Assessment Description
While the implementation plan prepares students to apply their research to the problem or issue, they have identified for their capstone project change proposal, the literature review enables students to map out and move into the active planning and development stages of the project.
A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Question and Literature Evaluation Table assignments to develop a 750-1,000-word review that includes the following sections:
- Title page
- Introduction section
- A comparison of research questions
- A comparison of sample populations
- A comparison of the limitations of the study
- A conclusion section, incorporating recommendations for further research
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
PICOT Question
Does using electronic medication compared to education and training of nurses reduce adverse drug events over a three-month period?
Problem being investigated
The existing problem is Adverse Drug Events (ADEs). The problem accounts for significant patient morbidity and mortality and legal, operational, and patient care costs (Mills et al., 2008). Medications that result in most ADEs include narcotics, chemotherapy, and diabetic and cardiovascular medications (Mills et al., 2008). Issues that cause most ADEs include wrong doses, wrong medication, missed medication, prescribing drugs to the wrong patients, and many prescribers for one patient.
The patient population under consideration is elders. The elderly population is at an increased risk of experiencing ADEs after medication. Available data shows that 15% or more of the elderly experience ADEs (Pretorius et al., 2013). The ADEs in the elderly population are manifested in various forms, including falls, orthostatic hypotension, heart failure, and delirium. Some ADEs, mainly gastrointestinal or intracranial bleeding and renal failure, result in mortalities. Effects of ADEs in hospitals include increased costs of operation, reduced effectiveness, and increased LOS. Adverse drug outcomes can be mediated using different strategies such as discontinuing medications, prescribing new medications sparingly, reducing the number of prescribers, and frequently reconciling medications.
Evidence-based Interventions for Reducing ADEs
The PICOT question compares two nursing interventions that can be applied to reduce ADEs among the elderly population. They are electronic medication and educational programs and training for nurses. Electronic medication system supports the improved quality, safety, and effectiveness of medication management within hospitals by enabling digital prescription, ordering, checking, reconciling, dispensing, and recording the medication. On the other hand, education and training involve equipping nurses with the requisite skills to reduce ADEs among elderly patients. The training can involve proper prescription and documentation of the drug.
Different scholars in the nursing field have published ample evidence on the efficacy of these interventions. In particular, (Wu et al., 2007) investigated the cost-effectiveness of introducing an electronic medication ordering and administration system and its potential impact on reducing ADEs. Their findings revealed that an electronic medication order entry and administration system could improve care by reducing adverse events (Wu et al., 2007). Thus, electronic medication is an evidence-based intervention.
Another study to assess the efficacy of electronic medication in reducing ADEs was done by Truitt et al., (2016). The authors analyzed the effects of implementing barcode medication administration (BCMA) and electronic medication administration record (eMAR) technology on ADEs. Data were analyzed using descriptive statistics, and findings showed that eMAR and BCMA technology improved patient safety by decreasing the overall rate of ADEs and the rate of transcription errors (Truitt et al., 2016). The two studies by Truitt et al., (2016) and Wu et al., (2007) agree that electronic medication can lower ADEs’ prevalence among the elderly population.
Scholarly evidence in support of the educational program to reduce ADEs also exists. (Trivalle et al., 2010) analyzed the impact of educational intervention in decreasing ADEs in elderly patients in a hospital setting using a randomized prospective study. Five hundred twenty-six patients included in the study were 65 years and above, while the study period was four weeks. The data collected showed that educational intervention program led to fewer ADEs in the intervention group (n = 38, 22%) than in the control group (n = 63, 36%; p = 0.004) (Trivalle et al., 2010). (Martin et al., 2018) also investigated the effects of a pharmacist-led education intervention on reducing ADEs among patients aged 65 and above. The outcomes indicated that pharmacist-led education reduced ADEs.
Summary
The two interventions for reducing ADEs among the elderly population are electronic medication and educational programs for healthcare providers. Based on the existing evidence, electronic medication is the best intervention because it is more feasible and can have a huge health impact.
References
Martin, P., Tamblyn, R., Benedetti, A., Ahmed, S., & Tannenbaum, C. (2018). Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults. JAMA, 320(18), 1889. https://doi.org/10.1001/jama.2018.16131
Mills, P. D., Neily, J., Kinney, L. M., Bagian, J., & Weeks, W. B. (2008). Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system. Quality and Safety in Health Care, 17(1), 37–46. https://doi.org/10.1136/qshc.2006.021816
Pretorius, R. W., Gataric, G., Swedlund, S. K., & Miller, J. R. (2013). Reducing the Risk of Adverse Drug Events in Older Adults. American Family Physician, 87(5), 331–336. https://www.aafp.org/afp/2013/0301/p331.html
Trivalle, C., Cartier, T., Verny, C., Mathieu, A.-M., Davrinche, P., Agostini, H., Becquemont, L., & Demolis, P. (2010). Identifying and preventing adverse drug events in elderly hospitalised patients: A randomised trial of a program to reduce adverse drug effects. The Journal of Nutrition, Health & Aging, 14(1), 57–61. https://doi.org/10.1007/s12603-010-0010-4
Truitt, E., Thompson, R., Blazey-Martin, D., Nisai, D., & Salem, D. (2016). Effect of the implementation of Barcode Technology and an electronic medication administration record on Adverse Drug Events. Hospital Pharmacy, 51(6), 474–483. https://doi.org/10.1310/hpj5106-474
Wu, R. C., Laporte, A., & Ungar, W. J. (2007). Cost-effectiveness of an electronic medication ordering and administration system in reducing adverse drug events. Journal of Evaluation in Clinical Practice, 13(3), 440–448. https://doi.org/10.1111/j.1365-2753.2006.00738.x
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Literature Evaluation Table
Student Name:
Change Topic (2-3 sentences): The aim of the evaluation is to determine the best method for reducing Adverse Drug Events (ADEs) in the older patients. Strategies being compared are educational programs and electronic medication.
|
Criteria |
Article 1 |
Article 2 |
Article 3 |
Article 4 |
|
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article |
Wang, H., Meng, L., Song, J., Yang, J., Li, J., & Qiu, F. (2018). Electronic medication reconciliation in hospitals: A systematic review and meta-analysis. European Journal of Hospital Pharmacy, 25(5), 245–250. https://doi.org/10.1136/ejhpharm-2017-001441 |
Kinlay, M., Ho, L. M., Zheng, W. Y., Burke, R., Juraskova, I., Moles, R., & Baysari, M. (2021). Electronic Medication Management Systems: Analysis of enhancements to reduce errors and improve workflow. Applied Clinical Informatics, 12(05), 1049–1060. https://doi.org/10.1055/s-0041-1739196 |
Fuller, A. E. C., Guirguis, L. M., Sadowski, C. A., & Makowsky, M. J. (2018). Electronic Medication Administration records in long‐term Care Facilities: A scoping review. Journal of the American Geriatrics Society, 66(7), 1428–1436. https://doi.org/10.1111/jgs.15384 |
Bugnon, B., Geissbuhler, A., Bischoff, T., Bonnabry, P., & von Plessen, C. (2021). Improving primary care medication processes by using shared electronic medication plans in Switzerland: Lessons learned from a participatory action research study. JMIR Formative Research, 5(1). https://doi.org/10.2196/22319 |
|
Article Title and Year Published |
Title- Electronic medication reconciliation in hospitals: A systematic review and meta-analysis. Year: 2018 |
Title: Electronic Medication Management Systems: Analysis of enhancements to reduce errors and improve workflow Year: 2021 |
Title: Electronic Medication Administration records in long‐term Care Facilities: A scoping review Year: 2018 |
Title: Improving primary care medication processes by using shared electronic medication plans in Switzerland: Lessons learned from a participatory action research study Year: 2021 |
|
Research Questions (Qualitative)/Hypothesis (Quantitative) |
Hypothesis: Medication reconciliation is a multi-professional process for the prevention of medication discrepancies. |
No research questions/hypothesis |
Null |
Null |
|
Purposes/Aim of Study |
To evaluate the available electronic medication reconciliation (eMedRec) tools and their effect on unintended discrepancies that occur in hospital institutions |
1. Identify system-related medication errors or workflow blocks that were the target of eMM system updates 2. Describe and classify the system enhancements made to target these risks |
To map the extent, range, and nature of research on the effectiveness, level of use, and perceptions about electronic medication administration records (eMARs) in long-term care facilities (LTCFs) |
Summarize lessons learned from primary care professionals involved in a pioneering pilot project in Switzerland for the system wide implementation of shared electronic medication plans. |
|
Design (Type of Quantitative, or Type of Qualitative) |
Meta-analysis |
Retrospective study |
Scoping review of quantitative and qualitative literature. |
Formative action research study. |
|
Setting/Sample |
Meta-analysis, 13 articles included |
Systematic analysis |
Literature review |
Longitudinal study |
|
Methods: Intervention/Instruments |
Methodological quality was assessed using the nine standard criteria of Cochrane Effective Practice and Organization of Care Review Group (EPOC) |
147 individual changes, were made to the eMM system over the 4-year period |
Systematically searched MEDLINE, CINAHL, Scopus, ProQuest, and the Cochrane Library. |
Group interviews |
|
Analysis |
Relative risk and significance difference |
Descriptive analysis (use of percentages) |
Level of significance analysis |
Descriptive analysis |
|
Key Findings |
Electronic Medical Reconciliation reduces the incidence of medication with unintended discrepancies and improves medication safety. |
Electronic Medication Management (eMM) reduces medication errors and optimize workflows |
Evidence linking electronic Medication Administration Records (eMAR) in reducing errors is weak. |
Participants considered medication plan management, digitalized or not, a core element of good clinical practice |
|
Recommendations |
Hospitals adopt electronic medication to reduce ADEs |
Hospital organizations can adopt eMM to enhance patient safety and operational efficiency |
More research need to be conducted to determine the effectiveness of electronic medication in reducing ADEs |
Digitalization is a key element of transforming hospital records |
|
Explanation of How the Article Supports EBP/Capstone Project |
It identifies the best approach that can reduce ADES between educational programs and electronic medication. |
Shows that electronic Medication Management is the best bet for reducing ADEs |
The article informs the need for conducting more robust research on the efficacy of electronic medication in reducing ADEs. |
More research should be done to assess the efficacy of electronic records. |
|
Criteria |
Article 5 |
Article 6 |
Article 7 |
Article 8 |
|
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article |
Gregory, L. R., Lim, R., MacCullagh, L., Riley, T., Tuqiri, K., Heiler, J., & Peters, K. (2021). Intensive Care Nurses' experiences with the new electronic medication administration record. Nursing Open, 9(3), 1895–1901. https://doi.org/10.1002/nop2.939 |
Li, R., Zaidi, S. T., Chen, T., & Castelino, R. (2019). Effectiveness of interventions to improve adverse drug reaction reporting by healthcare professionals over the last decade: A systematic review. Pharmacoepidemiology and Drug Safety, 29(1), 1–8. https://doi.org/10.1002/pds.4906 |
Lau, G., Ho, J., Lin, S., Yeoh, K., Wan, T., & Hodgkinson, M. (2018). Patient and clinician perspectives of an integrated electronic medication prescribing and dispensing system: A qualitative study at a multisite Australian Hospital Network. Health Information Management Journal, 48(1), 12–23. https://doi.org/10.1177/1833358317720601 |
Martin, P., Tamblyn, R., Benedetti, A., Ahmed, S., & Tannenbaum, C. (2018). Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults. JAMA, 320(18), 1889. https://doi.org/10.1001/jama.2018.16131 |
|
Article Title and Year Published |
Title: Intensive Care Nurses' experiences with the new electronic medication administration record Year: 2021 |
Title: Effectiveness of interventions to improve adverse drug reaction reporting by healthcare professionals over the last decade: A systematic review Year: 2019 |
Title: Patient and clinician perspectives of an integrated electronic medication prescribing and dispensing system: A qualitative study at a multisite Australian Hospital Network Year: 2018 |
|
|
Research Questions (Qualitative)/Hypothesis (Quantitative) |
What are intensive care nurses' experiences with the new electronic medication administration record? |
No research question and hypothesis |
Null |
Can a consumer-targeted, pharmacist-led educational intervention reduce prescriptions for inappropriate medication among community-dwelling older adults? |
|
Purposes/Aim of Study |
To explore the experiences of Registered Nurses who administered medications to patients using the electronic medication administration record. |
To assess the impact of various strategies to improve ADR reporting published in the last decade and compare this with the strategies identified in a previous systematic review |
To explore and compare patient and clinician attitudes towards an integrated e-prescribing and dispensing system |
o compare the effectiveness of a consumer-targeted, pharmacist-led educational intervention vs usual care on discontinuation of inappropriate medication among community-dwelling older adults. |
|
Design (Type of Quantitative, or Type of Qualitative) |
Qualitative descriptive exploratory approach |
Systematic review |
A cross-sectional survey |
A cluster randomized clinical trial |
|
Setting/Sample |
Five participants |
10,021 articles selected, 13 articles included |
Australian metropolitan teaching hospital |
Quebec, Canada |
|
Methods: Intervention/Instruments |
Focus group, observation |
MEDLINE and EMBASE databases |
Survey |
andomization occurred at the pharmacy level, with 34 pharmacies randomized to the intervention group (248 patients) and 35 to the control group (241 patients) |
|
Analysis |
Thematic analysis |
Descriptive analysis |
Descriptive analysis- percentages |
Descriptive and inferential statistics |
|
Key Findings |
eMAR reduced time nurse spent with patients |
Electronic method was found to be a better approach when reporting adverse drug reactions compared to educational method |
The majority of patients and clinicians reported a positive impact of e-prescribing on safety and efficiency |
A pharmacist-led educational intervention compared with usual care resulted in greater discontinuation of prescriptions for inappropriate medication after 6 months |
|
Recommendations |
More research needed on the effects of using eMAR to patients and healthcare providers. |
More research needed to find the robustness of each method |
Hospitals should implement e-prescribing |
More research needed to establish the effectiveness of educational programs in reducing ADEs |
|
Explanation of How the Article Supports EBP/Capstone |
Electronic medication has the potential to increase patient safety |
The article directly compares the effectiveness of educational programs and electronic records which are included in the PICOT question. |
The study adds to the evidence that electronic medication is the best approach to reduce ADEs |
The study contributes to the topic because educational program for nurses was found to be effective in dealing with ADEs. |
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