Week 8: Signature Assignment – Evidence-Based Project Proposal



Week 8: Signature Assignment – Evidence-Based Project Proposal

QUESTION
Assignment Prompt

The purpose of the signature assignment is for students to apply the research and EBP concepts they have learned in this course and develop a framework for the initial steps of the student’s capstone project. The assignment allows the student to initiate the steps for planning, researching and developing an evidence-based practice intervention project proposal.

On or before Day 7, of week eight each student will submit his or her final proposal paper to the week eight assignment link in D2L. This formal paper will include and expand upon work completed thus far in prior assignments.

Essential Components of the Final Project Proposal will include:

Introduction– Provide an introduction to your topic or project. The introduction gives the reader an accurate, concrete understanding what the project will cover and what can be gained from implementation of this project.
Overview of the Problem – Discuss the problem, why the problem is worth exploring and the potential contribution of the proposed project to the discipline of nursing.
Project Purpose Statement – Provide a declarative sentence or two which summarizes the specific topic and goals of the project.
Background and Significance – State the importance of the problem and emphasize what is innovative about your proposed project. Discuss the potential impact of your project on your anticipated results to the betterment of health and/or health outcomes.
PICOt formatted Clinical Project Question(s)– Provide the Population, Intervention, Comparison, Expected Outcomes and Timeframe for the proposed project.
Literature Review – Provide the key terms used to guide a search for evidence and discuss at least five (5) summaries of relevant, credible, recent, evidence-based research studies to support the project proposal.
Critical Appraisal of Literature – Discuss the strengths and weaknesses of the evidence, what is known from the evidence and what gaps in evidence were found from the appraisal of evidence-based research studies.
Develop an EBP Standard – Describe two to three interventions (or a bundle of care) from the evidence and discuss how individual patient preferences or the preferences of others will be considered.
Implications – Summarize the potential contributions of the proposed project for nursing research, education and practice.
Week 8: Signature Assignment – Evidence-Based Project Proposal

ANSWER
Week 8: Signature Assignment – Evidence-Based Project Proposal

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Week 8: Signature Assignment – Evidence-Based Project Proposal
Introduction
Healthcare organizations across the globe strive to deliver high-quality and safe care to the people to enable them to achieve better health outcomes and have an improved quality of life. This, however, is hindered by various challenges, either within the healthcare system or from the external environment, which affect the delivery of high-quality and safe care. This, therefore, emphasizes the need for various stakeholders within the healthcare system to develop appropriate interventions that will address the various challenges and facilitate the delivery of care for the people (Roberts et al., 2016). The most appropriate way is to identify the problem or challenge affecting care delivery, followed by developing interventions that should be supported by either evidence from literature or have been successful in other care settings.
This project aims to apply evidence from research and literature to propose the most appropriate intervention in addressing medication errors and their associated complications, which are major healthcare problems affecting the quality of care that patients receive and patient safety. Such interventions should then be implemented, and regular evaluations are done to determine their effectiveness in addressing the healthcare problem (Roberts et al., 2016). Therefore, the implementation of this project will help ensure that some of the factors contributing to medication errors are addressed. Thus the incidences will reduce, resulting in improved safety and quality of care to patients for better outcomes.
Overview of the Problem
Medication errors are a common occurrence in various care settings globally. Although preventable, whenever they occur, they result in adverse complications not only for the patients but for the caregivers and the health facilities at large. Various factors result in medication errors, with most incidences of errors occurring during the medication administration phase (WHO, 2016). The contributing factors to medication errors can be grouped into organization-based factors such as inadequate staffing and poor management, nurse-based factors such as negligence among the caregivers, and knowledge-based factors, which include insufficient pharmacological knowledge by the caregivers. Patients who are victims of medication errors are at risk of developing complications, which affect their health outcomes. These complications also result in prolonged duration of hospital stay, increased healthcare costs, and decreased levels of patient satisfaction (WHO, 2016).
To the caregivers, medication errors result in decreased job confidence and job satisfaction, increased anxiety levels due to fear of committing similar errors in the future, increased nurse turnover rates, and facing other consequences such as sanctions, having their practice licenses suspended, or even revoked, facing hefty fines and in other severe circumstances, face incarceration. This, therefore, affects their ability to deliver high-quality care that will address the various patient needs (WHO, 2016). Therefore, there is the need to develop interventions that will address the various contributing factors to such medication errors, thereby reducing their incidences. This will help prevent the resulting complications and thus, help patients achieve better health outcomes by improving their safety. It will also help prevent the adverse consequences such medication errors have on the caregivers and the health facilities at large (WHO, 2016).

Project Purpose Statement
Medication errors affect the quality of care, patient safety, and health outcomes. The primary purpose of this project is to determine an important measure to help prevent medication errors within care settings. The project focuses on determining how effective adequate staffing of health facilities and ensuring a recommendable nurse-to-patient ratio is in preventing medication errors and the associated complications.
Background and Significance
Patient safety is critical for better health outcomes. Addressing challenges affecting delivering high-quality and safe care to patients is essential in healthcare for better health outcomes. Medication errors are a significant healthcare concern, posing significant risks to patient safety and the quality of care they receive (WHO, 2016). Therefore, this interferes with the primary goal of healthcare organizations to offer high-quality and safe care for the population. This project, however, focuses on inadequate staffing as a significant cause of medication errors within healthcare organizations. Usually, the number of patients seeking healthcare services is high, attributed to the increasing incidences of chronic conditions affecting the population globally. Such influx of patients results in increased workload, requiring that healthcare facilities have an adequate number of healthcare providers to ensure efficient workflow.
This, however, is not the case in many healthcare facilities. As a result, the available caregivers have to care for the high number of patients seeking care in such facilities. This results in fatigue and burnout, which affects their work efficiency, performance, and overall productivity (SHoHani & Tavan, 2018). Such forms of burnout also result in work-related stress, where the caregivers project the stress to the patients, thus affecting the quality of care they offer to the patients. The fatigue and associated burnout also decrease the alertness and accuracy while delivering care. This increases their likelihood of committing specific medication errors, for instance, administering the wrong medication, giving medications to the wrong patient, or even using the wrong route of medication administration (WHO, 2016). Most caregivers often fail to report such incidences, primarily due to the fear of retaliation.
Therefore, the contributing factors often go unnoticed, and the incidences of medication errors continue to occur because no interventions are put in place to address the various factors (Hammoudi et al., 2018). Therefore, the patients experience the complications of medication errors, and the quality of care they receive continues to deteriorate. The project, therefore, proposes lowering of nurse-to-patient ratio through the recruitment of additional staff as a way of reducing and even preventing incidences of medication errors by preventing associated fatigue and burnout, which increases the likelihood of such errors. With a high number of caregivers, there will be reduced workload, proper shifting of caregivers, improved work efficiency and productivity, and reduced exhaustion, thus enhancing care delivery by preventing incidences of medication errors due to fatigue and burnout among the healthcare providers.
PICOt formatted Clinical Project Question(s)
The population, intervention comparison, outcome, and time (PICOT) framework has been applied in this project to determine the effectiveness of the proposed intervention in addressing medication errors. According to the healthcare problem, the PICOT question being analyzed is; for patients admitted within a health facility (P), dose reduction of nurse-to-patient ratio (I) compared to failure to take a corrective measure in addressing nurse shortage (C) help in preventing medication errors and associated complications (O) within six months (T)?
The population being investigated in the project involves all patients admitted to a health facility. All patients admitted are at risk of being victims of medication errors regardless of their gender, racial or ethnic background. The intervention being explored is reducing the nurse-to-patient ratio, which occurs by increasing the number of available healthcare providers; thus, each caregiver has fewer patients to attend to. This intervention reflects a reduced workload due to the increased number of caregivers providing care to the patients. The intervention is compared to cases and facilities where due to various reasons, they fail to ensure recommended nurse-to-patient ratio. Thus the caregivers within these settings continue to experience heavy workloads due to the high number of patients they have to attend to at any given time.
The outcome being assessed to evaluate the success of the intervention is the prevention of medication errors and their associated complications. This will include assessing the new incidences of medication errors following the implementation of the intervention and evaluating key performance indicators such as patient satisfaction and experience, duration of hospital stay, and healthcare costs linked to complications that may result from medication errors (WHO, 2016). The estimated time frame is six months, allowing the availability of required resources to implement the initiative. However, it is not prolonged due to the critical nature of the subject. Longer study duration will imply an increased exposure to such errors to get the results and conclusions, which will raise significant concerns over patient safety.

Literature Review
The literature sources used to obtain evidence regarding the effectiveness of the intervention in addressing medication errors were chosen based on meeting the various credibility criteria, which include; being from a reliable website, published by authorized professionals in the field and timeliness, where they were to have been published within the last five years to ensure that information in them are updated with the latest studies and research. This was to ensure that the information obtained was accurate and reliable evidence supporting the proposed initiative. Besides, keywords such as medication errors, nurse-to-patient ratio, nursing staff shortage, and patient health outcomes were used to narrow the search. Five relevant articles were selected and analyzed to establish evidence supporting the initiative in addressing the healthcare problem. The summary of the chosen articles is as below;
Izadpanah et al. (2018), in the article, Assessment of frequency and causes of medication errors in pediatrics and emergency wards of teaching hospitals affiliated with Tehran University of Medical Sciences, describe a cross-sectional descriptive study done to establish the existing connection between nurse shortage and type, frequency, and causes of medication errors in pediatric and emergency wards belonging to Tehran University of Medical Sciences in 2017. The study involved four hundred twenty-three nurses selected using the stratified sampling method. The findings identified various causes of medication errors but elaborated on workforce shortage and high workload as the commonest causes. The study concluded by recommending the need to ensure an adequate workforce to minimize the incidences of medication errors. The limitation of this study was the fear of retaliation among the nurses, which could have affected reporting all the incidences of medication errors.
SHoHani & Tavan (2018), in the article Factors affecting medication errors from the perspective of nursing staff, describe a descriptive-analytical study involving 120 nurses randomly selected to determine the factors affecting medication errors from nurses’ perspectives across various education hospitals in Ilam, Iran. The results indicated that nurses’ fatigue and a heavy workload were the leading causes of medication errors in the different facilities. The study went further to recommend the need to ensure adequate staffing to reduce the workload to prevent medication errors. This study was also limited by inadequate reporting of incidences of medication errors due to fear of retaliation among the nurses.
Hammoudi et al. (2018), in the article, Factors associated with medication administration errors and why nurses fail to report them, also describe a descriptive cross-sectional study that involved 367 nurses as participants, randomly selected from public hospitals. The findings identified inadequate nurse staffing as the third leading cause of medication errors, only coming after improper packaging and miscommunication between physicians and nurses. The study’s primary limitation was fear of retaliation among the nurses, hence inadequate reporting.
Piroozi et al. (2019, in the article, Frequency and potential causes of medication errors from nurses’ viewpoint in hospitals affiliated with a medical sciences university in Iran, describe a cross-sectional and descriptive-analytic study that involved 503 nurses as participants selected using the census method, to investigate the prevalence of medication errors and associated factors among nurses of Kurdistan University of Medical Sciences (KUMS) in 2016. The findings identified heavy workload and prolonged working hours among the nurses as the significant causes of a medication errors, thus further recommending the need for addressing these factors.
Zarea et al. (2018), in the article, Iranian nurses’ medication errors: A survey of the types, the causes, and the related factors, highlight a cross-sectional descriptive-analytical study involving 225 nurses selected using multistage random sampling to assess nurses’ medication errors and the associated factors. The findings identified heavy workload, inadequate staff, and fatigue among the caregivers as the fundamental causes of medication errors.
Critical Appraisal of Literature
The evidence from the various sources of literature indicates a clear and strong link between nurse-to-patient ratio and incidences of medication errors. All the articles established that the incidences of medication errors reported were in different ways associated with inadequate staffing. This manifests in a heavy workload, mainly when the number of patients is higher than that of required caregivers to take care of them. Healthcare providers, therefore, have a high work burden which results in fatigue and burnout, which puts them at risk of committing medication errors. From the significant contribution of medication errors to inadequate staffing, the various studies recommend the need to increase the healthcare workforce to minimize the associated work burden and workload. However, the accuracy of the results obtained is questionable, given the similar limitation that every study reported related to decreased reporting of incidences of medication errors by nurses due to fear of retaliation. This should be considered in future research to establish a more accurate and reliable connection between medication errors and inadequate staffing.
Evidence-Based Practice Standard
The current medical practice is guided by evidence from research studies and literature sources. The evidence obtained from the literature sources is a clear indication that a lower nurse-to-patient ratio is critical in preventing medication errors and improving patient care by preventing burnout and fatigue associated with heavy workload due to inadequate staffing. Therefore, health facilities should analyze the cause of medication errors within their facility by encouraging reporting of these errors or near misses (Hammoudi et al., 2018). Therefore, they should address errors caused by fatigue and burnout among nurses by increasing the number of healthcare workforce within their setting. When this is appropriately implemented, the evidence from the literature indicates that it will effectively help address the burnout issue and thus increase patient safety and health outcomes by preventing incidences of medication errors within the facilities (Piroozi et al., 2019). Besides, care delivery should be patient-centered. Through adequate staffing, caregivers will have ample time to effectively tailor care to address individual patient needs for better health outcomes.
Implications
Adequate staffing is a critical strategy in healthcare since it enhances the delivery of high-quality, safe, and effective healthcare to the patients. Most importantly, it prevents fatigue and burnout associated with a heavy workload that commonly occurs due to inadequate staffing. Prevention of burnout and fatigue aids in enhancing the productivity of the healthcare providers and work efficiency, thereby preventing the associated adverse outcomes such as medication errors (Piroozi et al., 2019). Through the collaboration of different stakeholders, healthcare facilities must ensure adequate staffing within their facility as a way of improving the quality of care delivery and enhancing patient safety.

References
Hammoudi, B. M., Ismaile, S., & Abu Yahya, O. (2018). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian journal of caring sciences, 32(3), 1038-1046. https://onlinelibrary.wiley.com/doi/abs/10.1111/scs.12546
Izadpanah, F., Nikfar, S., Imcheh, F. B., Amini, M., & Zargaran, M. (2018). Assessment of frequency and causes of medication errors in pediatrics and emergency wards of teaching hospitals affiliated with Tehran University of Medical Sciences (24 Hospitals). Journal of medicine and life, 11(4), 299. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6418340/
Piroozi, B., Mohamadi-Bolbanabad, A., Safari, H., Amerzadeh, M., Moradi, G., Usefi, D., … & Gray, S. (2019). Frequency and potential causes of medication errors from nurses’ viewpoint in hospitals affiliated with a medical sciences university in Iran. International Journal of human rights in healthcare. https://www.emerald.com/insight/content/doi/10.1108/IJHRH-11-2018-0072/full/html?casa_token=k3wKPIY60ioAAAAA:ibKQRNpCOTFzuY3mWLkZl8Wiza0MSEXxUGFvIaf010FO6OVPIQbcUkKOMm9a-AKcYysig_F7GG8dhomTd27r3IzqHJA7lc4xdr6X0OtNTAABRUDsuVRQ
Roberts, J. P., Fisher, T. R., Trowbridge, M. J., & Bent, C. (2016, March). A design thinking framework for healthcare management and innovation. In Healthcare (Vol. 4, No. 1, pp. 11-14). Elsevier. https://www.sciencedirect.com/science/article/pii/S221307641500113X
SHoHani, M., & Tavan, H. (2018). Factors affecting medication errors from the perspective of nursing staff. J Clin Diagn Res, 12(3). https://www.researchgate.net/profile/Masoumeh-Shohani/publication/324405979_Factors_Affecting_Medication_Errors_from_the_Perspective_of_Nursing_Staff/links/5af587dea6fdcc0c030bb2e3/Factors-Affecting-Medication-Errors-from-the-Perspective-of-Nursing-Staff.pdf
World Health Organization. (2016). Medication errors. https://apps.who.int/iris/bitstream/handle/10665/252274/9789241511643-eng.pdf
Zarea, K., Mohammadi, A., Beiranvand, S., Hassani, F., & Baraz, S. (2018). Iranian nurses’ medication errors: A survey of the types, the causes, and the related factors. International journal of Africa nursing sciences, 8, 112-116. https://www.sciencedirect.com/science/article/pii/S2214139117300811

Week 8: Signature Assignment – Evidence-Based Project Proposal


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