Evidence-Based Nursing Practice and Patient Safety NSG4053

1.Background of the study (Total: 5 marks)

1.1. Provide a summary of the introduction and background identifying the key concepts of the article. (100 - 150 words)

The research by Berdot et al. (2021) examines whether the use of do not interrupt vest intervention which is worn by medication administration staff minimizes the number of medication errors in clinical areas. Medication errors pose a significant threat in nursing since they impact patients outcomes. The introduction starts underlining that these errors are caused by interruptions during medications administration. The study will fill the gap of literature on creating Continuum environments for nurses to work without interruptions to minimize errors. The study aimed to use a crossover where interruptions were to be compared in different healthcare sectors in order to establish the effectiveness of the visual cue (vests with do not interrupt) message (Berdot et al., 2021). Westbrook et al. (2010) have established in prior work that interruptions during medications administration raise the probability of medical errors, and therefore, efforts to minimize interruptions are essential to improve quality of care. Focusing on the patient safety issue in medication administration, the article contextualises the need for a system to reduce distractions and outlines the deficiencies of the existing distractive minimisation interventions. Accordingly, the study presents the vest intervention as a realistic solution to this issue.

1.2.Why is the article relevant to nursing practice? (100 150 words)

This article is highly relevant to nursing practice as it addresses a common and critical issue. The major categories of adverse events that pharmacies became involved with were medication administration errors. Nurses get intermittent interruptions during the medication rounds and this makes them prone to errors that are dangerous to patients. In doing so, the study contributes to the state of knowledge of the best practice for an intervention purported to reduce these disruptions and improve enactment in clinical areas. Hayes et al. (2015) pointed that medication errors have ramifications that include higher morbidity and mortality of patients Thus, vest intervention studys results indicate that error usage could be effectively decreased by effective training and changes in the system. This study raises awareness on the need to enhance the environment in which the nurses work, in order to allow them to optimally execute their tasks in a process that seeks to enhance patient outcomes and safety.

2.Overview of research design (Total: 5 marks)

2.1What was the aim of the research? (25- 50 words)

The primary aim of the study is to establish the efficacy of the do not interrupt vest intervention in the reduction of actual interruptions and potential medication errors in a set of hospitals and a health centre in a multicentre cluster randomised controlled trial.

The secondary aim is to assess the nature and possible consequences of errors such as the relationship between errors and numerous risk factors such as interruptions and perceptions of the nurses

2.2. What research design did the authors use? Was it appropriate? Why/why not? (150 -200 words)

The authors used a multicentre, cluster-randomized controlled trial (RCT) for this study. This was an appropriate design because by using randomisation in the study, the research would be able to look at outcomes across many sites in the different hospitals. In medical study, RCTs are considered to have a very high level of evidence because they have minimal bias (Fletcher et al., 2021). The application of the cluster design where instead of individual subjects were generalized into groups (cluster) was inevitable because whole units were enrolled in the intervention (Berdot et al., 2021). A randomized controlled trial is acknowledged as a sound approach of indicating causality, which is always desirable when compared to interventions in healthcare. However, that kind of obstacles like cluster contamination: this means that people outside the target intervention group may also change behaviours and that risk has to be managed. For instance, in a cluster contamination, sometimes, populations other than the intervention group may also alter their behaviours and such a scenario has to be well managed during the research (Berdot et al., 2021).

3. Data collection (Total: 10 marks)

3.1 How was the data collected? (50 -100 words)

The study was conducted in 29 in-patient units of four French adult hospitals from February to July 2017. These include two training hospitals (Georges Pompidou in Europe and Paris Saint-Joseph) and two hospitals dedicated to postoperative care and rehabilitation (Corentin Celton and Vaugirard) (Berdot et al., 2021). Each of the teaching hospitals was randomly selected to provide ten units: 4 medical, 4 surgical and 2 critical care units; and 5 of the follow-up and rehabilitation hospitals each.

Data was collected through paper based coded structured observations. The following data were collected such as potential predictors including the age, sex and years of experience of the nurse, the number of patients per nurse to be cared for, the number of patients included in the round, the time taken to complete the round and whether the vest was removed at the end of the round in the intervention units. Observers recorded information concerning the drug prepared and administered (Berdot et al., 2021). The variables collected on medication administration included the name of the medication, the dose, the dosage form, the route of administration, the preparation of injectable drugs such as the diluent, solvent and speed of administration, the number of interruptions and the kind, and the type of vest worn in the experimental groups.

3.2 Was the data collection method appropriate for the study question and the research design? Why/why not? (100 150 word)

The direct observation method was most appropriate for the study question since it delivered raw information on interruptions and mistakes without interfering with the procedure of medication administration to get a clear picture of the effect of the intervention. Furthermore, using trained observers in the RCT studies ensured that the observers themselves largely removed bias and that enhanced reliability (Naseralallah et al., 2023). However, the response of the Hawthorne effect may have impacted the result, in which its focus of awareness causes people to modify their behaviour. Nonetheless, it fits both the research design and objectives to the letter because it enabled the authors to systematically evaluate the practical implementation of the intervention. However, Hawthorne effect has some disadvantages, which include observer bias; the behaviour of the participants may change due to the fact that they are under observation (Oswald et al., 2014). However, this appears to be valid since conducting direct observation enables researchers to capture the details and the process of medication administration as well as the effect of many procedures inclusive of the do not interrupt.

4.Results (Total: 5 marks)

4.1 What were the findings? Discuss the findings of the selected research article? (150 200 words)
The research revealed that increased specificity of the do not interrupt vest intervention had little effect on decreasing medication administration errors as well as interruption rates. The error rates for the administration were 7.09% to the experimental group and 6.23% to the control group with no difference between them (p = 0.192). The most frequent type of error classified was wrong dosage-form and the majority of the errors were found not to have caused any clinical consequence on the patient. The interruption rate was 15.04% for the experimental group and 20.75% for the control group (Berdot et al., 2021). The study found out that several factors that may increase the risk of errors and injury include the patients age, the nurses experience, nurses workload, and exposure to the unit; however, there was no correlation between them and the error rate.

Moreover, the research revealed how the do not interrupt vest intervention was effective at cutting down the number of interruptions that staff made during the administration of medication. However, in the present study, although the percentage of interruption was decreased through the implementation of the intervention, the percentage of medication errors also decreased with moderate degree. As such, this study recommends that in order to minimize medication errors, it is important to reduce interruptions but there might be other underlying values that predispose an environment to errors.

4.2 What other studies did the authors compare their results to and were the results the same or different? (100 150 words)

The findings of the author were discussed in relation to the previous literature on interventions aimed at minimising medication errors and interruptions. Other research has produced less conclusive findings, and interventions such as bar-coding technology and electronic medication administration record (eMAR) have been found to be more effective than others (Moreland et al., 2012). The results of the present study also support other studies that indicated that single bundled interventions like the do not interrupt vest do not reduce errors independently. Addressing a problem at multiple levels and using several interventions are usually more successful.
The authors also stated that the vest intervention was most beneficial in smaller, more active areas where it would not be possible to establish no intervention area. These comparisons supported the conclusion of the study, by presenting the vest intervention as a more versatile method of preventing medication mistakes in various forms of healthcare organisations.

5. Evidence utilization (Total: 10 marks)

5.1 How does the summarised evidence inform the clinical practice of Australian Registered Nurses? (100-150)

The study evidence summarized in this study contributes to the clinical practice of Australian Registered Nurses by highlighting the sources of single interventions in minimizing medication giving errors. However, it also points out that the issue requires intervention from virtually all fronts by harnessing visual signals such as the do not interrupt vest alongside training, redesign of work interface, and technology assistance. This evidence instructs nurses and healthcare organizations to integrate elaborate precautions to reduce interference and improve the safety of patients during medication administration.

The intervention is easier to implement and financially accessible owing to its cheap nature, hence, could be embraced easily in all trilogy facets of healthcare facilities in the country. In addition, the research points out the need to promote a safer work environment for nurses that would be in line with the national patient safety objectives. Through this evidence, nurses can be able to propel the implementation of such interventions in their facilities in order to promote desirable patients results.

5.2 Would you implement the findings of this study in your own clinical practice? Why or why not? (150 200)

I would apply the findings of this study in my clinical practice because minimizing interruptions during medication administration is one of the ways in which patient safety can be enhanced. This paper argues that through wearing the do not interrupt vest, the frequency of interruptions can be minimized with the nurses being able to attend to their work better. Yet, I would add to this intervention other ones, like enhancing the workflow in the healthcare team and possibilities of communication. The following would rid of other predisposing factors to medication errors as according to the study findings. Combining the elements mentioned above could have a very positive effect on patient safety.

However, in my perspective, precautions should be taken regarding the problems mentioned by some of the nurses in the study such as complaining of loneliness when they wore the vest. To compensate for this, the intervention would be accompanied by education to the rest of the team and the patients about its necessity. This would assist in creating awareness on the use of the vest within the nursing profession because when used by nurses, they would feel close with their fellows and patients. In summary, the present intervention holds great promise towards enhancing medication safety and would indeed be beneficial to clinical work.

6.Presentation

(Expression/writing & Literature sources/ references) (Total: 5 marks)

6.1 Referencing in-text and in reference list conforms to APA 7th edition referencing style See link for help: https://www.newcastle.edu.au/library/referencing/apa7

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