Create a professional presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and

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Capstone project: Adverse Drug Reaction in elderly

NRS 493

06/4/2022

Background

The paper focuses on Adverse Drug Events (ADEs). The effects of ADEs on the current healthcare settings cannot be overlooked. According to CDC, ADEs causes 1.3 million emergency visits annually. Americans 65 years and above are at the highest risk of experiencing ADEs. (Sarkar et al., 2011) researched the effects of ADEs on ambulatory visits. Their study was done between 2005 and 2007. They found that 13.5 million ADE-related visits occurred between 2005 and 2007, with most cases related to outpatient settings while others to the emergency visits. ADEs also add an extra burden to the healthcare system, with the same research showing that approximately 17 to 19 billion dollars were used to deal with ADEs.

Studies have presented additional evidence to show how ADEs include enhanced medication costs, unplanned operations, increased patient mortality, and morbidity and operations. The focus has been to control the effects that result from medical malpractice by eliminating the problem from healthcare. Several scholars have investigated the problem from different perspectives. Although the scholars have approached the problem from different perspectives, all the studies aim to develop evidence-based solutions to the problem. The current study is not different as it compared the effectiveness of electronic medication and educating and training the nurses as means of adverse effects

Clinical Statement Problem

The clinical problem is Adverse Drug Events (ADEs). ADEs increase financial in the healthcare system, lead to a high risk of infections, lowers healthcare quality, and cause unwanted deaths. Due to these impacts, there is a need for an evidence-based solution to mitigate ADEs occurrence in the healthcare settings.

Purpose of the Change Proposal

Several pieces of research show that ADEs add economic burden by resulting in lost incomes, disabilities, and increased healthcare expenditures (Sarkar et al., 2011). Therefore, one purpose of developing a change proposal is to reduce the economic burden incurred from ADEs. Through appropriate interventions, the health care system will tackle high treatment costs while the patients will be able to resume their economic activities on time.

The second purpose of the proposed change is to reduce infections in the healthcare settings. ADEs increase the Length of Stay (LOS) in hospitals. Increased LOS increases the risk of infections that threaten patients and staff safety. In addition, mitigating ADEs will increase healthcare treatment delivery quality and make hospital facilities more attractive to patients.

PICOT Question

Is electronic medication compared to education and training effective in reducing ADEs among older adults aged above 65 years?

Literature Search Strategy

The literature aimed to identify reputable sources related to education, training, and electronic medication. All the studies included in the literature were published between 2018 and 2022 and are not more than five years old). Using current sources was to obtain more recent and reliable findings on appropriate interventions to reduce ADEs.

The articles were searched on reputable academic databases of Google Scholar and PubMed. To obtain more accurate sources, keywords and Boolean operators (and, or) were used. For instance, one search term using Boolean operators was electronic medication and adverse drug events. Efforts were made to identify articles related to either education and training and electronic medication and their effectiveness in reducing ADEs.

Evaluation of Literature

Eight studies were evaluated in the literature. Gregory et al., (2021) investigated the experiences of Registered Nurses who administered medications to patients using the electronic medication administration record using a qualitative descriptive exploratory study and thematic analysis. They collected data using focus groups and observation. The analysis results showed that electronic medication reduced the time nurses spend with their patients, and thus, more study is needed to determine the effectiveness of the electronic medication. Li et al., (2019) investigated the effectiveness of different interventions that can apply to mitigate ADEs. The study was a systematic review of different articles, and the findings showed that electronic medication was the best intervention. In addition, a study by Lau et al., (2018) analyzed patients’ perspectives on electronic medication using a cross-sectional survey in an Australian Metropolitan hospital setting. They analyzed data using descriptive statistics and found that patients were more optimistic about e-prescribing. Martin et al., 2018 researched the effectiveness of the educational intervention on medical safety and found a positive correlation.

Wang et al., (2019), Kinlay et al., (2021), Fuller et al., (2018), and Bugnon et al., (2021) have also conducted additional research on the efficacy of the electronic medication and educational intervention in reducing ADEs in medical settings. The study by Wang et al., (2019) was a meta-analysis investigating the efficacy of electronic medical reconciliation in reducing ADEs. The results showed that electronic medical reconciliation reduces unintended medical discrepancies and improves medical safety. The articles by Kinlay et al., (2021) and Fuller et al., 2018) were also systematic reviews. Kinlay et al., (2021) investigated the effects of electronic medical management in enhancing medical safety. The results showed that electronic medical management reduces medical errors and improves workflow in healthcare settings.

Fuller et al., (2018) intended to map the extent, range, and nature of research on the effectiveness, level of use, and perceptions about electronic medication administration records (eMARs) in long-term care facilities (LTCFs). The findings revealed that evidence linking electronic Medication Administration Records (eMAR) as effective in reducing errors was weak, and thus, more robust research is needed. Bugnon et al., (2021) conducted a longitudinal study to summarize lessons learned from primary care professionals involved in a pioneering pilot project in Switzerland for the system-wide implementation of shared electronic medication plans. Using group interviews and descriptive data analysis methods, the authors found that study participants considered medication plan management, digitalized or not, a core element of good clinical practice

In summary, there is a broad literature on the efficacy of the electronic medication and education training in reducing ADEs. Most of the articles show that electronic medication or digitized medical management effectively reduces medical errors in healthcare settings. Nevertheless, more research is needed to support these findings further.

Applicable Change

The current findings in the literature show that stakeholders can handle the issue of ADEs in healthcare. Since most research support using electronic medication to reduce medical errors, the applicable change should be electronic medication, including e-prescribing, to deal with ADEs.

Proposed Implementation Plan and Outcome Measures

The proposed plan introduces electronic medication in healthcare facilities to reduce ADEs. The first implementation plan will identify the desired outcomes after implementing the plan. The first desired outcome is increased patient safety after introducing electronic medication. Other expected outcomes will be reduced ambulatory visits and infection risks. The second step in implementing the proposal will be identifying areas that will be affected by the change. Thirdly, the implementation team will craft a working plan that defines time frames for each task within the change and assign responsibilities to different individuals. Afterward, the management will allocate a budget that will be used in implementing the change process. A process and outcome analysis will be initiated during the implementation to ensure the program aligns with initial goals.

The use of Evidence-Based Practice in Creating the Plan

Robust research on the implementation of a project was conducted before the implementation plan was adopted. During implementation, the stakeholders first identify required goals before embarking on a work plan that will lead to the achievement of the project. A risk assessment is also conducted before a budget is allocated for the project.

Evaluating the Intervention

The intervention plan will be evaluated based on the desired goals set at the start of the implementation process. For instance, the plan is expected to increase patient safety by improving quality care, reducing ambulatory visits, and lowering healthcare costs. After implementation, the change team will research whether these objectives were met. Besides measuring the outcomes, the change team will evaluate the impact to determine patients’ perspectives on the new intervention. Data for evaluation will be collected from medical records, observations, and interviews.

Potential Barriers

One of the potential barriers to implementing the initiative is financial constraints. Some healthcare facilities may lack enough funds to support electronic medication or e-prescribing. Secondly, insufficient expertise to implement the initiative could also hinder attaining intended goals. Lastly, electronic medication is susceptible to cyber-attacks, and thus, organizations will have to invest more in data security measures, which could add to operational costs

References

Bugnon, B., Geissbuhler, A., Bischoff, T., Bonnabry, P., & von Plessen, C. (2021). Improving primary care medication processes by using shared electronic medication plans in Switzerland: Lessons learned from a participatory action research study. JMIR Formative Research, 5(1). https://doi.org/10.2196/22319

Fuller, A. E. C., Guirguis, L. M., Sadowski, C. A., & Makowsky, M. J. (2018). Electronic Medication Administration records in long‐term Care Facilities: A scoping review. Journal of the American Geriatrics Society, 66(7), 1428–1436. https://doi.org/10.1111/jgs.15384

Gregory, L. R., Lim, R., MacCullagh, L., Riley, T., Tuqiri, K., Heiler, J., & Peters, K. (2021). Intensive Care Nurses' experiences with the new electronic medication administration record. Nursing Open, 9(3), 1895–1901. https://doi.org/10.1002/nop2.939

Kinlay, M., Ho, L. M., Zheng, W. Y., Burke, R., Juraskova, I., Moles, R., & Baysari, M. (2021). Electronic Medication Management Systems: Analysis of enhancements to reduce errors and improve workflow. Applied Clinical Informatics, 12(05), 1049–1060. https://doi.org/10.1055/s-0041-1739196

Lau, G., Ho, J., Lin, S., Yeoh, K., Wan, T., & Hodgkinson, M. (2018). Patient and clinician perspectives of an integrated electronic medication prescribing and dispensing system: A qualitative study at a multisite Australian Hospital Network. Health Information Management Journal, 48(1), 12–23. https://doi.org/10.1177/1833358317720601

Li, R., Zaidi, S. T., Chen, T., & Castelino, R. (2019). Effectiveness of interventions to improve adverse drug reaction reporting by healthcare professionals over the last decade: A systematic review. Pharmacoepidemiology and Drug Safety, 29(1), 1–8. https://doi.org/10.1002/pds.4906

Martin, P., Tamblyn, R., Benedetti, A., Ahmed, S., & Tannenbaum, C. (2018). Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults. JAMA, 320(18), 1889. https://doi.org/10.1001/jama.2018.16131

Wang, H., Meng, L., Song, J., Yang, J., Li, J., & Qiu, F. (2018). Electronic medication reconciliation in hospitals: A systematic review and meta-analysis. European Journal of Hospital Pharmacy, 25(5), 245–250. https://doi.org/10.1136/ejhpharm-2017-001441

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