Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

The Assignment (Evidence-Based Project)

Part A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewedarticles you selected by completing the Evaluation Table within the CriticalAppraisal Tool Worksheet Template. Choose a total of four peer- reviewedarticles that you selected related to your clinical topic of interest in yourprevious assignments.

Note: You can choose any combination of articles from your previous assignments for your Critical Appraisal. For example, you may choose two unfiltered research articles from assignment 1 and two filtered research articles (systematic reviews) from assignment 2 or one article from assignment 1 and three articles from 2nd assignment. You can choose any combination of articles from the prior Assignments as long as both assignment articles and types of studies are represented.

Part B: Critical Appraisal of Research

• Based on your appraisal, in a 2-3-page critical appraisal, suggest a best practice that emerges from the research you reviewed.
• Briefly explain the best practice, justifying your proposal with APA citations of the research.

Criteria

This criterion is linked to a Learning Outcome

Part 3A: Critical Appraisal of Research Critical Appraisal of Research Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tool Worksheet Template. Be sure to include: An Evaluation Table

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5 pts

Part 3B: Evidence-Based Best Practices Evidence-Based Best Practices Based on your appraisal, suggest a best practice that emerges from the research you reviewed.

Briefly explain the best practice, justifying your proposal with the selected resources.

35 pts

Resource Synthesis

5 pts

Written Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria.

5 pts

Written Expression and Formatting—English Writing Standards: Correct grammar, mechanics, and proper punctuation.

5 pts

Written Expression and Formatting: The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.

5 pts

Total Points: 100

Critical Appraisal Tool
Worksheet Template
Evaluation Table
Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical
Appraisal of Research
Article #1
Article #2
Article #3
Article #4
Full APA formatted citation of
selected article.
Evidence Level *
(I, II, or III)
Conceptual Framework
Describe the theoretical basis for
the study (If there is not one
mentioned in the article, say
that here).**
Design/Method
Describe the design and how the
study was carried out (In detail,
including inclusion/exclusion
criteria).
Sample/Setting
The number and characteristics of
patients, attrition rate, etc.
© 2023 Walden University, LLC
1
Major Variables Studied
List and define dependent and
independent variables
Measurement
Identify primary statistics used to
answer clinical questions (You
need to list the actual tests
done).
Data Analysis Statistical or
Qualitative findings
(You need to enter the actual
numbers determined by the
statistical tests or qualitative
data).
Findings and Recommendations
General findings and
recommendations of the research
Appraisal and Study Quality
Describe the general worth of this
research to practice.
What are the strengths and
limitations of study?
What are the risks associated with
implementation of the suggested
practices or processes detailed in
the research?
© 2023 Walden University, LLC
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What is the feasibility of use in
your practice?
Key findings
Outcomes
General Notes/Comments
*Refer to the Johns Hopkins Evidence-Based Practice Model for Nursing and HealthcarePprofessionals, Hierarchy of Evidence Guide on the following page
**Note on Conceptual Framework
•
The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link
https://academicguides.waldenu.edu/library/conceptualframework
•
Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the
outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.
•
As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint.
By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”
•
Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects
to fill the gap in the literature.
•
Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.
© 2023 Walden University, LLC
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© 2023 Walden University, LLC
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References
The Johns Hopkins Hospital/Johns Hopkins School of Nursing (2022). Johns Hopkins evidence-based practice for nursing and healthcare professionals: appendix
D: Hierarchy of Evidence Guide
Grant, C., & Osanloo, A. (2014). Understanding, selecting, and integrating a theoretical framework in dissertation research: Creating the blueprint for your
house. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.
Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. https://academicguides.waldenu.edu/library/conceptualframework
© 2023 Walden University, LLC
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Matrix Worksheet
Template
Matrix Worksheet Template
Use this document to complete Part 1 of the Module 2 Assessment, Evidence-Based Project, Part 1: Identifying Research
Methodologies
Full citation of
selected article
Article #1
Alomari, A.,
Sheppard‐Law, S.,
Lewis, J., & Wilson, V.
(2020). Effectiveness of
clinical nurses’
interventions in
reducing medication
errors in a paediatric
ward. Journal of
Clinical Nursing, 29(1718), 3403-3413.
https://doi.org/10.1111/j
ocn.15374
Article #2
Berdot, S., Vilfaillot, A.,
Bezie, Y., Perrin, G.,
Berge, M., Corny, J., &
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), 153.
https://doi.org/10.1186/
s12912-021-00671-7
© 2021 Walden University, LLC
Article #3
Manias, E., Cranswick,
N., Newall, F.,
Rosenfeld, E., Weiner,
C., Williams, A., &
Kinney, S. (2019).
Medication error trends
and effects of
person‐related,
environment‐related
and
communication‐related
factors on medication
errors in a paediatric
hospital. Journal of
Paediatrics and Child
Health, 55(3), 320-326.
https://doi.org/10.1111/j
pc.14193
Article #4
Westbrook, J. I., Li, L.,
Raban, M. Z., Woods,
A., Koyama, A. K.,
Baysari, M. T., & White,
L. (2021). Associations
between doublechecking and
medication
administration errors: a
direct observational
study of paediatric
inpatients. BMJ Quality
& Safety, 30(4), 320330.
https://doi.org/10.1136/
bmjqs-2020-011473
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Why you chose this
article and/or how it
relates to the clinical
issue of interest
(include a brief
explanation of the
ethics of research
related to your clinical
issue of interest)
This article was
selected because it reports
the findings of action
research study on
interventions to reduce
medication errors. The
article is a peer-reviewed
journal article on various
interventions for medication
errors. It relates to the
clinical issue of interest
because it focuses on
means to address errors.
The study observes the
ethical consideration of
autonomy and informed
consent. This relates to the
research participants’ right
to withdraw from the study
at any moment.
This article was
selected for its contribution
to the research on solutions
to reduce medication errors.
It is a randomized controlled
trial on medication error
interventions to reduce
interruptions during
medication administration.
The article provides
evidence regarding the use
of ‘do not interrupt’ vests in
medications administration.
A potential ethical issue in
this study is the
confidentiality of patients’
information and data. All
data in the study was
processed anonymously
and participants’ identity
was protected.
The rationale for
selecting this study is its
reporting on factors
associated with medication
errors. It was selected
because it outlines
important factors to consider
in order to reduce errors. It
relates to the issue of
concern by outlining factors
leading to the problem of
medication errors. As a
retrospective evaluation, the
article has few ethical
concerns. However, it is still
necessary to ensure
informed consent is
obtained from the
participants. This study
presents no need for
informed consent.
Brief description of
the aims of the
research of each
peer-reviewed article
The aim of the study
was to test the effectiveness
of a bundle of interventions
to reduce medication errors.
The researchers’ aim was to
develop and implement
medication error reduction
interventions. This research
served to test the
effectiveness of the
methods and implemented
interventions. These
included mobile medication
The aim of the research
was to evaluate whether
wearing a ‘do not interrupt’
vest reduced medication
administration errors. The
‘do not interrupt’ vest is an
intervention whereby nurses
can reduce interruptions
from the environment when
administering medications.
The aim for the study was to
determine whether the vest
appropriately reduced
This study aimed to
retrospectively evaluate the
number of errors reported in
a hospital. The setting was
an Australian pediatric
hospital. The researchers
aimed to determine the
rates of errors in a five-year
period and also identify
person-, environment-, and
communication-related
factors affecting severity of
errors. The study sought to
© 2021 Walden University, LLC
This study was selected
for the project because of its
focus on medication
administration errors. It
contributes to the current
project by identifying a
potential intervention to
reduce errors. The topic of
medication errors is
associated with patient
harm and this article was
selected due to its potential
to reduce errors and hence
harm to the patients. The
study recruited pediatric
patients, a vulnerable
population. It is essential to
consider the rights of the
children and potential
impact of research on their
well-being. This study
presented no foreseeable
harm but also included
ethics approval.
The purpose of the
study was to improve
medications safety by
reviewing effectiveness of
an intervention. The
intervention was doublechecking, a process for
nurses to separately check
information and then share
it. The researchers identified
the lack of quantification of
double-checking in
preventing medication
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administration trolleys,
parental involvement,
monthly safety and quality
meetings, change in
medication administration
hours, and policy revision.
Brief description of
the research
methodology used
Be sure to identify if
the methodology used
was qualitative,
quantitative, or a
mixed-methods
approach. Be specific.
The methodology used
was action-research using a
quantitative research
approach. Quantitative
research involves statistical
data and hypothesis testing
(Hoare & Hoe, 2013). In this
study, for instance, the main
outcome is the rates of
medication errors reported
as errors per 1,000
prescribed medications. The
researchers evaluated the
rates of errors before and
after the interventions,
essentially a pre- and posttest quantitative approach.
interruptions and
consequently led to safer
medication administration.
This study focuses on a
potential solution to reduce
medication administration
errors in the ward.
The study was
conducted using a
quantitative methodology.
Specifically, it is defined as
a multicenter cluster
randomized controlled trial.
In this methodology, the
study was conducted by
randomly selecting hospitals
to participate in the study. A
comparison of pre- and
post-intervention rates of
errors in the intervention
and control groups was
conducted. Data was
analyzed using descriptive
statistics approach.
A brief description of
the strengths of each
of the research
methodologies used,
including reliability
and validity of how
the methodology was
The main strength of the
research methodology used
in this article is the inclusion
of employees and the valid
evaluation of the pre- and
post-intervention outcomes.
Action-research is
This study is reliable
and valid and preferred due
to the methodology. The
preference for randomized
controlled trial reduces bias
and enhances attribution of
outcomes to the
© 2021 Walden University, LLC
establish the frequency and
severity of errors including
factors that affected the
latter.
errors. The study, therefore,
sought to fill that gap and
determine whether doublechecking was associated
with reduction of frequency
and severity of errors.
The research
methodology was a
quantitative retrospective
audit of the hospital. The
audit was performed
through a collection of
quantitative statistical data
on medication errors.
Medication errors were
reported as errors per 1000
bed days. Data was
analyzed statistically using
SPSS with univariate
associations and multiple
logistic regression analysis.
The study is a
quantitative methodology
approach for analyzing
errors through observation.
Among participants, a
trained observer was
recruited to examine their
process for medications
preparation and
administration including
identifying any errors.
Medication administration
errors were also rated for
severity. Researchers then
compared errors before and
after intervention using
statistical data analysis.
This study has a good
quality of research and
methodology used for the
research process. The
researchers used a
retrospective study
approach. The advantage of
The direct observation of
staff presents a strength as
well as a weakness. On the
one hand, it promotes less
biased reporting and data
analysis to ensure a valid
and reliable process.
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applied in each of the
peer-reviewed articles
you selected.
advantageous in that the
staff are involved in making
permanent changes
(Banegas & de Castro,
2019). It can be classified
as a form of quality
improvement with a
research aspect. The main
tool used to measure
outcomes apart from rates
of errors was the Safety
Attitudes Questionnaire
(SAQ), a validated tool. The
reliability of the tool is high
with Cronbach alpha of 0.9
and validity acceptable. The
research methodology was
rigorous and hence the
article presents a valid and
reliable resource to consult
in the clinical issue
research.
interventions (Hoare & Hoe,
2013). Moreover, the study
was conducted in several
hospitals, increasing its
reliability and
generalizability. Reliability is
the confidence that the
outcomes can be replicated
and validity is the
confidence that the study
measures what it purports to
measure (Hoe & Hoare,
2012). It is reliable due to
the inclusion of several
hospitals. It is valid because
trained observers have
been deployed in the study.
this methodology is that
there is little risk of bias as
the evaluated events have
already occurred. Therefore,
a retrospective audit and
data analysis presents a
more objective and less
biased approach. The study
is valid since specific
records for medication
errors with voluntary
reporting were maintained
and used in this study.
Similarly, it is reliable
because the reporting
system and measures
remained constant
throughout the data
collection period.
Observers were rigorously
trained. On the other hand,
observation may increase
compliance with policy due
to the presence of the
observer in the participant’s
environment (Fix et al.,
2022). The Precise
Observation System for the
Safe Use of Medicines
(POSSUM) was the tool
used and its reliability is
high, about 0.83 alpha level.
It has also acceptable
validity. Overall, the article
presents an important
contribution in the
evaluation of doublechecking interventions.
General
Notes/Comments
© 2021 Walden University, LLC
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References
Alomari, A., Sheppard‐Law, S., Lewis, J., & Wilson, V. (2020). Effectiveness of clinical nurses’ interventions in reducing medication
errors in a paediatric ward. Journal of Clinical Nursing, 29(17-18), 3403-3413. https://doi.org/10.1111/jocn.15374
Banegas, D. L., & de Castro, L. S. V. (2019). Action research. In The Routledge handbook of English language teacher education (pp.
570-582). Routledge.
Berdot, S., Vilfaillot, A., Bezie, Y., Perrin, G., Berge, M., Corny, J., & 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), 153. https://doi.org/10.1186/s12912-021-00671-7
Fix, G. M., Kim, B., Ruben, M. A., & McCullough, M. B. (2022). Direct observation methods: A practical guide for health
researchers. PEC Innovation, 1, 100036. https://doi.org/10.1016/j.pecinn.2022.100036
Hoare, Z., & Hoe, J. (2013). Understanding quantitative research: Part 2. Nursing Standard, 27(18), 48–55.
https://doi.org/10.7748/ns2013.01.27.18.48.c9488
Hoe, J., & Hoare, Z. (2012). Understanding quantitative research: Part 1. Nursing Standards 27(15), 52–57.
https://doi.org/10.7748/ns2012.12.27.15.52.c9485
Manias, E., Cranswick, N., Newall, F., Rosenfeld, E., Weiner, C., Williams, A., & Kinney, S. (2019). Medication error trends and
effects of person‐related, environment‐related and communication‐related factors on medication errors in a paediatric hospital.
Journal of Paediatrics and Child Health, 55(3), 320-326. https://doi.org/10.1111/jpc.14193
Westbrook, J. I., Li, L., Raban, M. Z., Woods, A., Koyama, A. K., Baysari, M. T., & White, L. (2021). Associations between doublechecking and medication administration errors: a direct observational study of paediatric inpatients. BMJ Quality & Safety,
30(4), 320-330. https://doi.org/10.1136/bmjqs-2020-011473
© 2021 Walden University, LLC
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1
Database Search
Name
Institution
Course
Professor
Date
2
Database Search
The clinical issue of interested considered in this database search was medication errors
in the hospital. The rationale for considering this issue is that medication errors are a major cause
of preventable harm in the hospital setting. There are approximately 100,000 reports of suspected
medication errors reported to the Food and Drug Administration (FDA) each year (FDA, 2019).
Errors are a major cause of injury and adversely affect health safety and quality of care provided
to patients. Therefore, they must be addressed to promote high quality and safe care.
Interventions to reduce medication errors can be studied in current research.
The two databases included in this search were PubMed and Google Scholar. The search
was conducted based on the preliminary PICOT question: In an in-patient primary care setting
(P) does barcode medication administration (I) compared to no barcode (C) reduce the rates of
medication errors (O) in three months (T)? The proposed intervention, according to this PICOT,
is barcode medication administration. The keywords used in the search are: “medication errors”
and “barcode medication administration.”
The initial search produced 91 articles on PubMed after limiting the search to articles
published between 2000 and 2023 and free full-text available. However, after applying filters to
only include primary research, this narrowed to only 16 articles. Further, after limiting to the last
five years, only five articles met the criteria. Using the two keywords and changing the Boolean
phrase from AND to OR, the search was expanded to 528 results. From this search, it occurs that
the Boolean phrase and specific restrictions can expand or restrict the search results. The search
on Google Scholar presented the same patterns with more than 100 articles without restrictions
and less than 10 after all restrictions were applied.
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An effective way to increase the rigor of database search is to use several databases as
well as cross-referencing. Multiple database search can help produce the maximum number of
articles on the topic. For instance, an article could be on CONAHL but not on PubMed.
Moreover, cross-referencing is an important approach whereby using one article can help find
other articles in a snowballing approach (Morin et al., 2021). For instance, studies used in a
systematic review can be accessed as primary research. This can expand the number of articles
and help access high quality research.
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References
Morin, J. É., Olsson, C., & Atikcan, E. Ö. (Eds.). (2021). Research methods in the social
sciences: An AZ of key concepts. Oxford University Press, USA.
US Food and Drug Administration. (2019, Aug. 23). Working to Reduce Medication Errors.
https://www.fda.gov/drugs/information-consumers-and-patients-drugs/working-reducemedication-errors
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Evidence-Based Practice and Quadruple Aim
Name
Institution
Course
Instructor
Date
2
Evidence-Based Practice and Quadruple Aim
In healthcare, EBP entails utilizing the best available evidence and integrating that
evidence with clinical expertise as well as the values and needs of patients to inform healthcare
decisions. Kim et al. (2016) outline that EBP promotes the utilization of scientific evidence to
improve patient outcomes and update healthcare practices. Typically, EBP involves analyzing
existing studies, synthesizing data, and applying it to advance patient care. On the other hand, the
Quadruple Aim, according to Sikka et al. (2015), is an improved version of the Triple Aim
model as it encompasses four dimensions of healthcare transformation, including improving
population health, enhancing patient experience, lowering healthcare costs, and advancing the
well-being of healthcare professionals. Generally, the Quadruple Aim was established to advance
the performance of the healthcare system. As a result, EBP and Quadruple Aim are related in
such that EBP plays a big part in promoting the attainment of the Quadruple Aim’s objectives. In
other words, the implementation of EBP enables healthcare systems to attain the objectives of
Quadruple Aim by advancing patient experience and population health as well as decreasing
healthcare costs and improving healthcare providers’ well-being.
EBP might help reach the Quadruple Aim in several ways. When it comes to patient
experience, EBP can improve the experiences of patients by guaranteeing that healthcare
providers regardless of the clinical setting provide optimal and patient-centered care (Kim et al.,
2016). By applying EBP, healthcare providers can access the best evidence, and using this
evidence they can make well-informed choices about treatment approaches and medical tests. In
one way or another, EBP allows healthcare providers to minimize the occurrence of medical
errors, contributing to better health outcomes.
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Regarding population health, EBP is crucial as it contributes to better population health
results. Currently, healthcare systems play a big part in mitigating and addressing public health
issues that contribute to increased rates of mortality and morbidity. As a result, by applying EBP,
healthcare systems can implement comprehensive preventive measures and introduce appropriate
health initiatives and interventions that benefit all patient populations regardless of their age,
background, and gender, among other factors. Also, EBP enables healthcare organizations to
apply effective population health strategies that facilitate early detection and the use of suitable
treatment techniques, leading to better health results at the population level.
Increased healthcare costs are one of the major challenges associated with reduced
utilization of clinical and preventive services. However, through the application of EBP, the
issue of increased healthcare costs can be mitigated as it facilitates the use of effective practices
and approaches (Degu et al., 2022). Generally, EBP improves healthcare delivery processes by
helping healthcare professionals circumvent unwanted treatments, tests, and procedures,
lowering healthcare spending.
Lastly, when it comes to healthcare providers’ work life, the implementation of EBP can
improve their health and well-being. According to Crabtree et al. (2016), EBP methods
associated with statistical concepts, research, and study designs, improve the confidence of
healthcare providers, particularly nurses. With improved confidence, these healthcare providers
can make informed choices, reducing the occurrence of ethical dilemmas. In addition to that,
EBP streamlines work processes in clinical settings, reducing burnout rates. This contributes to
better job satisfaction among healthcare providers and the establishment of a supportive work
environment that values professional growth.
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References
Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing
engagement in evidence‐based practice. Worldviews on Evidence‐Based Nursing, 13(2),
172-175. https://doi.org/10.1111/wvn.12126
Degu, A. B., Yilma, T. M., Beshir, M. A., & Inthiran, A. (2022). Evidence-based practice and its
associated factors among point-of-care nurses working at the teaching and specialized
hospitals of Northwest Ethiopia: A concurrent study. Plos one, 17(5), e0267347.
https://doi.org/10.1371%2Fjournal.pone.0267347
Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A. M., & Davidson, J. E. (2016).
Predictors of evidence‐based practice implementation, job satisfaction, and group
cohesion among regional fellowship program participants. Worldviews on
Evidence‐Based Nursing, 13(5), 340-348. https://doi.org/10.1111/wvn.12171
Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and
meaning in work. BMJ quality & safety, 24(10), 608-610.
http://dx.doi.org/10.1136/bmjqs-2015-004160