduce interventions in healthcare of nurses while administering medication on aged patients.
Search Question and Plan
Medication administration error is a growing issue that have had several implications on costs as well as on factors as health of patients. Most important evaluation had been related to health of patients in emergency care and on pediatric cases. Such implications have been evaluated by multiple researchers to reflect useful findings related to the area. The PICO question for this systematic review is “How intervention affects administration of medication on aged patient?”
Database used- PubMed, Medline, Science Direct were searched thoroughly for the purpose of findings relevant articles. Assessing and evaluating several articles allowed attaining of the PICO question. The above databases allowed several peer-reviewed articles as well as journals f or arriving at conclusions related to the study.
Keywords used- Intervention, Medication, Aged Care, Medical Administrative Errors (MAE), patients, emergency care
Search operations- Boolean operators as OR and AND were used in conjunction with keywords
Inclusion criteria- Articles that were published post 2008 were considered for evaluation for the study.
Figure 1: PRISMA FLOW Diagram
PICO diagram explains the research methods that has been used for the study. There is a qualitative evaluation of several papers used for the purpose of the study. Removing duplicate records present in data collected, necessary journals and articles for analysing interventions methods related to the study had been undertaken. It becomes essential to evaluate various facts and data related to interventions methods that have been used by multiple scholars in understanding processes that are adopted by nurses is evaluated. Announcing the comparator (control) gather intervention(s, for example, common care, medication, or fake treatment, is fundamental for scholars to completely comprehend the determination criteria of essential examinations incorporated into precise audits, and maybe a wellspring of heterogeneity specialists need to manage. Comparators are frequently ineffectively portrayed.
Results and Discussion:
Westbrook, Hooper, Raban, Middleton and Lehnbom (2017) conducted a systematic review of several literatures and conducted study on medication related errors from interventions (Westbrook 2017). Wrongly administered medications have been severely affecting old aged patients in general departments as well as emergency departments. The scholars had evaluated several data that it collected from across all departmental nurses with two spate groups. One group of nurses was made to wear vests whereas data from another group acted as the control group. The aim of the scholars and researcher was to primarily demonstrate scopes for improvements to reduce interruptions in medication related errors. The study has conducted in-depth analysis of several intervention techniques that causes disruptions in capability to generate long-term sustainable impacts. Reducing intervention in nurses of medication related errors can have significant impact on cost structures as well. Basic evaluation is applying an efficient way to deal with dissecting and recognize unprejudiced or one-sided and substantial analysis (Ammenwerth 2008). A comprehensive analysis ought not to be a rundown condensing each article recovered. Rather, it ought to show up as sorted out areas into subjects or ideas, combined and assessed, as indicated by the examination question. To examine for demonstrating pursue is the best course for affirming based practice. To check for demonstrate different process is finished reasoning about the request footings or catchphrases as a base. There was a number of diversion methods used for the purpose of identifying reasons that impacted medication administrative errors. Several techniques that could reduce interruptions to nurses as medication strategies, patient education, clinician practice and other factors were evaluated (Trbovich 2010).
Currie (2014) is another article relevant in the area that had evaluated ways in which medication administration errors could be reduced (Currie 2014). The scholar had evaluated preventable errors in medication administration and ways in which it could be overcome. Several patient safety considerations were totaled from The Joint Commission for the purpose of preventing medication related errors. Risk of any errors in medication interventions increases by 12.7% in any patient cases. The scope of this article conducted quasi-experimental design by observing nurses for a prolonged period of two weeks. Most integral type of errors that was conducted was identified to be medication intervention errors in emergency care units. Several researchers aimed at analysing aspects related to emergency care medication application errors and errors committed during morning medications. There was high levels of correlation obtained with such errors which depicted prevalence of an intervention method to be applied for the purpose of reducing such errors. Scholars conducted several interventions for reducing errors as training given to nurses, conducting procedural checks while administration of medication on nurses. Nursing practice catered to aged patients often comprised of non-dignified care rendered with led to high levels of errors (Rothschild 2010). Nurses have major role and responsibility towards dispensing roles towards patients, that includes dispensing, prescribing, administering and monitoring. Nurses are the primary point of contact between doctors and patient parties. Different intercessions (exposures) may incorporate analytic, protection, or helpful medications, game plans of particular procedures of care, a way of life changes, psychosocial or instructive mediations, or hazard factors. Obviously announcing the comparator (control) gather intervention(s, for example, common care, medication, or fake treatment, is fundamental for scholars to completely comprehend the determination criteria of essential examinations incorporated into precise audits, and maybe a wellspring of heterogeneity specialists need to manage (Relihan 2010). Comparators are frequently ineffectively portrayed. It is nurses that communicates patient related data to doctors and then coordinates various treatments with them. Therefore, role of nurses was considered to be pivotal in delivery of high standard care to aged patients. Hence research scholars need to focus on ways by which nurses efficiency and effectiveness can be improved.
Hayes, Jackson, Davidson and Power (2015) evaluates several literatures related to nurses that causes disruptions in medication related errors (Hayes 2015). Medication related errors have been known to impact mortality in United States. Dispensing errors is another reason that accounts for medication errors along with mortality and morbidity are known to increase health care costs or add economic burden on the society. Patient parties might litigate cases for faulty dispensing that increases costs adding liability on professional costs, which adds to expenses. Moreover errors due to dispensing can lead to trauma for patients as well as pharmacists (Ford 2010). Hence the central focus of pharmacy as well as healthcare centers is to reduce burden related to dispensing errors and medication administration errors. Medication administration errors can be related to wrong quantity of medicine, inappropriate drug dosage, inappropriate timing and so on. The literature suggested several methods and ways that can allow reduction in errors associated with medication administration. Nurses needs to organize their workplaces and avoid as much distractions as possible while medication administration. Work environment have shown tremendous results related to reducing medication errors. Appropriate lighting, counter space, comfortable temperature and humidity can significantly affect organization of work flow (Biron 2009). Nurses should aim at avoiding as much as distractions as possible for reducing medication related errors. Cognitive errors have significant impact on performance routine that can impact workflow. Reducing workflow can help reduce stress related to regular jobs by balancing workloads in a better way. Workload is known increase errors, sharing responsibilities is known to reduce medication errors and increase positive impacts on patients.
Pham, Story, Hicks, Shore, Morlock, Cheung and Pronovost (2011) analyses medication related errors specifically in emergency departments (Pham 2011). Medication errors are known to be the leading cause that harms patients admitted into hospitals. While key to healthcare is patient safety and do least harm on patients but often they are unnecessarily harmed by drug errors. Interruptions and distractions have become part of nurses’ working lives. Researchers conducted analysis on nurse medication rounds and found common interruptions to be phone calls, medications, other nurses or teams demanding for equipment and medication. Interview conducted on nurses of several hospitals revealed high medication administration errors especially in elderly departments and rehabilitation units (Otero 2008). Illegible handwriting of doctors was another factor that contributed to nurses administrating wrong medicines and pharmacists packing wrong medicine leading to medicine administration errors. Inappropriate drug calculations also contributed significantly to medication based errors. Nurses that lagged numerical efficiency were generally regarded as being deficient in nursing skills, inspite of having key nursing competency. Poor numerical skills have led to medical errors across hospitals and community centers. A test conducted on nurses to test their numerical ability established that most nurses failed the test hence ability to calculate drugs. Nurses often found it difficult to calculate and interpret multiple information involving various calculations of fractions (Yin 2010). Inadequacy in education and compliance further led to poor following of medicine policy with lack of compliance.
The study had to obtain prior ethical clearance from Hospital Research Ethics Committee. It had followed all ethical considerations that were critical. All participants had been informed regarding objective of the study. Moreover nurses and managers who participated from various departments had agreed to be a part of the research procedure. All human association, incorporating the collaboration engaged with human research, has moral measurements. In any case, 'moral lead' is more than just making the best choice (Valentin 2009). It includes acting in the correct soul, out of a standing admiration and worry for one's kindred animals. Be that as it may, human research can include noteworthy dangers and it is workable for things to turn out badly. In some cases, dangers are acknowledged notwithstanding the best of aims and care in arranging and practice (Gonzales 2010). Now and then they are acknowledged on account of specialized blunder or moral lack of care, disregard or negligence. Patients who participated in the study had also agreed to research processes.
Analysing the study from PICO question and PRISMA format helped reveal several details regarding the study. Medication administration related errors are high and increasing amongst healthcare centers. Nurses needs to be provided with proper training and performance report format such that they are able to perform according to deliverables as need by the center. Patients are at high risks from medication related errors, healthcare centers, hospitals and government bodies needs to concern themselves with rising complexities associated with medication administration errors. There needs to be formulated steps adopted that establishes interventions techniques aimed at reduced errors in medication administrations.
Ammenwerth, E., Schnell-Inderst, P., Machan, C., & Siebert, U. (2008). The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. Journal of the American Medical Informatics Association, 15(5), 585-600.
Biron, A. D., Loiselle, C. G., & Lavoie?Tremblay, M. (2009). Work interruptions and their contribution to medication administration errors: an evidence review. Worldviews on Evidence?Based Nursing, 6(2), 70-86.
Currie, L. (2014). Reducing interruptions during medication administration: the White Vest study. Journal of Research in Nursing, 19(3), 262-263.
Ford, D. G., Seybert, A. L., Smithburger, P. L., Kobulinsky, L. R., Samosky, J. T., & Kane-Gill, S. L. (2010). Impact of simulation-based learning on medication error rates in critically ill patients. Intensive care medicine, 36(9), 1526-1531.
Gonzales, K. (2010). Medication administration errors and the pediatric population: a systematic search of the literature. Journal of pediatric nursing, 25(6), 555-565.
Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. Journal of clinical nursing, 24(21-22), 3063-3076.
Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Annals of Pharmacotherapy, 47(2), 237-256.
Otero, P., Leyton, A., Mariani, G., & Cernadas, J. M. C. (2008). Medication errors in pediatric inpatients: prevalence and results of a prevention program. Pediatrics, 122(3), e737-e743.
Pham, J. C., Story, J. L., Hicks, R. W., Shore, A. D., Morlock, L. L., Cheung, D. S., ... & Pronovost, P. J. (2011). National study on the frequency, types, causes, and consequences of voluntarily reported emergency department medication errors. Journal of Emergency Medicine, 40(5), 485-492.
Relihan, E., O'brien, V., O'hara, S., & Silke, B. (2010). The impact of a set of interventions to reduce interruptions and distractions to nurses during medication administration. BMJ Quality & Safety, qshc-2009.
Rothschild, J. M., Churchill, W., Erickson, A., Munz, K., Schuur, J. D., Salzberg, C. A., ... & Jaggers, R. (2010). Medication errors recovered by emergency department pharmacists. Annals of emergency medicine, 55(6), 513-521.
Sasangohar, F., Donmez, B., Easty, A., Storey, H., & Trbovich, P. (2014). Interruptions experienced by cardiovascular intensive care unit nurses: an observational study. Journal of critical care, 29(5), 848-853.
Trbovich, P., Prakash, V., Stewart, J., Trip, K., & Savage, P. (2010). Interruptions during the delivery of high-risk medications. Journal of Nursing Administration, 40(5), 211-218.
Valentin, A., Capuzzo, M., Guidet, B., Moreno, R., Metnitz, B., Bauer, P., & Metnitz, P. (2009). Errors in administration of parenteral drugs in intensive care units: multinational prospective study. Bmj, 338, b814.
Westbrook, J. I., Li, L., Hooper, T. D., Raban, M. Z., Middleton, S., & Lehnbom, E. C. (2017). Effectiveness of a ‘Do not interrupt’bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study. BMJ Qual Saf, 26(9), 734-742.
Yin, H.S., Mendelsohn, A.L., Wolf, M.S., Parker, R.M., Fierman, A., Van Schaick, L., Bazan, I.S., Kline, M.D. and Dreyer, B.P., 2010. Parents' medication administration errors: role of dosing instruments and health literacy. Archives of pediatrics & adolescent medicine, 164(2), pp.181-186.