Capella 4020 Assessment 3

Capella 4020 Assessment 3 : Improvement Plan In-Service Presentation

Student Name

Capella University

Capella 4020 Assessment 3

Prof. Name

Date

Improvement Plan In-Service Presentation

Good Morning everyone! My name is Dulijeta and today I am here to conduct in-service training for nurses, nurse managers, and leaders related to improvement plans on medication administration errors. 

Purposes and Goals of In-Service Session

The objectives of today’s presentation are as follows. By the end of the session, you will be able to learn:

1. What are medication administration errors? 
2. Why there is a need for reducing these errors?
3. We will discuss the safety improvement plan, and elements of the improvement plan and explain why is it important for the organization to address the current situation.
4. We will learn about the roles of various stakeholders in the prevention of these errors
5. And a short activity related to the improvement of the practices and skills will be shared. 

This in-service session will enable nurses to recognize medication administration errors, drawbacks in nursing practices, safety improvement strategies, and how to implement those methods to bring change and ensure patients’ safety. 

Medication Administration Errors

Literature defines medication administration errors as errors related to any of the five rights of medication administration- wrong drug, wrong patient, wrong dose, wrong route, and/or wrong time. Medication errors are the leading causes of preventable dangers that are caused to patients in healthcare settings. Nurses are the primary responsible person who spends 40% of their routine time in medication administration hence they are the group of people who are the last safety check in the medication process and patients’ well-being (Wondmieneh et al., 2020). 

Need for Safety Improvement Plan

The question that arises now is why there is a need for a medication error safety improvement plan. Various pieces of research conducted their studies around this topic to analyze the prevalence and epidemiology of medication administration errors which concluded that MAEs are a global concern and must be addressed using a safety improvement plan so that patient safety can be ensured and quality care is provided. Kruk and colleagues (2018) mentioned in their study that unsafe medication practices result in high morbidity and mortality for patients in hospital settings (Kruk et al., 2018). A further study conducted in Malaysia identified that 30.5% of medication errors occur at the administration phase in which 46.9% of errors were due to wrong time, 25.4% were due to utilization of illegal drugs, omission errors account for 18.5% and 9.2% are caused by dose error (Shitu et al., 2020). These errors and the adverse events related to drugs (ADEs) are primarily responsible for patient harm, for example, morbidity, excess hospital stays, increased healthcare finances, and in some cases mortality. Almost 5-6% of hospitalizations are due to drug-related negative events which cost around US$ 42 billion annually, worldwide (Assiri et al., 2018). These statistics present the need for safety improvement strategies which will be discussed further in the presentation. 

Safety Improvement Plan

Various evidenced-based strategies will help in eradicating medication administration errors and improving patient safety. In today’s safety improvement plan, I will discuss two of the major strategies which will enable nurses and other stakeholders to bring a change in the Vila Health hospital. These are: 

Training nurses for five rights of medication administration framework: it is evident that incorporating the medication administration framework in nursing practice enables nurses to follow standard guidelines during medication time. Research identifies that 40% of medication errors are due to nurses hence effective training and utilization of the five “R”s change their behavior and enable them to adhere to the policies and procedures (Mula, 2019). These rights will be further explained in the next slide. 

Another strategy is retaining/hiring nurses (Maresova et al., 2020): Workload has been considered one of the important risk factors for medication administration errors. This workload results in nurse burnout hence nurses leave their jobs. Research indicates that burnout results in 43.3% of nurses being distracted during medication preparation hence 90% of nurses reported that this results in incorrect administration of the drug (Boutou et al., 2021). It is therefore important to either retain current nurses with retaining strategies or hire new nurses for increasing the workforce ultimately decreasing medication errors. Retaining and hiring strategies will be discussed further in the presentation. 

Five Rights of Medication Administration

The five “Rs” are the right patient, the right drug, the right dose, the right route, and the right time (Jones & Treiber, 2018). 

1. Right Patient: This is to identify that the patient who is getting a particular medication is the correct recipient of the drug for whom the medication is prescribed. This is best- practiced using two identifiers-patient’s name and ID number which is either asked by the patient (if conscious) or checked on their identification wrists band. In cases of psychiatric settings, nurses should utilize other means of identification as patients’ mental state is not eligible and wristbands are not available.
2. Right Drug: In this step, it is to ensure that the drug prescribed and about to administer are the same. Nurses are also required to check the appropriateness of the drug with patients’ history, expiration date, and the category of the drug along with checking the reasons it is prescribed to the patient and must know its side effects. 
3. Right Dose: This implies for all nurses to check before they administer medications. Even if the patient is identified correctly, the right drug is analyzed but incorrect dosage or conversion of units and inappropriate concentrations can lead to various modalities of medication errors. Hence it is important to train nurses in drug-dosage calculation and frequently conduct their knowledge testing to ensure patients’ medication safety is maintained. 
4. Right route: Some drugs are route specific and can’t be given through other routes. For example, suppositories are given through the rectal area rather than orally. Other than that, some drugs have routes-specific efficacies which are why they are prescribed in specific routes so that immediate outcomes are observed. Thus, it is important to identify the prescribed route and correctly administer it through them. 
5. Right time: Certain drugs have specific intervals during which the doses must be administered to maintain therapeutic effects. Nurses should not deviate from this time by more than 30 minutes to avoid negative consequences such as altering bioavailability or other chemical mechanisms (Patrisia, 2022).

Implementation of the rights of medication administration empowers nurses to become liable for their actions and the administration process becomes legitimate with standard protocols.

Retaining/Hiring Nurses

Another strategy is either retaining senior nurses or hiring new nurses to a) senior nurses have good nursing practices, b) decrease workload, and c) improve patient outcomes by increasing the workforce. According to the general salaries of nurses in the US, the lowest salary for an individual graduate nurse is almost $39,000/year. Investment in organizational financial resources can help in hiring 5/6 nurses per department. However, recruiting nurses and training them requires more finances hence studies advocate the importance of retention of nurses rather than hiring new ones (Opinion et al., 2021). Retention strategies like increasing salaries, providing medical allowances, extra sick/casual leaves other than the annual leaves, annual trips, and short/long service agreements will help in reducing nurses’ brain drain hence decreasing the workload on present nurses. 

Role of Audience and Importance of Safety Improvement Plan

So as we have discussed the safety improvement strategies in this session, we move to the next and important part of this presentation which is the role of every individual who is part of the session. We will discuss the roles individually. 

1. Nurses: Let’s start with the primarily responsible group of people. Nurses being the frontline staff in medication administration have this duty to ensure that safety guidelines are followed in every circumstance. Moreover, they must ensure that their knowledge about recent trends and processes is up-to-date, and if they have any concerns, they must reach out to the head of the department so that concerns are immediately and appropriately resolved. Study reveals that minimal knowledge of drugs among nurses probes them to cause errors while administering the drugs without noticing the adverse events hence patients’ safety is impaired (Escrivá Gracia et al., 2019). 
2. Nurse leaders: In connection to the nurses’ training, nurse leaders need to encourage their staff for continuing professional education (CPE). Authors state that CPE is essential for nurses as it gives them lifelong learning and updates their knowledge and skill according to the trends (Mlambo et al., 2021). Additionally, 78.7% of medication error cases are documented due to poor training (Tsegaye et al., 2020). Hence such in-service sessions should be conducted weekly and nurses’ knowledge testing must be done related to medication administration. Later in this presentation, a short activity will be discussed as a resource to improve nursing practice and knowledge. Moreover, leaders should also create a positive working environment so that nurses do not leave their jobs and the workload on current nurses can be decreased. This also helps in saving the financial resources of the hospital by reducing the number of hires. Studies have identified that nurses who are supported by their managers and are engaged positively are more likely to be loyal to their organization thus improving patient care outcomes (Opinion et al., 2021). 
3. Human resource and finance personnel: They are responsible for establishing a budget related to retaining nurses and conducting interviews for hiring new nurses to make sure that each department has a sufficient workforce to ensure quality and safety. 
4. Quality improvement (QI) department: Their job is to conduct weekly/monthly audits for checking and keeping a record of patient unsafety incidences so that successful implementation of the plan can be measured. To measure the success of the improvement plan, clinical data, surveys, job satisfaction levels among nurses, and nurses’ education and knowledge can be assessed. 

The importance of this improvement plan is to ensure positive patient outcomes are achieved, nurses become reliable and trustworthy in their nursing practice, patient safety is ensured and quality healthcare is provided. 

Resources and Activities

To develop skills and knowledge related to medication administration errors some resources must be created and pasted in nursing stations and medication rooms to ensure that nurses are frequently reminded of the correct guidelines. Some of these resources are presented here. Other than these, frequent in-service sessions, questionnaires, drug-dosage calculation training, and medication administration certification exams are some of the methods to examine nurses’ knowledge and ensure safe practices. 

Conclusion

To conclude today’s presentation, let’s review the objectives. We covered what are medication errors and why there is a need to eradicate these errors from the healthcare system. Furthermore, we discussed the safety improvement plan that included five rights of medication framework and retaining/hiring of new nurses. Then we shared the role of the audience in this session and created some of the resources for the successful implementation of the plan and development of medication administration skills in nurses.

References

Assiri, G. A., Shebl, N. A., Mahmoud, M. A., Aloudah, N., Grant, E., Aljadhey, H., & Sheikh, A. (2018). What is the epidemiology of medication errors, error-related adverse events, and risk factors for errors in adults managed in community care contexts? A systematic review of the International Literature. BMJ Open, 8(5). https://doi.org/10.1136/bmjopen-2017-019101  

Boutou, A. et al. (2021) “Nursing errors in ICU and their association with burnout, anxiety, insomnia and working environment: A cross-sectional study,” Acute Critical Care [Preprint]. https://doi.org/10.1183/13993003.congress-2021.pa2423

Escrivá Gracia, J., Brage Serrano, R., & Fernández Garrido, J. (2019). Medication errors and drug knowledge gaps among critical-care nurses: A mixed multi-method study. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4481-7  

Capella 4020 Assessment 3

Jones, J. H., & Treiber, L. A. (2018). Nurses’ rights of medication administration: Including authority with accountability and responsibility. Nursing Forum, 53(3), 299–303. https://doi.org/10.1111/nuf.12252  

Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., García-Saisó, S., & Salomon, J. A. (2018). Mortality due to low-quality health systems in the universal health coverage era: A systematic analysis of amenable deaths in 137 countries. The Lancet, 392(10160), 2203-2212. https://doi.org/10.1016%2FS0140-6736(18)31668-4

Maresova, P., Prochazka, M., Barakovic, S., Baraković Husić, J., & Kuca, K. (2020, June). A shortage in the number of nurses—A case study from a selected region in the Czech Republic and international context. In Healthcare (Vol. 8, No. 2, p. 152). MDPI. https://doi.org/10.3390%2Fhealthcare8020152 

Mlambo, M., Silén, C., & McGrath, C. (2021). Lifelong learning and nurses’ continuing professional development, a metasynthesis of the literature. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00579-2 

Mula, C. (2019). The examination of nurses’ adherence to the ‘five rights’ of antibiotic administration and factors influencing their practices: A mixed methods case study at a Tertiary Hospital, Malawi. Malawi Medical Journal, 31(2), 126. https://doi.org/10.4314/mmj.v31i2.4 

Opinion, F. B., Alhourani, F., Mihdawi, M., & Afaneh, T. (2021). Exploring the relationship between work engagement and turnover intention among nurses in the Kingdom of Bahrain: A cross-sectional study. Open Journal of Nursing, 11(12), 1098–1109. https://doi.org/10.4236/ojn.2021.1112087  

Patrisia, I. (2022). The implementation of five rights medication administration by nurses at a private hospital in Western Indonesia. Nursing Current: Jurnal Keperawatan, 10(2). https://doi.org/10.19166/nc.v10i2.5377  

Shitu, Z., Aung, M. M., Tuan Kamauzaman, T. H., & Ab Rahman, A. F. (2020). Prevalence and characteristics of medication errors at an emergency department of a teaching hospital in Malaysia. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-4921-4 

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

Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020). Medication administration errors and contributing factors among nurses: A cross sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC Nursing, 19(1). https://doi.org/10.1186/s12912-020-0397-0 

Capella 4020 Assessment 3