Week 5 Research Proposal Project: Implementation Plan (Ethics, Recruitment, Data Collection)

Implementation Plan

For this section of your research proposal assignment, you will focus on the implementation plan, which includes considerations for ethics, recruitment practices, and a plan for how you will collect your data. Please note that you will not explain how to analyze your data in this section, but rather how you will go about collecting the data.

The following components must be addressed:

• Explain how you will ensure your research is conducted in an ethical manner
• Include a copy of an informed consent that will be included for participants of your research proposal project (see pp. 202–203 for a sample)
• Explain how you will recruit participants for your study, and how your recruitment process will remain ethical. Be sure to address any incentives (if applicable)
• Explain what quantitative data you will collect and how you will go about collecting this data (survey, questionnaire, observation, etc.)

APA formatting, references, and citations are required.

Your research project implementation plan should be included as part of your final submission for your research proposal project in week 7 and your research proposal presentation in week 8. Use the feedback you receive from your instructor on your implementation plan to modify and improve before submission of your final project in weeks 7 and 8.

Due Sunday, 11:59 p.m. (Pacific time)

Points Possible: 75

1
In Acute Care Settings, How Does the Use of Electronic Health Records Compared to
Paper Based Systems Impact Medication Documentation Errors and Patient Safety During
the Last Decade?
Literature Review
Michelle Caballero
Professor Knapp
West Coast University
January 27, 2024
2
In Acute Care Settings, How Does the Use of Electronic Health Records Compared to
Paper Based Systems Impact Medication Documentation Errors and Patient Safety During
the Last Decade?
Nursing documentations are records of nursing care that are planned and are given to
patients by qualified nurses within the healthcare environment (Bjerkan et al., 2021). This
documentation is used for various purposes within the healthcare environment such as quality
assurance and the improvement of patient care outcomes. It is a critical aspect of healthcare
provision and serves various purposes such as enhancing communication among healthcare
providers, continuity of care, legal and regulatory requirements, and supporting evidence-based
practice. Adequate nursing documentation is vital in ensuring patient safety, quality of care, and
effective communication between interdisciplinary healthcare team (Bjerkan et al., 2021).
The literature review in this case, will synthesize existing knowledge on medication
documentation errors with a focus on acute cares settings. Specifically, it will provide a
comparison between electronic health record system and paper-based system during the last
decade. Through evaluation of the current state of research, existing gaps, and key findings, the
review will help contribute to the growing body of evidence on nursing documentation practices.
Moreover, by incorporating a comparative analysis, the research will help uncover the unique
challenges posed by each documentation system and their overarching impact on patient safety.
Overview of medication documentation errors
According to Tsegaye et al. (2020), medication documentation errors are those errors that
occur due to inaccuracies, omissions, or discrepancies in the recording and documentation of the
patient’s medication related information. Tsegaye et al. (2020) further noted that these errors can
3
occur at any stage of the medication process from prescription and dispensing to administration
and monitoring. When it comes to nursing documentation, accurate documentation of patient
medication can literally mean life or death. Improper medication documentation can have serious
impact on patient treatment outcomes. Tsegaye et al. (2020) also noted various medication
documentation errors such as sloppy handwriting, prescription errors, dispensing errors,
documentation omission, incomplete documentation, and administration errors. Such errors may
impact patient treatment outcome because failure to document patient medication can result in
administration of the wrong drug to the patient.
Bjerkan et al. (2021) in their study on patient safety through nursing documentation
argued that high quality patient medication documentation in acute care setting is vital in
ensuring the continuity of care, quality of care and patient safety. In their analysis, the authors
noted that new technology has created a new set of opportunities for healthcare workers
particularly to improve on patient safety. The introduction of EHRs has enabled nurses to
improve documentation structures to promote increased standardization. While nurses are the
primary point of contact with patients, ensuring proper medication documentation is vital in
improving quality and patient safety spectrum.
In their study on medication administration errors and their contributing factors,
Wondmieneh et al. (2020) noted that there are many contributing factors to medication
administration errors. One of the primary factors is medication documentation errors whereby
nurses fail to document vital patient treatment information such as medication dosage,
medication timeline, wrong drug, and omission of doses (Wondmieneh et al., 2020). The author
further noted that adequate documentation of the patient medication information is critical in
4
ensuring that there is flow of patient treatment journey that facilitate communication among
healthcare workers.
Evolution of Nursing Documentation Systems
The evolution of nursing documentation system highlights the transformative journey of
the medication documentation from traditional paper method to modern methods that are driven
by technology (Shafiee et al., 2022). This transformation has been aimed at enhancing the
efficiency and quality of patient care. Shafiee et al. (2022) noted that nursing documentation has
been historically rooted in handwritten notes and manual records and has continued to transition
into electronic health record system and other more advanced digital platforms. The continued
evolution of nursing documentation system has been driven by several factors such as improved
accessibility to patient health records, improved communication between interdisciplinary teams,
and the need to comply with the regulatory standards (Shafiee et al., 2022).
Initially, patient medication records were hand written and stored in paper-files which
were so unreliable when it comes to the provision of a comprehensive patient healthcare (Shafiee
et al., 2022). With the advancement in technology, recording, storage, and sharing of patient
medication records have been eased through the development of electronic health record system.
Electronic health record system offers numerous advantages to nurses such as real-time data
updates, interoperability, and streamlined patient information retrieval which facilitates a more
comprehensive and interconnected approach to patient care (Shafiee et al., 2022). The shift in
nursing documentation thus signifies a promise for increased efficiency and accuracy in patient
medication documentation. Shafiee et al. (2022) further noted that the ongoing evolution of
5
nursing documentation system represents a rapid change in the healthcare landscape with the
need to balance the benefits of technology and patient safety and continuity of care.
Rinne et al. (2023) examined approaches for transition to EHRs and noted that
transitioning to EHRs is a complex organizational change that requires adequate planning and
execution. Many healthcare organizations that transition from paper-based record system to have
the potential to realize improve healthcare outcomes for their patients. According to Rinne et al.
(2023), there are several drivers and motivations for transitioning to EHRs. These drivers include
but not limited to improving patient treatment outcomes, reduction of medication documentation
errors, and improving communication between different providers and interdisciplinary
healthcare team.
Comparative Studies on Medication Documentation Errors
Patient information is an important asset in healthcare delivery and proper documentation
of this information is vital in the delivery of high quality patient care. In a study conducted by
Abiy et al. (2018), it was noted that quality nursing documentation is a vital aspect of healthcare
delivery. However, nursing documentation varies depending on the need of patient and the
healthcare organization. In their study, Abiy et al. (2018) noted that utilizing EHRs enhances
patient care by providing a more comprehensive and efficient approach of managing and sharing
patient information. The author further noted that EHRs can also minimize medication
documentation errors by improving accuracy of patient medication records, making health
information more readable, and enabling Interprofessional healthcare team to share patient health
information in a more effective and dynamic manner.
6
Ayatollahi et al. (2009) compared paper-based and computer based medical record
system and noted that computer based medication documentation is vital since it helps nurses in
avoiding duplication of medication records. The author further noted that EHRs helps in
increasing speed of processing patient medication records during emergency situations thus
facilitating faster and more streamlined patient care. Ayatollahi et al. (2009) argued that, in acute
care setting, patient past medication records are vital in facilitating faster medication. However,
paper-based recording system cannot facilitate faster retrieval and use of past medication records
of patients. However, EHRs improves access to patient medication records including past
medication, notes, diagnosis, and other critical information that can help in improving clinical
decision making. In their study Slyngstad and Helgheim (2022) noted that EHRs facilitates better
decision making within the acute healthcare setting. The authors further noted that EHRs
improves the legibility of writing by healthcare professionals such as physicians. One of the
challenges of paper-based medication documentation is that it is subject to errors in writing
whereby the nurse or the physicians may compose patient information upon diagnosis in
handwritten notes that can be wrongly read or interpreted based on eligible handwriting. In this
case, EHRs can help minimize such errors thus reducing errors in dispensing of medication drugs
and providing accurate medication.
Impact of Medication Documentation Errors on Patient Safety Outcomes
Medication documentation errors have adverse impact on patient safety outcomes within
the acute care settings. Emmerich (2023) examined some of the impacts that medication
documentation errors have on patient health outcomes. In his study, he highlighted some of the
7
medication documentation errors that are common within the acute care setting. These errors
included errors of omission, prescription, dispensing, incomplete documentation, and
transcription errors. These errors have adverse impact on how acute care patients are handled by
nurses. For instance, errors in prescription that result from poor documentation can sometimes
lead to wrong prescription particularly when acute care nurses have incomplete or wrong
prescription information of the patient (Emmerich, 2023). According to Tsai et al. (2020),
documentation errors that occur through the use of paper-based documentation often result in
errors in interpretation that can further limit effect diagnosis and treatment of patients within the
acute care setting. However, a reduction in medication errors and adverse events not only
improve patient care within the acute care setting but also reduces the cost involved in treatment
of patient within the acute care setting (Campanella et al., 2016).
Conclusion
As hospitals and other healthcare organizations continues to transition to electronic health
record system (EHRs) from paper based system, it is imperative to understand the impact of this
shift more so on patient medication documentation errors and safety outcomes. The introduction
of EHRs has enabled many healthcare organizations to enjoy accessibility of patient health
records, interoperability, and real-time health information update. However, the introduction of
this electronic health record system also introduced new sets of challenges and risks that may
compromise the reliability and accuracy of patient medication documentation and other related
information. In this case, a thorough exploration of the comparative impact of electronic health
record system and paper-based system on medication documentation errors is critical. This
information will help inform evidence-based practice and provide an important guide on how
healthcare professionals can optimize patient care.
8
References
Abd El Rahman, A., Ibrahim, M., & Diab, G. (2021). Quality of Nursing Documentation and its
Effect on Continuity of patients’ care. Menoufia Nursing Journal, 6(2), 1–18.
https://doi.org/10.21608/menj.2021.206094
Abiy, R., Gashu, K., Asemaw, T., Mitiku, M., Fekadie, B., Abebaw, Z., Mamuye, A., Tazebew,
A., Teklu, A., Nurhussien, F., Kebede, M., Fritz, F., & Tilahun, B. (2018). A comparison
of electronic records to paper records in Antiretroviral Therapy Clinic in Ethiopia: What
is affecting the Quality of the Data? Online Journal of Public Health Informatics, 10(2).
https://doi.org/10.5210/ojphi.v10i2.8309
Ayatollahi, H., Bath, P. A., & Goodacre, S. (2009). Paper-based versus computer-based records
in the emergency department: Staff preferences, expectations, and concerns. Health
Informatics Journal, 15(3), 199–211. https://doi.org/10.1177/1460458209337433
Bjerkan, J., Valderaune, V., & Olsen, R. M. (2021). Patient Safety through Nursing
Documentation: Barriers Identified by Healthcare Professionals and Students. Frontiers
in Computer Science, 3(1), 1–11. https://doi.org/10.3389/fcomp.2021.624555
Campanella, P., Lovato, E., Marone, C., Fallacara, L., Mancuso, A., Ricciardi, W., & Specchia,
M. L. (2016). The impact of electronic health records on healthcare quality: a systematic
review and meta-analysis. The European Journal of Public Health, 26(1), 60-64.
Emmerich, E. (2023). Benchmark Study: Impact of Electronic Health Records vs. Paper-based
Records.
9
Rinne, S. T., Brunner, J., Mohr, D. C., Adena-Cohen Bearak, & Anderson, E. (2023). Practices
Supporting Electronic Health Record Transitions: Lessons from Four US Healthcare
Systems. Journal of General Internal Medicine, 38(S4), 1015–1022.
https://doi.org/10.1007/s11606-023-08279-0
Shafiee, M., Shanbehzadeh, M., Nassari, Z., & Kazemi-Arpanahi, H. (2022). Development and
evaluation of an electronic nursing documentation system. BMC Nursing, 21(1).
https://doi.org/10.1186/s12912-021-00790-1
Slyngstad, L., & Helgheim, B. I. (2022). How Do Different Health Record Systems Affect Home
Health Care? A Cross-Sectional Study of Electronic- versus Manual Documentation
System. International Journal of General Medicine, Volume 15, 1945–1956.
https://doi.org/10.2147/ijgm.s346366
Tsegaye, D., Alem, G., Tessema, Z., & Alebachew, W. (2020). Medication Administration
Errors and Associated Factors Among Nurses. International Journal of General
Medicine, Volume 13(13), 1621–1632. https://doi.org/10.2147/ijgm.s289452
Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020). Medication administration errors
and contributing factors among nurses: A cross sectional study in tertiary hospitals, Addis
Ababa, Ethiopia. BMC Nursing, 19(4), 1–9. https://doi.org/10.1186/s12912-020-0397-0
1
Research Proposal Project: Design (Sampling, Reliability, Validity)
Michelle Caballero
Professor Knapp
West Coast University
February 3, 2024
2
Research Proposal Project: Design (Sampling, Reliability, Validity)
The research study will employ a systematic review approach whereby the evaluation of
secondary research studies will be conducted. In this methodology, major databases will be used
to search relevant sources. The notable databases that will be used include PubMed, Medline,
Google Scholar, and Web of Science. To search the relevant sources that answer the underlying
research question, a comprehensive search strategy will be utilized to identify the studies that are
pertinent to the research topic (Borges Migliavaca et al., 2020). Relevant key terms, phrases,
MeSH terms, and other Boolean terms will be used to search relevant articles that answer the
underlying research questions. The systemic review approach will only incorporate peer review
articles, journals, and other research papers for more precise and credible results. PRISMA
guidelines and JBI assessment will be utilized to evaluate the obtained studies since the two tools
are considered to be highly reliable when it comes to the evaluation of research studies.
Sample Size
All studies chosen for systematic review will follow the inclusion and exclusion criteria.
The full study articles that will be designated for synthesis must meet the stated and standardized
inclusion criteria that include peer-reviewed, relevant to the research topic, and focused on the
use of an electronic health record system compared to the paper-based system and how it has
impacted medication documentation and patient safety of the last decade. In this case, the study
will synthesize 15 research studies. PRISMA guidelines and JBI assessment will be utilized to
appraise, evaluate, and screen a total of 15 research studies that are pertinent and answer the
primary research questions. The sample size of 15 peer-reviewed research studies supports the
3
acclaimed practices highlighted in the PRISMA procedures and JBI assessment for systematic
reviews (Zeng et al., 2015). This sample size is suitable because it permits for an inclusive
synthesis of the current literature, making sure there is passable coverage to draw significant
conclusions and insights from the gathered evidence.
Reliability
A systematic review of research studies appropriate to the study topic is consistent and
reliable in the sense that it incorporates a predefined and clear approach for examining, choosing,
and gathering data from applicable peer-reviewed articles and journals. This methodology
ensures there is uniformity and reliability in the research process (Zeng et al., 2015). The practice
also follows the predefined inclusion and exclusion criteria which enable it to minimize any form
of biases, thus enhancing the reliability of the collected data. More importantly, the systematic
review approach ensures transparency by following the stated guidelines which allows for further
replication of the study and fosters the synthesis of evidence which leads to a robust and
trustworthy conclusion. PRISMA guidelines and JBI assessment are the measurement tools or
the quality assessment tools that will be used in this study (Zeng et al., 2015). These tools are
reliable because they provide a standardized and transparent framework for appraising the
quality of each study included in the systematic review.
Validity
In systematic review studies, having a valid sample ensures there is sufficient data and
evidence that are vital in answering the underlying research question. In this study, to ensure
there is a valid sample, the study will utilize carefully defined inclusion and exclusion criteria
when selecting the study samples to be included in the review. The study will also involve a
4
comprehensive literature search, properly documenting the literature search strategy that
minimizes biases (Sullivan, 2011). This will be conducted through independent dual screening
through the use of PRISMA guidelines and JBI assessment thus ensuring the validity of the
sample. The validity of the measurement tools will be assessed through convergent validity and
discriminate validity. A high correlation in the scores obtained through the two techniques will
indicate high validity.
5
References
Sullivan, G. M. (2011). A Primer on the Validity of Assessment Instruments. Journal of
Graduate Medical Education, 3(2), 119–120. https://doi.org/10.4300/jgme-d-11-00075.1
Borges Migliavaca, C., Stein, C., Colpani, V., Barker, T. H., Munn, Z., & Falavigna, M. (2020).
How are systematic reviews of prevalence conducted? A methodological study. BMC
Medical Research Methodology, 20(1). https://doi.org/10.1186/s12874-020-00975-3
Zeng, X., Zhang, Y., Kwong, J. S. W., Zhang, C., Li, S., Sun, F., Niu, Y., & Du, L. (2015). The
Methodological Quality Assessment Tools for Preclinical and Clinical Studies,
Systematic Review and meta-analysis, and Clinical Practice Guideline: a Systematic
Review. Journal of Evidence-Based Medicine, 8(1), 2–10.
https://doi.org/10.1111/jebm.12141