...UNDERSTANDING EVIDENCE - BASED NURSING | Evidence-based Literature Search and Review on Interruptions during Drug Rounds | Cohort: March 2010 | | Student ID: | | Word count: 3292 Additional Module 1 | It is generally accepted that evidence-based practice (EBP) is the way forward in contemporary nursing. It provides the rationale behind nursing practice and allows for the delivery of optimal nursing care. Evidence-Based Nursing (EBN) involves the process of researching and implementing proven evidence in providing better patient care and is crucial as the role of the nurse is ever expanding (Banning, 2005). This essay will demonstrate that as a student nurse, the author has gained the necessary skills to conduct an evidence-based literature search and review and implement that knowledge into practice. Starting with a brief discussion on EBN it will go on to identify a suitable research question. During a placement on a medical ward the author noticed that nurses experienced many interruptions whilst conducting medication rounds and this review will consider ways to minimise interruptions and thus improve patient safety. Using the PICO acronym a suitable research question was formulated, ‘do interruptions during medication rounds increase the drugs administration errors made by nurses?’ A short description of the literature search is given and a summary of findings is presented in tabular form. Five original articles were selected and one chosen to critically...
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...unlike many high-risk industries has made slow progress in improving patient’s safety. The role of nursing in improving medication safety has been largely underestimated. Much of the research undertaken to date in relation to adverse medication events has neglected the impact that nurses have or could have in improving patient safety. In examining literature regarding adverse medication events one can see the urgent need for significant improvement in medication practices and processes. In addition that this health care issue will only improve with the participation of all disciplines working towards a common goal of improving the safety of those in our care. Introduction Medications play a key role in healthcare but can also be a significant key cause of medical error and of adverse patient outcomes. Nurses by the nature of their roles in medication administration can be the last line of defense in eliminating or reducing adverse medication events. The administration of medication is a common and almost routine activity in a nurse’s daily work, yet it is fraught with complexity and risk for both the patient and nurse. As a student nurse working in partnership with a registered nurse I have observed a variety of practices in medication administration that have varied from what I have been taught in class. On reflecting on these practices and questioning nurses why such practice has been adopted has illustrated to me both the flawed processes and environment that nurses provide...
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...Drug Errors Introduction Administration of medicines is a key element of nursing care. Every day some 7000 doses of medication are administered in a typical NHS hospital (Audit commission 2002). Drug administration forms a major part of the clinical nurses role. Medicines are prescribed by the doctor and dispensed by the pharmacist but responsibility for correct administration rests with the registered nurse (O'Shea 1999). Each registered nurse is accountable for his/her practice. This practice includes preparing, checking and administering medications, updating knowledge of medications, monitoring the effectiveness of treatment, reporting adverse drug reactions and teaching patients about the drugs that they receive (O'Shea 1999). The patient is expected to receive the correct medication at each drug round but several studies have shown that this is not always the case (Raju et al 1988, Ferner 1995). Medication errors do occur and are a persistent problem associated with nursing practice (O'Shea 1999). The aim of this paper is to answer the question: Why are nurses still continuing to make drug errors? In order to answer this question this paper shall examine the guidelines that nurses must adhere to when administering drugs, shall provide a definition of a drug errors, look at reasons why drug errors occur and approaches that are aimed at reducing drug errors on the ward. There are a number of pieces of legislation that relate to prescribing, supply, storage and administration...
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... * Mental Health * Diabetes * Wound care * Assessment skills * Medicine management * Leadership * Midwifery and neonatal nursing * More ... * Search the Archive * Browse by clinical topic * Browse by issue date * Awards * Nursing Times Awards * Student Nursing Times Awards * Patient Safety Awards * Care Integration Awards * Write for Us * Nursing events * Courses * Subscribe from overseas * Francis report * Nursing Practice * Nursing Times Learning * Opinion * Student Nursing Times * Jobs * Subscribe * You are here: Home * Clinical Zones * Medicine management How to ensure patient safety in drug dose calculation 12 October, 2012 Medicines management is a core nursing skill. This review gives an introduction to and taster of our newly launched online Nursing Times Learning unit on drug calculations. Keywords: Patient safety/Drug calculation/Medicines management * This article has been double-blind peer reviewed * Figures and tables can be seen in the attached print-friendly PDF file of the complete article in the ‘Files’ section of this page Medication incidents accoun-ted for 11% of all patient incidents reported to the National Reporting and Learning System (2012) in England and...
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...Association of Colleges of Nursing, when you compare a nurse with an associate’s degree to a nurse who has a bachelorette degree, the nurse that is prepared with the bachelorette is more prepared clinically and has shown to have lower mortality rates, fewer medication errors, and more positive outcomes for patients. I have read over and compared the Grand Canyon University’s philosophy to the College of Southern Nevada’s nursing programs mission statement. It is not hard to see why research shows that a nurse with a bachelorettes degree is more prepared and knowledgeable to care for patients than a nurse holding an associate’s degree. The College of Southern Nevada’s mission statement states to graduate competent, compassionate, and caring nurses who strive for excellence in their delivery of care to meet the health needs of the community and to contribute to the profession of nursing. The goals of the program are to assist the nurse to be caring, competent, be creative by using their critical thinking skills for decision making while caring for patients, to assist the nurse with communications skills that allow them to collaborate with other disciplines, and professionalism to teach the nurse to continue lifelong learning, accountability, and to be a patient advocate. The 2 year program offered by College of Southern Nevada believes in preparing a nurse to be able to care for a patient safely and to the pass NCLEX, which proves that the student is safe for practice. The associate’s...
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...Increasing Nursing Compliance with Safe Medication Preparation and Administration Marie Shelly Capstone Course Increasing Nursing Compliance with Safe Medication Preparation and Administration The importance of safe medication preparation and administration in healthcare settings is being increasingly recognized. There have been numerous publications describing the transmission of bloodborne pathogens, viruses, and bacteria related to unsafe injection practices. The current field of nursing requires concerned parties to exercise a critical appraisal of research findings, and, establish a synthesis of contextual and empirical evidence that is relevant. However, practitioners have not established better alternatives regarding their practice. In addition, the essential evidence-based methods and critical skills in thinking are still lacking; yet they are ideal for the maximization of the cost-effectiveness and quality of health care (Camiletti, & Huffman, 1998). The Center for Disease Control reported that between 1998 and 2008 a total of 33 outbreaks of patient to patient transmission of HBV or HCV due to breaches of infection control by health care personal (http://www.cdc.gov/injectionsafety/CDCsRole.html1). More than 60,000 patients were at risk and 448 patients acquired with HBV or HCV. The disease transmission was primarily from lapses in aseptic technique, the reuse of syringes and contamination of medications that were multi-dose vials. In 2001(Luby, 2001) The World...
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...Wrong-time Medication Administration Errors NUR 45200 Quality and Safety for Professional Nursing Practice May 1st, 2016. Patient Safety/Quality Improvement Statement and Chosen Cause that will Drive Improvement Wrong-time medication administration error has been identified as one of the major components of medication errors committed my health care professionals especially nurses. Several factors or causes are responsible for this error, but nursing factor will be discussed in this essay focusing majorly on medications pass time insufficiency and med pass rule of 30 minute. Nurses are directly involved in medication administration and they can play a huge role in preventing or reducing wrong-time medication administration error. Current Knowledge of the Patient Safety Concern/Quality Improvement Issue Wrong-time medication administration error is the most common type of medication errors committed by nurses. It can simply be defined as failure to administer medications 30min before or after the due due/scheduled time. The last element of the 5 Rights -- right time -- has often been governed by the "30-minute medication rule." For as long as many nurses can remember, every hospital, unit, and nurse has passed medications by this rule, which says that a medication is "on time" if it is administered 30 minutes before or 30 minutes after the scheduled administration time (although some hospitals have policies that allow a 60-minute, rather than a 30-minute, window). Such...
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...Singapore Nursing Board Standards for Nursing Practice defines that Nurses/midwives have the professional responsibility and accountability to uphold Standard of care and to contribute to their dissemination, interpretation and development despite medical advances, social and demographic changes and an increasingly complex healthcare delivery system that challenge the ability of nurses to provide safe quality of care. Should nurses fail to uphold certain standards and by doing so cause harm or injury to the client, they would be held liable in the tort of negligence. Description of a practical situation which raised ethical issues: Mr Lim 70 years old has been hospitalised for medical treatment with the diagnosis of chronic heart failure. He was ordered intravenous therapy by Dr Peter the medical resident. Nurse Su questions the order because it is for an infusion of Dextrose 50%. Dr Peter tells her that he checked it with Dr Lee, the medical officer. Nurse Su checks it with Nurse May before administration. Later, Mr Lim has a cardiac arrest and suffers extensive brain damage as a result of the infusion. The hospital inquiry is held and it determined that the correct infusion would be Dextrose 5%. Mr Lim’s family members are very upset and seek legal advice. All names mentioned in the above scenario are pseudonym. Identification of the ethical issues within the situation: Negligence Negligence is the breech of an obligation or duty to act with care, or failure...
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...Nursing Research Utilization Project Proposal Sally Martin Torres NUR 598 September 11, 2011 Dr. Veta Massey Nursing Research Utilization Project Proposal Section D: Methods of Implementation Health care throughout the history has shown many changes. Every change brings in challenges in a workplace because change is more often met with resistance. It also brings in innovative ideas that steers the organization’s advancement and performance. The major motivation of change in this organization is to sustain a successful future in its continuum. For change to succeed, brilliant strategy, and clever implementation are necessary (Gandossy and Sonnenfield, 2004). Organizing the Plan The problem that was stated in Part A of this proposal was medication error and the organization is aiming at reducing the incidents of administration errors that involve medications. Although there are three proposed solutions, the one that gained the highest priority is the use red disposable apron during the medication rounds. This type of innovation is cost-effective, requiring short staff in-service by the nurse clinical educator, it is maintenance free, and does not require space for storage. This intervention will also allow a less difficult data collection for measuring outcomes. Every institution requires the approval of the Chief Nurse Officer (CNO) to pilot an intervention. The intervention will be introduced in a small 30-bed medical-surgical unit which will last for four months...
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... Recent evidence and current trends show both nursing and medical professions have a lack of understanding in certain aspects of safe prescribing and safe administration of medicines. The concept of prescribing and the ability to calculate is the basic requirement of all qualified medical and nursing professions We are proposing over a three year period to run an inter professional collaborative working programme, whereby both student nurses and doctors will come together on a regular basis in a teaching environment to work alongside each other to gain the following skills: • Patient safety in relation to drug administration • Patient safety in relation to drug prescribing • A clearer understanding of each others role • Practical experience in drug administration and drug prescribing in a non –threatening environment • Insight into pharmacology and pharmokinetics and it’s importance in prescribing and administration of drugs. This three-year study we propose to write up and evaluate and hope to publish with the intention to produce learning materials and educational packs to be marketed at later date Rationale for Change Project Medications Errors within any health care setting can have severe consequences not only for the patient but financially for the organisation if litigation comes about. Medication errors can be defined as “any incorrect or wrongful administration of a medication, such as a mistake in dosage or route of administration...
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...Nurses are the fine line between medication administration errors and medication administration error prevention. Nurses should be required to go above and beyond to avoid medication errors for the safety of the patient. This paper includes studies on the nurses knowledge, adherence and opinions on two-nurse double-check method for medication administration. The research concludes the evidence proved to be insignificant. Keywords: time management, medication errors, patient safety, double-check medication administration THE LINK BETWEEN INDEPENDENT DOUBLE CHECK AND PATIENT SAFETY Introduction The risk of medication errors will always exist, despite the many methods of preventing medication administration errors. The steps of the medication administration process are vital for patient safety. Unfortunately due to the lack of nurses in hospitals, nurses tend to skip steps of safe medication administration because of patient load and the time required to perform the steps. Are double checks essential in preventing medication errors? A diabetic patient on the medical-surgical floor needs the...
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...Accreditation Audit AFT Task 1 Roland Helmuth Western Governors University Accreditation Audit AFT Task 1 Medication Management A. Compliance Status I will be reviewing three specific areas dealing with medication management. They are the following with the correlating Joint Commission Standard following each one: 1. The hospital plans its medication management process, (MM.01.01.01). 2. Label all medications, medication containers, or other solutions on and off the sterile field, (NPSG.03.04.01). 3. Reduce the likelihood of patient harm associated with the use of anticoagulation therapy, (NPSG.03.05.01). In review of standard MM.01.01.01, I see that Nightingale Community Hospital (NCH) has a policy that speaks directly to this standard. The elements of performance are met by the policy that is in place and includes further information to make this important standard compliant with Joint Commission standards. In review of standard NPSG.03.04.01, I do not find the NCH has a policy that addresses this. Seeing that NCH has surgical and sterile procedures performed at its facility this standard needs to have a policy in place. The basis of this is patient safety related to the five rights of medication administration; Right patient, Right medication, Right dose, Right route and Right time. Even in a controlled environment of a surgical suite, this is vital to any procedure performed. In review of...
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...Implementation of Evidence-Based Practice Sheila Wright Submitted to Sharon Mooney, RN, MSN in partial fulfillment of NR 460R Evidence-Based Practice in Nursing Regis University April 9, 2010 Implementation of Evidence-Based Practice Throughout history, nursing practice has experienced change. Florence Nightingale initiated the greatest change in nursing in the mid-1800’s when she gathered data regarding the morbidity and mortality of soldiers (Chitty & Black, 2007). Nightingale recognized there was a need for change to improve patient outcomes. Her determination to provide the best possible care, based on the evidence she gathered, has inspired a profession. Today, the process of using research to care for patients is referred to as evidence-based practice. The purpose of this paper is to define and explain the importance of evidence-based practice, discuss qualitative and quantitative research studies which affect medical-surgical areas, and barriers preventing research utilization and how they may be overcome. Definition of Evidence-Based Practice There are numerous definitions of evidence-based practice (EBP). EBP is defined by Boswell and Cannon (2007) as, “A research-based, decision-making process used to guide the delivery of holistic patient care by nurses” (p. 340). Cope (as cited in Chitty & Black, 2007), defines EBP as “using the best available research findings to make clinical decisions that are most effective and beneficial for patients”...
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...Running head: PRACTICE PROBLEM: MEDICATION ERRORS Practice Problem: Medication Errors Amy Courcier Grand Canyon University NRS-433 V Christine Thompson-Sanxter September 22, 2012 Career progression: preventing drug errors. Ashurst, A. (2008). Career progression: preventing drug errors. Nursing & Residential Care, 10(10), 498-501. Abstract: Making errors in drug administration can have serious consequences for the patient and the nurse involved. In the second of two articles Adrian Ashurst discusses the ways that risk can be minimized and drug errors prevented. Nurses' experiences of drug administration errors Schelbred, A., & Nord, R. (2007). Nurses' experiences of drug administration errors. Journal Of Advanced Nursing, 60(3), 317-324. doi:10.1111/j.1365-2648.2007.04437.x Abstract: This paper is a report of a study to describe the experiences of nurses who had committed serious medication errors, the meaning these experiences carry, and what kind of help and support they received after committing their error. Background. Medication administration is an important nursing task. Work overload, combined with increased numbers and dosages of medication prescribed, puts nurses at risk of making serious errors. A drug error has the potential for disastrous consequences for patients. What is sometimes disregarded is the effect on the nurse involved. The majority of research on nurses and medication errors is framed within biomedicine, law and management. Methods...
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...Nurses are urged to integrate and use evident based practice in everyday nursing. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values (Melnyk et al, 2009). I have been working at Virginia Beach psychiatric center and during a replacement on psychiatric rapid stabilization unit this nurse noticed that medication nurses face many disruptions while conducting court order medication rounds and witnessing nurse considered ways to minimize disruptions and thus develop nurse and patient safety. Disruptions are unavoidable because everybody must respond to broadcasted code when alerted. The author came up with a research question using the PICOT acronym, ‘do disruptions during court order medication rounds increase the medications errors made by nurses. The research question in this situation is to address the patient and nurse safety and using the PICOT structure to address the issue of disruptions during court order medication round (as perceived by this nurse), the ultimate research question was articulated: ‘do disruptions during court order medication rounds increase the medications administration errors made by nurses? PICOT is an acronym for the elements of the clinical question (Melnyk et al, 2009): P -Patient or Population/Problem I -Intervention C -Comparison O -Outcome T -Time Intervention...
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