Two Journal Articles Analyzed
Question:
Discuss about the Comparative Essay Analysis on Medication Errors.
Healthcare facilities as hospitals administer various medications to patients every day, where errors occur randomly (Keers, 2013). Researchers and studies have been continuously focused on ways and means to reduce interruptions to nurses while they are preparing or administering dosage of medications. While interruptions were analysed, they were found to be related to medication administration errors (MAEs), which in case reduced could lead to lesser impact being made on patients. Approximately 36% errors were found to have occurred in the emergency department during administration phase. The scope of this analysis reviews two journal articles related to medication errors, comparing them. A comprehensive analysis using qualitative and quantitative techniques was used to arrive at findings related to the study. Using data analysis techniques journals, namely J. I. Westbrook, T. D. Hooper, M. Z. Raban, S. Middleton and E. C. Lehnbom (2017) article, Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study. In the BMJ Qual Saf (Westbrook, 2017). Another journal by F. S. Blank, J. Tobin, S. Macomber, M. Jaouen, M. Dinoia and P. Visintainer (2011) article, A “back to basics” approach to reduce ED medication errors. In Journal of emergency nursing analyses medication related errors in emergency departments (Blank, 2011).
Medication related errors are frequent in hospitals as well as across emergency departments. Aim of researchers had been focused at findings ways and means by which these errors can be reduced such as to prevent harm caused to patients (Ammenwerth, 2008). There are two journal that provides insights into medication related errors, however the context of analysis of both the journals are different in nature.
Aims: Article by Johanna I Westbrook, Ling Li, Tamara D Hooper, Magda Z Raban, Sandy Middleton, Elin C Lehnbom examines effect for reduction in non-medication based interruptions to nurses. This study conducted quantitative based analysis by randomly controlled study in Adelaide, Australia. The study was conducted using feedback from manger nurses. The study adopted ethical approval from Hospital Research Ethics Committee. Another article by F. S. Blank, J. Tobin, S. Macomber, M. Jaouen, M. Dinoia and P. Visintainer examines ways in which knowledge can impact clinical practice amongst nurses in emergency departments. Medication related errors taking place in emergency departments mostly due to overcrowding. Medication given to patients at emergency departments often leads to patient harm, which can range from being permanent to temporary injuries (Sanderson, 2015). While previously article concerned examination of entire range of errors that occurs across all departments of hospitals the second article concerns itself with identification of medication based errors in emergency departments only. The first article is more concerned with several interruptions that causes nurses to administer dosage incorrectly (Currie, 2014). The scope of the other article identifies issues specific in nature that causes errors, as specifically being overcrowding. Initial study is related to obtaining feedback from nurses and all other departments while this study adopts a methodology where nurses in emergency departments were considered for the study.
Aims of the Studies
Methods: In the first study four wards were selected for the purpose of collecting data, where interventions included wearing vest while providing medications. Primary aim of the study was to divert attention during the process of interruptions (Hayes, 2015). Various observations were made over a prolonged time period, which showed that wearing vests was consuming substantial amounts of their time. It was relevant from the study that nurses experienced that was not related to medication. This study demonstrated tremendous scope for improvements in regards to unnecessary interruptions that was causing errors in medication (Rothschild, 2010). The discussion in this article therefore derived that there was costs associated with alternative interventions that likely generates impact on long-term sustainability related to such interventions. Therefore, in order to increase effectiveness related to interventions there costs associations has to be established such that they can be reduced in a substantial manner.
The second article on the other hand, analyses basic medication administration procedure within emergency departments for reducing errors. This study adopted methodology whereby education intervention by way of non-randomized methods of a single group was compared pre and post outcome (Hopkinson, 2013). The study was conducted using 95 nurses where measures adopted for intervention included knowledge regarding medication administration process, behaviour that reflects recommended medication practices and medication administration errors. This study demonstrates that education based interventions were able to impact medical administration practices. But nurses with improved knowledge did not change their behaviour significantly, hence more research in the area was required in order to impact clinical practices amongst nurses (Pham, 2011).
Internal Validity and External Validity: In the first study, the scholars used a method of interruption to nurses by use of vests to distract their attention. The study focused at connecting findings of medication effectiveness to non-medication based interruptions. There were mixed ways to interrupt nurses in intervention wards and then results were compared to control wards in pre and post interventions (Palese, 2009). The study reflected low correlation in intervention wards as against control wards, reflecting that cost effective measures can be included to reduce such interruptions. Internal validity of variables in the study is too low and external validity can be drawn as results are more generalized in nature.
For the second study, internal validity was also established to be low. As nurses that were subjected to the study pre and post increasing their knowledge reflected on very low effects in regards to their clinical practice. External validity can be obtained in this study as results are more generalized in manner. Nurses showed significant increase in knowledge levels post the study however there were no impacts on results.
Methods Used
Results: The scope of the first study did not try to impact result, rather was interested in findings related to interventions that causes harm on patients. The second study was more focused on enhancing ways in which medication related errors could be reduced. While the first study was conducted using all departments within the hospital, the second one was focused on emergency department. In the first study a methodology was adopted to collect feedback from two separate groups as a control group and experimental group. The second study knowledge was imparted uniformly to nurses in ED so as to impact their outcomes (Sasangohar, 2014). Medication administration process was not a matter of concern in the first case as it was merely concerned with examining ways intervention can impact medication administration. The second study was moreover focused in nature with understanding impacts of knowledge on the process of medication administration.
Trustworthiness of Each Paper: Both the papers had been conducted using data collection and their analysis. The findings related to the first study can be generalized as it was conducted through all departments. However, the interventions cannot be used for instrument design. In the second study conducted, it was done only in emergency department hence cannot be generalized or findings adopted across other departments. The research design adopted cannot be for purpose of instrumentation design. The scope of the studies had been limited to single hospitals only, which is the main limitations or drawbacks associated with the study. However, the scholars has derived findings for the study in relation to various attributes that makes these studies important in nature. Moreover, implications of these studies can be used across in developing more studies for further research in the domain. While both the study has certain limitations but the study has been derived from well researched studies conducted in the past. Therefore, both the papers can be regarded as trustworthy and capable of conducting further studies on.
Conclusion
Analysing medication related errors can reveal facts regarding various impacts that patients suffer. while aim and focus on healthcare centers and hospitals is to reduce such errors by appointing capable nurses and providing adequate training it often remains ineffective. The scope of these two journals have provided an extension to previously conducted studies in the area aimed at reducing interruptions and providing knowledge to improve medication administration procedure. While both the articles have provided in-depth insights into the topic, they have not been effective in suggesting ways in which medication administration effectiveness can be attended. Therefore scope of further research in the area will still reamin prevalent.
Reference Lists
Ammenwerth, E., Schnell-Inderst, P., Machan, C., & Siebert, U. (2008). The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. Journal of the American Medical Informatics Association, 15(5), 585-600.
Blank, F. S., Tobin, J., Macomber, S., Jaouen, M., Dinoia, M., & Visintainer, P. (2011). A “back to basics” approach to reduce ED medication errors. Journal of emergency nursing, 37(2), 141-147.
Currie, L. (2014). Reducing interruptions during medication administration: the White Vest study. Journal of Research in Nursing, 19(3), 262-263.
Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. Journal of clinical nursing, 24(21-22), 3063-3076.
Hopkinson, S. G., & Jennings, B. M. (2013). Interruptions during nurses’ work: A state?of?the?science review. Research in nursing & health, 36(1), 38-53.
Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Annals of Pharmacotherapy, 47(2), 237-256.
Palese, A., Sartor, A., Costaperaria, G., & Bresadola, V. (2009). Interruptions during nurses’ drug rounds in surgical wards: observational study. Journal of nursing management, 17(2), 185-192.
Pham, J. C., Story, J. L., Hicks, R. W., Shore, A. D., Morlock, L. L., Cheung, D. S., … & Pronovost, P. J. (2011). National study on the frequency, types, causes, and consequences of voluntarily reported emergency department medication errors. Journal of Emergency Medicine, 40(5), 485-492.
Rothschild, J. M., Churchill, W., Erickson, A., Munz, K., Schuur, J. D., Salzberg, C. A., … & Jaggers, R. (2010). Medication errors recovered by emergency department pharmacists. Annals of emergency medicine, 55(6), 513-521.
Sanderson, P. M., & Grundgeiger, T. (2015). How do interruptions affect clinician performance in healthcare? Negotiating fidelity, control, and potential generalizability in the search for answers. International Journal of Human-Computer Studies, 79, 85-96.
Sasangohar, F., Donmez, B., Easty, A., Storey, H., & Trbovich, P. (2014). Interruptions experienced by cardiovascular intensive care unit nurses: an observational study. Journal of critical care, 29(5), 848-853.
Westbrook, J. I., Li, L., Hooper, T. D., Raban, M. Z., Middleton, S., & Lehnbom, E. C. (2017). Effectiveness of a ‘Do not interrupt’bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study. BMJ Qual Saf, 26(9), 734-742.
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