How to Answer Improvement Plan Took Questions (Complete Guide)

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Original Question

Improvement Plan Took Kit This improvement plan tool kit will implement safety and help improve mediation administration and decrease errors in the emergency department. The tool kit consists of four categories, and within the categories are three annotated sources. The four categories are medication errors and reporting, new processes for safety in medication administration, bar code scanning in medication administration, the use of simulation in nursing education. Annotated Bibliography Medication Errors and Reporting Manias, E., Kusljic, S., & Wu, A. (2020). Interventions to reduce medication errors in adult medical and surgical settings: A systematic review. SAGE Publications. https://doi.org/10.1177/2042098620968309 Medication errors can happen at any point in the medication administration process and can cause death or major harm. This article compares the effectiveness of several interventions in reducing errors made in prescribing, dispensing, and administration. Meta-analysis was used to show that prescribing errors had been reduced when a pharmacist reconciled the medication. Medication errors cost $42 billion worldwide. Khalifa, D. A. S., Reda, N. A., & Hassan, E. A. (2024). Medication administration errors and contributing factors from critical care nurses’ perspective. Alexandria Scientific Nursing Journal, 26(4), 432-445. https://doi.org/10.21608/asalexu.2024.392740 The National Coordinating Council for Medication Error and Reporting and Prevention is explained as a medication error is an avoidable incident that could result in patient injury. This article focuses on medication error within the critical care unit. In the critical care unit medications are the most common intervention when it comes to patient care. There are several factors that play a role in possible errors occurring such as product labeling, packing, dispensing, distribution, and administration. The article mentions that there are phases of medication administration and those are prescription, administration, and monitoring. After an error has taken place a patient can experience adverse reactions, a longer hospital stay, or death. Medication errors cost upwards of $42 billion globally, making the extended hospital stay around $2,500 for each patient. The NCC-MERP as mentioned prior use four categories for medication errors, those are, potential or non-error; error, no harm; error, harm; and error, death. A potential error is described as an error that does not cause harm, meaning no medical intervention is warranted. There are several factors that lead to errors such as lack of staff, nursing fatigue, and increased patient ratios. Interruptions and procedural failure have been linked to potential medication errors. There is a known lack of reporting medication errors in healthcare due to nurses fearing punishment and negative attitudes. The article states that a study was conducted showing that younger nurses or nurses with only a few years of experience were more likely to make majors errors than older nurses were, possibly linked to the lack of knowledge and experience. Schuermann, A. A., Arkin, L., & Loerzel, V. (2024). An exploration of nurses’ attitudes and beliefs on reporting medication errors. Journal of Nursing Care Quality, 39(3), 279-285. https://doi.org/10.1097/NCQ.0000000000000770* The Journal of Nursing Care Quality published this article about incident reporting systems and their use to capture errors. Error reporting by nurses has become inconsistent in recent years due to fear or negative consequences, along with nurses not feeling supported for reporting the error. Although nurses do want to do the right thing for their patients and do report medication errors but lean toward informal reporting systems. The nurse will informally be reporting an error to peers, charge nurse and nurse leaders. Using an informal reporting system can have a negative impact on the patient. The article continues to inform the reader that there are internal and external factors that contribute to the nurse making formal or informal reports of medication errors. Internal factors such as personal beliefs may have an impact on how a nurse practices and their reaction to the error and if they would report it. A nurse might describe their feelings of vulnerability, shame or guilt that an error was made. Those feelings are the reason a report was not made after the error occurred. A nurse’s personal belief also interfered with weather or not they would report the error. For example, the severity of the error and the positive or negative outcome of reporting the error. Nurses also would monitor the patient to see how the situation would play out, such as the patient’s outcome before reporting the error. External are described as processes or places. For example, policies, rules, and guidelines that impact medication error reporting. The negative response from nursing leadership hindered the impact of reporting errors such as the lack of support and the delay in follow-up. To improve medication errors in nursing a supportive environment need to be implemented for nurses to feel safe to report medication errors. New Process for Safety in Medication Administration Berdot, S., Vilfaillot, A., Bezie, Y., Perrin, G., Berge, M., Corny, J., Thi, T. T. P., Depoisson, M., Guihaire, C., Valin, N., Decelle, C., Karras, A., Durieux, P., Lê, L. M. M., & Sabatier, B. (2021). Effectiveness of a ‘do not interrupt’ vest intervention to reduce medication errors during medication administration: A multicenter cluster randomized controlled trial. BMC Nursing, 20(1), 1-153. https://doi.org/10.1186/s12912-021-00671-7 Francois, O., Hufschmid Thurnherr, E., Blatrie, C., Cousein, E., Herranz, A., Sadeghipour, F., & Bonnabry, P. (2024). Integrating automated dispensing cabinets into the medication dispensing process: Feedback from the practice in european hospitals. European Journal of Hospital Pharmacy. Science and Practice, , ejhpharm-2024-004195. https://doi.org/10.1136/ejhpharm-2024-004195 Vital, C. J., & Nathanson, B. H. (2023). Effects of the interruption management strategy “stay S.A.F.E.” during medication administration. Rehabilitation Nursing, 48(2), 65-74. https://doi.org/10.1097/RNJ.0000000000000404 Barcode Scanning Medication Barakat, S., & Franklin, B. D. (2020). An evaluation of the impact of barcode patient and medication scanning on nursing workflow at a UK teaching hospital. Pharmacy, 8(3), 148. https://doi.org/10.3390/pharmacy8030148 Ho, J., & Burger, D. (2020). Improving medication safety practice at a community hospital: A focus on bar code medication administration scanning and pain reassessment. BMJ Open Quality, 9(3), e000987. https://doi.org/10.1136/bmjoq-2020-000987 BMJ Open Quality published this article in 2020 stating that the United States medication error rate is over 30% at the point of administration. Bar code scanning at the bedside helps implement the five rights of medication administration. There are five rights to medication administration that nurses are taught at the beginning of their education in school. These include right patient, right time, right route, right dose and right medication, and following these rights reduce errors. A non-profit organization called The Leapfrog Group has recommended that 95% that nurses should have a 95% bedside medication scan rate. The bedside scan rate is required for all inpatient areas. Owens, K., Palmore, M., Penoyer, D., & Viers, P. (2020). The effect of implementing bar-code medication administration in an emergency department on medication administration errors and nursing satisfaction. Journal of Emergency Nursing, 46(6), 884-891. https://doi.org/10.1016/j.jen.2020.07.004 This article from the Journal of Emergency Nursing studies the use of bar code scanning in medication administration that has shown to reduce medication errors. The author studied how to use bar coded medication within the emergency department to reduce medication errors. The study was over three months and compared medication error rated before the implementation of bar code scanning and after. Over the three-month period, a total of 656 medication administration were surveyed. Before the bar code scanning was implemented into the unit the medication errors were at 2.96% and after the error rate dropped to 0.76%. A decrease in medication errors and an improvement in medication administration was associated with the implementation of bar code scanning administration. Simulation Shahzeydi, A., Dianati, M., & Kalhor, F. (2024). Clinical simulation in nursing students’ safe medication administration: A systematic review. Iranian Journal of Nursing and Midwifery Research, 29(5), 522-529. https://doi.org/10.4103/ijnmr.ijnmr_323_23 Shin, S., Park, J., & Kim, J. (2015). Effectiveness of patient simulation in nursing education: Meta-analysis. Nurse Education Today, 35(1), 176-182. https://doi.org/10.1016/j.nedt.2014.09.009 This article informs the reader that using clinical simulation has become an accepted form of education in nursing. Simulation is explained as a real situation using mannequins that is harmless to any patients; these simulations teach nurses and students procedures, decision-making, and critical thinking skills. This type of learning experience has been studied to show that it improves learning efficiency. Students who engage in simulation will gain enhanced knowledge, self-confidence, satisfaction, and critical thinking skills. Nelson, R. (2016). Replicating real life: Simulation in nursing education and practice. The American Journal of Nursing, 116(5), 20-21. https://doi.org/10.1097/01.NAJ.0000482956.85929.d8 Conclusion References Barakat, S., & Franklin, B. D. (2020). An evaluation of the impact of barcode patient and medication scanning on nursing workflow at a UK teaching hospital. Pharmacy, 8(3), 148. https://doi.org/10.3390/pharmacy8030148 Berdot, S., Vilfaillot, A., Bezie, Y., Perrin, G., Berge, M., Corny, J., Thi, T. T. P., Depoisson, M., Guihaire, C., Valin, N., Decelle, C., Karras, A., Durieux, P., Lê, L. M. M., & Sabatier, B. (2021). Effectiveness of a ‘do not interrupt’ vest intervention to reduce medication errors during medication administration: A multicenter cluster randomized controlled trial. BMC Nursing, 20(1), 1-153. https://doi.org/10.1186/s12912-021-00671-7 Francois, O., Hufschmid Thurnherr, E., Blatrie, C., Cousein, E., Herranz, A., Sadeghipour, F., & Bonnabry, P. (2024). Integrating automated dispensing cabinets into the medication dispensing process: Feedback from the practice in european hospitals. European Journal of Hospital Pharmacy. Science and Practice, , ejhpharm-2024-004195. https://doi.org/10.1136/ejhpharm-2024-004195 Ho, J., & Burger, D. (2020). Improving medication safety practice at a community hospital: A focus on bar code medication administration-n scanning and pain reassessment. BMJ Open Quality, 9(3), e000987. https://doi.org/10.1136/bmjoq-2020-000987 Khalifa, D. A. S., Reda, N. A., & Hassan, E. A. (2024). Medication administration errors and contributing factors from critical care nurses’ perspective. Alexandria Scientific Nursing Journal, 26(4), 432-445. https://doi.org/10.21608/asalexu.2024.392740 Manias, E., Kusljic, S., & Wu, A. (2020). Interventions to reduce medication errors in adult medical and surgical settings: A systematic review. SAGE Publications. https://doi.org/10.1177/2042098620968309 Nelson, R. (2016). Replicating real life: Simulation in nursing education and practice. The American Journal of Nursing, 116(5), 20-21. https://doi.org/10.1097/01.NAJ.0000482956.85929.d8 Owens, K., Palmore, M., Penoyer, D., & Viers, P. (2020). The effect of implementing bar-code medication administration in an emergency department on medication administration errors and nursing satisfaction. Journal of Emergency Nursing, 46(6), 884-891. https://doi.org/10.1016/j.jen.2020.07.004 Schuermann, A. A., Arkin, L., & Loerzel, V. (2024). An exploration of nurses’ attitudes and beliefs on reporting medication errors. Journal of Nursing Care Quality, 39(3), 279-285. https://doi.org/10.1097/NCQ.0000000000000770 Shahzeydi, A., Dianati, M., & Kalhor, F. (2024). Clinical simulation in nursing students’ safe medication administration: A systematic review. Iranian Journal of Nursing and Midwifery Research, 29(5), 522-529. https://doi.org/10.4103/ijnmr.ijnmr_323_23 Shin, S., Park, J., & Kim, J. (2015). Effectiveness of patient simulation in nursing education: Meta-analysis. Nurse Education Today, 35(1), 176-182. https://doi.org/10.1016/j.nedt.2014.09.009 Vital, C. J., & Nathanson, B. H. (2023). Effects of the interruption management strategy “stay S.A.F.E.” during medication administration. Rehabilitation Nursing, 48(2), 65-74. https://doi.org/10.1097/RNJ.0000000000000404

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