Evidenced-Based Project

To Prepare:

• Reflect on the four peer-reviewed articles you critically appraised, related to your clinical topic of interest and PICOT.
• Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.

Consider the best method of disseminating the results of your presentation to an audience.

The Assignment: (Evidence-Based Project)

Part 4: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following:

• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:A summary of the critical appraisal of the peer-reviewed articles you previously submittedAn explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides). CriteriaRatingsPtsThis criterion is linked to a Learning OutcomePart 4: Disseminating ResultsCreate a, 8-9-slide narrated PowerPoint presentation of your Evidence-Based Project:Briefly describe the following: your healthcare organization and culture, current opportunity for change, scope of issue, and EBP best practice recommendation.Explain how you would plan knowledge transfer and dissemination.Describe measurable outcomes with the implementation of EBP best practice.Summarize lessons learned.75 to >67.0 ptsExcellentThe narrated presentation accurately and completely summarizes the evidence-based project. The narrated presentation is professional in nature and thoroughly addresses all components of the evidence-based project. …The narrated presentation accurately and clearly describes in detail the healthcare organization and culture, current opportunity for change, scope of the issue, and EBP best practice recommendation. …The narrated presentation accurately and clearly describes how to plan for knowledge transfer, disseminate the results of the project to an audience, citing specific and relevant examples. …The narrated presentation clearly and accurately describes measurable outcomes with the implementation of the EBP best practice and summarizes lessons learned.67 to >59.0 ptsGoodThe narrated presentation adequately summarizes the evidence-based project. The narrated presentation is professional in nature and adequately addresses the components of the evidence-based project. …The narrated presentation accurately describes in detail the healthcare organization and culture, current opportunity for change, scope of the issue, and EBP best practice recommendation. …The narrated presentation accurately describes how to plan for knowledge transfer, disseminate the results of the project to an audience, citing specific and relevant examples. …The narrated presentation accurately describes measurable outcomes with the implementation of the EBP best practice and summarizes lessons learned.59 to >52.0 ptsFairThe narrated presentation vaguely, inaccurately, or incompletely summarizes the evidence-based project. The narrated presentation may be professional in nature and somewhat addresses the components of the evidence-based project. …The narrated presentation inaccurately or vaguely describes the healthcare organization and culture, current opportunity for change, scope of the issue, and EBP best practice recommendation. …The narrated presentation inaccurately or vaguely describes how to plan for knowledge transfer, disseminate the results of the project to an audience, citing specific and relevant examples. …The narrated presentation vaguely or inaccurately describes measurable outcomes with the implementation of the EBP best practice and summarizes lessons learned.52 to >0 ptsPoorThe narrated presentation vaguely and inaccurately summarizes the evidence-based project or is missing. The narrated presentation is not professional in nature and inaccurately and incompletely addresses the components of the evidence-based project or is missing. …The narrated presentation vaguely and inaccurately describes the healthcare organization and culture, current opportunity for change, scope of the issue, and EBP best practice recommendation, no examples are provided, or it is missing. …The narrated presentation vaguely and inaccurately describes how to plan for knowledge transfer, disseminate the results of the project to an audience, citing no specific and relevant examples. …The narrated presentation vaguely or inaccurately describes measurable outcomes with the implementation of the EBP best practice and summarizes lessons learned.75 ptsThis criterion is linked to a Learning OutcomeResource Synthesis5 to >4.0 ptsExcellentThe narrated presentation fully integrates at least two outside resources and two or three course-specific resources that fully support the presentation.4 to >3.5 ptsGoodThe narrated presentation integrates at least one outside resource and two or three course-specific resources that may support the presentation.3.5 to >3.0 ptsFairThe narrated presentation minimally integrates resources that may support the presentation.3 to >0 ptsPoorThe narrated presentation fails to integrate any or presents minimal resources to support the presentation.5 ptsThis criterion is linked to a Learning OutcomePresentation Narration10 to >0.0 ptsExcellentNarration is present.0 ptsPoorNarration is missing.10 ptsThis criterion is linked to a Learning OutcomePowerPoint Presentation:The presentation is professional; images are appropriately attributed; images are clear. The presentation text is readable. Presentation flows well and is presented in a logical order.5 to >4.0 ptsExcellentThe presentation is professional; images are appropriately attributed; images are clear. The presentation text is readable. Presentation flows well and is presented in a logical order.4 to >3.0 ptsGoodEighty percent of the presentation is professional; images are appropriately attributed; images are clear. The presentation text is readable. Presentation flows well and is presented in a logical order.3 to >2.0 ptsFairSixty to seventy nine percent of the presentation follows these guidelines: presentation is professional; images are appropriately attributed; images are clear. The presentation text is readable. Presentation flows well and is presented in a logical order.2 to >0 ptsPoorLess than sixty percent of the presentation follows these guidelines: presentation is professional; images are appropriately attributed; images are clear. The presentation text is readable. Presentation flows well and is presented in a logical order.5 ptsThis criterion is linked to a Learning OutcomeWritten Expression and Formatting—English Writing Standards:Correct grammar, mechanics, and proper punctuation.5 to >4.0 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.4 to >3.0 ptsGoodContains a few (one or two) grammar, spelling, and punctuation errors.3 to >2.0 ptsFairContains several (three or four) grammar, spelling, and punctuation errors.2 to >0 ptsPoorContains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.5 ptsTotal Points: 100

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
1
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
2
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.
3
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
4
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
5
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.
3
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.
4
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
1
Evidence-Based Project Critical Research Appraisal
Name
Institution
Course
Professor
Date
2
Evidence-Based Project Critical Research Appraisal
Safe medication preparation and administration practice are integral to the consistent
delivery of quality and effective clinical care services that result in better health outcomes for
patients. However, the complexities of the processes for completing these tasks and the existence
of various organizational and human factors make it difficult for nurses and other clinicians to
prevent errors during these processes (Manias et al., 2019). In this medication errors are major
clinical issues that should be addressed through evidence-based practice measures to strengthen
the capacity of hospitals and clinics to deliver safe and effective care to patients. Therefore, this
paper presents the findings from a critical appraisal of peer-reviewed literature on the best
practices for reducing medication administration error rates and the severity of their potential
harm to patients and other stakeholders.
Part 3A:
Full APA
formatted
citation of
selected
article.
Article #1
Article #2
Article #3
Article #4
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/10.11
86/s12912-02100671-7
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/10.11
36/bmjqs-2020011473
Degu, A. B., Yilma,
T. M., Beshir, M. A.,
& Inthiran, A.
(2022). Evidencebased 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/10.13
71%2Fjournal.pone.
0267347
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), 34033413.
https://doi.org/10.1
111/jocn.15374
3
Evidence
Level *
Level I
Level I1
Level II
Level II
Conceptual
Framework
No conceptual
framework was
indicated.
No conceptual
framework was
indicated.
No conceptual
framework was
indicated.
No conceptual
framework was
indicated.
Design/
Method
A multicenter,
cluster, controlled,
and randomized trial
that used direct
observation for data
collection from the
experimental and
control groups. The
inclusion criteria are
nurses who worked
in the selected units
and medication
administration
during nonemergencies, while
nurses who worked
in multiple units and
medication
administration
during emergencies
were excluded.
Participants in the
experimental group
wore “Do not
interrupt” vests
during medication
rounds and their
patients were
educated using
posters. The control
group did not use the
vest during
medication rounds
A prospective direct
observational study
of medication
administration
practices of nurses in
a tertiary pediatric
hospital. The study
used 7 observers
who were trained
extensively on how
to collect real-time
observational data of
the variables,
including a number
of interruptions
using the specialized
handheld device.
The observation of
medication
administration was
conducted during
designated times by
randomly selected
observers over 22
weeks. No inclusion
or exclusion criteria
were indicated.
A concurrent mixed
study was conducted
at two tertiary
medical facilities.
Systematic random
sampling was used
for selecting
participants for the
quantitative
research, while
purposive sampling
was used for those in
the qualitative study.
Nurses with a
minimum of BSN
degree at these
facilities were
included while those
on leave, working as
academic staff,
postgraduate nursing
students, and freshgraduate nurses were
excluded from the
study. Quantitative
data was collected
using a pretested,
self-administered
questionnaire, while
an in-depth
interview was used
to collect qualitative
data.
A three-phase
quantitative action
research design
that used the pretest and post-test
approach to
generate data from
the study setting.
Convenience
sampling was used
to select the
participants who
provided the study
data. No inclusion
and exclusion
criteria were
indicated by the
researchers. Data
were collected
from the incident
information
management
system for all
phases, audit of
medication
handling practices
of nursing staff
during phases 1
and 3, and
questionnaires
from all staff
during phases 1
and 3.
(I, II, or III)
Describe the
design and
how the study
was carried
out (In detail,
including
inclusion/excl
usion
criteria).
4
and no poster was
placed in their units.
Sample/
Setting
The number
and
characteristics
of
patients,
attrition rate,
etc.
Major
Variables
Studied
List and
define
dependent and
independent
variables
A total of 178 nurses
and 1,346 adult
patients were
sampled from 29
adult inpatient units
of 4 hospitals.
Participants were
randomly sampled
into the
experimental and
control group in a
ratio of 1:1 and no
attrition rate was
reported by the
researchers.
A total of 298 nurses
and 1,523 pediatric
patients were
sampled from 9
medical/surgical
wards of a 340-bed
tertiary children’s
hospital. No attrition
rate was reported.
Independent
variables:
Characteristics of
the nurse, nurse
workload, time for
the round, and drug
prepared and
administered.
Dependent
variables:
Administration error
rate, types of error,
rates and types of
interruption, nurses’
experiences, and
potential clinical
impact of the errors.
Independent
variables:
Characteristics of
patients and nurses,
and dose
administrations.
Dependent
variables:
Independent doublechecking and
medication
administration error
rate and types.
A total of 507 nurses
who met the
inclusion criteria
consisting of 10
administrative
nurses, 34 nurse
leaders, and 463
staff nurses were
sampled for this
study. 12 out of this
sample population
were randomly
selected for the indepth interview
session. No attrition
rate was reported.
Independent
variables:
Age, educational
level, work
experience, current
place of work,
working unit, work
position, and
training related to
EBP.
Dependent
variables:
EBP, EBP
knowledge,
preferences/use of
available
information sources,
awareness about
electronic
information sources,
information
searching skills,
nurses’ self-efficacy,
attitude, and factors
associated with
A total of 36 staff
nurses, which
consist of 33
registered nurses,
2 emergency
nurses, and 1
nursing assistant
were sampled
from the staff
population of the
specialized
pediatric ward of a
17-bed hospital.
Independent
variables:
Medication
management and
handling,
teamwork climate,
safety climate, job
satisfaction, stress
recognition, and
perceptions of
management and
working
conditions.
Dependent
variable:
Medication error
rate.
5
evidence-based
practice.
Measurement Opportunities for
Error (OE),
calculated as one or
more errors divided
by the Total
Opportunities for
Error (TOE) and
multiplied by 100).
Data Analysis The collected were
Statistical or analyzed using the
Chi-2 test, mixed
Qualitative
logistic regression
findings
model, univariate
analysis, and odds
ratios (95% CI, pvalue < 0.05). The study found that administration error rates were higher for the experimental group (7.09%) than the control group (6.23%) despite having a lower interruption rate of 15.04% as compared to 20.75% for the latter. Generalized linear mixed models (GLMMs) to test the relationship between double-checking and the occurrence and potential severity of errors. Logistic regression and multinomial ordinal logistic regression were used for statistical analysis of the data collected. The results showed that 92.5% of the 3,563 medication administrations that required mandatory double-checking received primed double-checks. Also, the association between doublechecking and MAE and potentially severe MAE was statistically insignificant at (OR 0·89 (0·65–1·21); p=0·44) and (OR 0·86 (0·65–1·15); p=0·31) respectively. Inferential statistics of the EBP and its associated factors among nurses using the Shapiro–Wilk test of the selfreported, structured questionnaire. Descriptive statistical analysis, chi-square test, multi-colinearity test, and binary logistic regression were performed for the collected data at 95% CI and a pvalue of 0.05. Higher educational level, administrative support, positive attitude towards EBP, and availability of preferred information sources were found to be related to EBP. No statistical measurement or test was conducted. Descriptive statistical analysis, Poisson regression analysis, and twotailed t-test were performed for the collected data at 95% CI and a pvalue of 0.05. Medication error rates were reduced by 56.9% after implementing the interventions despite the increased rate of medication prescription and a higher number of patients. 6 Findings and Do-not-interrupt Recommenda vests are ineffective tions in reducing rates of medication administration errors and interruptions. General findings and recommendati ons of the research Educational levels, administrative support, availability of preferred information sources, and positive attitude towards EBP are vital to encouraging nurses to use EBP at a high level. The active involvement of clinical nurses in safe medication use policies is vital for reducing medication error rates in hospitals. Appraisal and Study Quality The study provided credible and reliable evidence on the factors that promote the use of EBP in nursing practice. Its main strengths are the use of mixed method research design, pre-testing of tools and procedures, high response rate (97.5%), and potential generalization of the findings. However, its main limitation is the lack of existing local data or studies to compare the results with before making inferences. The study's findings have implications for practice, education, and research, which means that there are no potential risks associated with its implementation in practice. As a result, there is a possibility The study provided highlevel evidence on the use of a bundle of nurse-based interventions in reducing MAE rates and improving the safe medication practices of nurses. Its main strength is the study of threephase action research. However, its main limitations include failure to measure the independent effects of each intervention, use of a single site, and risk of biases due to the use of self-reporting questionnaires. In this regard, the failure to utilize the multidimensional approaches used in the study when implementing the findings in Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementatio n of the suggested practices or processes detailed in the research? What is the feasibility of Prime doublechecking is mostly used by nurses but does not have a better impact on medication error reduction rates or potential severity of harm than singlechecking despite high compliance by nurses. The study provided The study provided high-level evidence credible and reliable on the use of do-not- evidence on the interrupt vests to patient safety prevent MAEs in benefits of practice. The study's mandatory doublemain strength is its checking policies of use of clusterhospitals. The controlled study's main strength randomized design is the provision of to prevent all forms additional scientific of biases and evidence on the Hawthorne effects concerns regarding from impacting its the effectiveness of results. However, its mandatory doublemain limitations are checking in that it failed to preventing MAEs address the and directions for heterogeneity of the future research. groups during the However, these intervention phase, findings are limited standardize the by their use of direct practice, and include observation as a data other measures to collection method prevent potential and the use of a interruptions. subsample to Therefore, the use of generate time and the study's findings cost estimates. Also, is feasible in practice there are no potential and would not place risks from the patients, staff, implementing the and organization at practices for doubleany risk. checking medications before 7 use in your practice? administration in any clinical setting. Therefore, there is a high feasibility of using these findings in my practice. of using these results practice would in my practice. present a risk of failure, thereby making their use in resourceconstrained practices such as mine non-feasible. Key findings The use of do-notinterrupt vests has zero impact on reducing administration error or interruption error rates. The high compliance with mandatory double-checking does not have positive impacts on efforts to reduce MAE rates and potential severity from them. The factors related to the use of evidence-based practice in nursing. Outcomes Low administration error and interruption rates. Low MAE rates and potential severity of MAEs. Improved use of EBP by nurses. General Notes/Comm ents A bundle of interventions is effective in reducing medication error rates and promoting safe medication use practices in any clinical setting. Low MAE rates and better medication administration practices by nurses. 8 Part 3B: Critical Appraisal of Research The best practice for reducing medication administration error rates and their related adverse events in any healthcare setting was identified from the critical appraisal of current peerreviewed research articles. According to Alomari et al. (2020), a bundle of interventions is the most appropriate measure for addressing the different elements of the factors that result in different types of medication errors. In this regard, their study recommended an MAE-reduction bundle that consists of mobile medication administration trolleys, patient and family engagement, incident review meetings, changes in medication rounds, and an updated medication use policy (Alomari et al., 2020). Also, the components of this bundle of interventions are expected to eliminate the risk factors during preparation and administration processes and permit the integration of other measures for enhanced safe medication use in the clinical setting. Similarly, the incorporation of patient and family engagement during medication administration is necessary to eliminate the risks of route errors, wrong patient, wrong doses of the right medications, and other forms of medication errors that diminish the quality and safety of patient care in high-risk medical settings such as general and surgical units for pediatric patients (Manias et al., 2019). Therefore, a comparative analysis of the benefits of this best practice with other measures was performed to determine its potential to address this patient safety problem. Mandatory double-checking and do-not-interrupt vests are other preventive methods against medication administration errors that were identified in the literature. Berdot et al. (2021) noted that the use of a do-not-interrupt vest during medication preparation and administration processes by nurses is considered by most healthcare organizations as an effective method for reducing the risks of medication errors in their units/wards. However, the outcomes of their 9 multicenter controlled randomized trial showed that these vests do not provide any significant impacts on efforts to reduce MAE rates. Also, Westbrook et al. (2021) claimed that their direct observational study did not find any beneficial effect of using mandatory double-checking to reduce MAE rates or the potential harm that could result from patients' exposure to them. While this study provided moderate evidence to demonstrate the ineffectiveness of double-checking as a safe medication practice, Alomari et al. (2021) found that its inclusion as part of nurse-led bundle intervention would address some of the limitations to its effectiveness that Westbrook et al. (2021) identified in their study. Specifically, the perception that double-checking increases nurses' workload and requires time that nurses do not have, would be addressed through the medication administration schedule that is included in Alomari et al.'s (2021) recommended bundle of targeted interventions. Therefore, there is strong evidence from peer-reviewed literature that a nurse-led bundle of intervention is the best practice for addressing the factors that contribute to medication errors and eliminating the potential occurrence of their related adverse events. Conclusion Medication errors remain a major patient safety issue that increases patients' risks of mortality and morbidity due to the complexities of their causes. While research interests in various interventions to deal with the human and organizational factors that contribute to the problem have increased recently, the identification and use of a bundle of targeted interventions remain low among healthcare organizations. However, the critical appraisal of multiple research studies showed that the simultaneous implementation of multiple interventions is most effective in addressing the problem. As a result of the strength of evidence on the efficacy of this 10 intervention, it is recommended as the best practice and reducing the occurrence of medication errors and their related harm to patients and nurses in any clinical setting. 11 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 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 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 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 double-checking 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