Fluent Essays

1.EBP (PowerPoint Slides 7 and 8)  assignment number 1   2. Resume and Cover Letter. ssignment number 2 & 3  Each student will submit a copy of his or her resume and cover letter to the assignment area in BrightSpace. The goal of this assignment is to allow the student to begin preparing for their professional nursing career.  Grading will focus on the student’s ability to professionally present themselves. Please utilize career services for assistance. Gear your resume and cover letter toward the specialty that interests you.   Resume Grading Rubric and Criteria   Opening/Intro   Includes name, address, telephone, professional email address. ALL page(s) must have header with name and page number.  Summary of Qualifications   Summary of Qualifications are focused, targeted, and concise. Uses action verbs in the same tense.    Education section emphasizes relevant coursework, GPA if better than average (3.5 or greater), what degree student expects to attain. Education is put before employment unless student has extensive career-related job experience (LPN, EMT, MA). Education is listed in reverse chronological order and all institution/degrees earned are listed. Do not include High School experience after attaining a college degree. Do not include colleges or universities that were attended but no degree was awarded.  Work experience includes job titles, locations, list of duties/ accomplishments. Experience listed in resume parallels position applicant is applying for.   1 OR 2 full pages; Balanced, white space, good font choices, pleasing design; Single spaced; 1-inch margins.   Begin each bullet with an action verb. Approved action word list provided. No spelling errors. No grammatical errors. Word processing mechanics are perfect.   Cover Letter Grading Rubric   Opening Paragraph   The opening paragraph arouses the interest of the employer by stating why you are interested in the organization, names the specific job applied for and states where you heard of the job.   Middle Paragraph   The middle paragraph is neatly written and creates a desire for an employer to know more about you.  It emphasizes the resume pointing out achievements and qualifications that meet the job description.   Closing Paragraph  The closing paragraph paves the way for an interview by offering to call in the future.  Layout  The letter is organized.  It includes all the required components in the correct order with the correct spacing between elements. https://doi.org/10.1177/2042098620968309 https://doi.org/10.1177/2042098620968309 Ther Adv Drug Saf 2020, Vol. 11: 1–29 DOI: 10.1177/ 2042098620968309 © The Author(s), 2020. Article reuse guidelines: sagepub.com/journals- permissions Therapeutic Advances in Drug Safety journals.sagepub.com/home/taw 1 Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Lay summary Activities to reduce medication errors in adult medical and surgical hospital areas Introduction: Medication errors or mistakes may happen at any time in hospital, and they are a major reason for death and harm around the world. Interventions to reduce medication errors in adult medical and surgical settings: a systematic review Elizabeth Manias , Snezana Kusljic and Angela Wu Abstract Background and Aims: Medication errors occur at any point of the medication management process, and are a major cause of death and harm globally. The objective of this review was to compare the effectiveness of different interventions in reducing prescribing, dispensing and administration medication errors in acute medical and surgical settings. Methods: The protocol for this systematic review was registered in PROSPERO (CRD42019124587). The library databases, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched from inception to February 2019. Studies were included if they involved testing of an intervention aimed at reducing medication errors in adult, acute medical or surgical settings. Meta-analyses were performed to examine the effectiveness of intervention types. Results: A total of 34 articles were included with 12 intervention types identified. Meta-analysis showed that prescribing errors were reduced by pharmacist-led medication reconciliation, computerised medication reconciliation, pharmacist partnership, prescriber education, medication reconciliation by trained mentors and computerised physician order entry (CPOE) as single interventions. Medication administration errors were reduced by CPOE and the use of an automated drug distribution system as single interventions. Combined interventions were also found to be effective in reducing prescribing or administration medication errors. No interventions were found to reduce dispensing error rates. Most studies were conducted at single-site hospitals, with chart review being the most common method for collecting medication error data. Clinical significance of interventions was examined in 21 studies. Since many studies were conducted in a pre–post format, future studies should include a concurrent control group. Conclusion: The systematic review identified a number of single and combined intervention types that were effective in reducing medication errors, which clinicians and policymakers could consider for implementation in medical and surgical settings. New directions for future research should examine interdisciplinary collaborative approaches comprising physicians, pharmacists and nurses. Keywords: hospitals, medication errors, medical order entry systems, medication reconciliation, medication therapy management, nurses, patient safety, pharmacists, physicians, systematic review Received: 27 May 2020; revised manuscript accepted: 23 September 2020. Correspondence to: Elizabeth Manias School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia Department of Medicine, Royal Melbourne Hospital [email protected]; [email protected] Snezana Kusljic Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia Angela Wu Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia 968309TAW0010.1177/2042098620968309Therapeutic Advances in Drug SafetyE Manias, S Kusljic research-article20202020 Systematic Review https://uk.sagepub.com/en-gb/journals-permissions https://uk.sagepub.com/en-gb/journals-permissions https://journals.sagepub.com/home/taw mailto:[email protected] mailto:[email protected] http://crossmark.crossref.org/dialog/?doi=10.1177\%2F2042098620968309&domain=pdf&date_stamp=2020-11-12 2 journals.sagepub.com/home/taw Therapeutic Advances in Drug Safety 11 Objective: To compare the effectiveness of different activities in reducing medication errors occurring with prescribing, giving and supplying medications in adult medical and surgical settings in hospital. Methods: Six library databases were examined from the time they were developed to February 2019. Studies were included if they involved testing of an activity aimed at reducing medication errors in adult medical and surgical settings in hospital. Statistical analysis was used to look at the success of different types of activities. Results: A total of 34 studies were included with 12 activity types identified. Statistical analysis showed that prescribing errors were reduced by pharmacists matching medications, computers matching medications, partnerships with pharmacists, prescriber education, medication matching by trained physicians, and computerised physician order entry (CPOE). Medication-giving errors were reduced by the use of CPOE and an automated medication distribution system. The combination of different activity types were also shown to be successful in reducing prescribing or medication-giving errors. No activities were found to be successful in reducing errors relating to supplying medications. Most studies were conducted at one hospital with reviewing patient charts being the most common way for collecting information about medication errors. In 21 out of 34 articles, researchers examined the effect of activity types on patient harm caused by medication errors. Many studies did not involve the use of a control group that does not receive the activity. Conclusion: A number of activity types were shown to be successful in reducing prescribing and medication-giving errors. New directions for future research should examine activities comprising health professionals working together. Introduction Medication errors occur at any point of the medi- cation management process involving prescrib- ing, transcribing, dispensing, administering and monitoring,1,2 have been reported to account for approximately one-quarter of all healthcare errors.3 Medication errors are a major cause of death and harm globally.4 According to the World Health Organisation (WHO), medication errors cost an estimated US$42 billion annually world- wide, which is 0.7\% of the total global health expenditure.5 Systematic reviews examining interventions aimed at reducing medication errors have largely focused on specialty settings, such as patients sit- uated in adult and paediatric intensive care units, emergency departments, and neonatal intensive care and paediatric units.6–10 Previous relevant systematic reviews relating to testing interven- tions for reducing medication errors in general hospital settings have focused on administration errors only,11,12 have involved adult and paediat- ric settings or have tested interventions in spe- cialty and general hospital settings with no differentiation in results.11–13 This systematic review aims to compare the effectiveness of differ- ent interventions in reducing prescribing, dis- pensing and administration medication errors in acute medical and surgical settings. Information obtained from this review can inform clinicians and policymakers about the types of interventions that have been shown to be effective, which can guide the development of comprehensive guide- lines for clinical practice and policy directives. Methods In conducting this systematic review, the authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.14 The review protocol was registered with PROSPERO (CRD42019124587). Search strategy A search was conducted of the following library databases, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials, from inception to February 2019. A search strategy was devised following consulta- tion with a university research librarian to yield relevant studies. Keywords used in the search comprised five categories: the setting, with key- words ‘hospital’, ‘acute’, ‘medical’, ‘surgical’; https://journals.sagepub.com/home/taw E Manias, S Kusljic et al. journals.sagepub.com/home/taw 3 perspective, with keywords ‘medication manage- ment’, ‘medication process’, ‘medicines manage- ment’, ‘prescribing’, ‘dispensing’, ‘administration’, ‘monitoring’; population, with keyword ‘adult’; activity, with keywords ‘pro- gram’ and ‘intervention’; and phenomenon of interest, with keywords ‘medication errors’, ‘pre- ventive adverse drug events’, and ‘medicine errors’. Keywords in each category were searched using the operator OR, and then combined between categories using the operator AND. Search histories for all databases are listed in Supplemental file S1. Key article cross-checking was performed using citation-linking databases, Scopus and Web of Science in an attempt to iden- tify further articles. Reference lists of relevant articles were checked to identify additional papers. Previous systematic reviews on a similar topic were also examined to determine possible papers for inclusion.11–13 Eligibility criteria Studies were included if they involved testing an intervention aimed at reducing medication errors in adult acute medical or surgical settings. Adults were defined as patients aged 18 years or over. If patients received the intervention during hospitali- sation and the effect on medication errors was measured in the hospital setting, these studies were included. Medication errors comprised any pre- ventable events that may cause or lead to inappro- priate medication use or patient harm during prescribing, dispensing or administration.15 The prevalence of medication errors must have been identified as a primary or secondary outcome to be included. Papers were considered for inclusion if they were published before 2000, as this was the year when the landmark publication, To Err is Human: Building a Safer Health System was released by the Institute of Medicine.16 This publication drew attention of the need for health services to develop tools and systems to address problems in patient safety, such as medication errors. Near misses were not included as medication errors. Only papers published in English were included. Case studies, commentaries, editorials, reviews, epidemiological studies and conference abstracts were excluded. If studies examined medication-related problems as an outcome, which often comprised a combination of medica- tion errors, as well as problems with medication knowledge, medication adherence and other aspects of medication management, these studies were not included. If the effect of the intervention was measured outside the hospital setting, these studies were excluded. Specialty wards such as intensive care, emergency care, perioperative care, neurological and cancer care were excluded. Outpatient settings and subacute settings, such as rehabilitation wards and geriatric evaluation and management units were excluded. Study selection Rayyan (Qatar Computing Research Institute), an online platform, was used for independent screening of articles at the title and abstract level, and subsequently at the full text level.17 Two authors reviewed titles and abstracts indepen- dently. The third author assessed discrepancies at the title and abstract level. Any uncertainty or disagreement about articles meeting the inclusion criteria was resolved after discussion among all authors. Full texts of papers were then examined independently by two authors to determine if studies were eligible for inclusion in the review. Any discrepancies identified at the full-text level were examined by the third author. Previous sys- tematic reviews on similar topics were also exam- ined to determine possible papers for inclusion. Quality assessment Quality assessment was undertaken using the Equator reporting guidelines whereby ran- domised controlled trials were assessed using the CONSORT guidelines,18 non-randomised stud- ies were assessed using the TREND guide- lines,19 and quality improvement studies were assessed using the SQUIRE guidelines.20 No study was excluded on the basis of the score obtained for quality assessment. Risk of bias assessment was also undertaken using Review Manager, version 5.3 (RevMan) (Cochrane Collaboration) software. Data extraction Data were extracted from each paper to a stand- ard form for study design, country and setting, number of patients, intervention type, type of medication error analysed and effect of the inter- vention (Table 1). If the studies provided infor- mation about the severity of medication errors using their approach for measuring severity, these data were also included in data extraction. https://journals.sagepub.com/home/taw 4 journals.sagepub.com/home/taw Therapeutic Advances in Drug Safety 11 Ta b le 1 . O ve rv ie w o f st u d ie s in cl u d ed in t h e sy st em at ic r ev ie w ( n = 34 ). R ef er en ce (c ou n tr y) S tu d y d es ig n S et ti n g N u m b er o f p at ie n ts In te rv en ti on t yp e Ty p e of m ed ic at io n e rr or a n al ys ed ( m et h od o f d at a co ll ec ti on f or m ed ic at io n e rr or s) , ef fe ct o f in te rv en ti on o n m ed ic at io n e rr or r at e P L -M R A l- H as h ar e t al .2 1 (O m an ) P ro sp ec ti ve ra n d om is ed co n tr ol le d s tu d y M ed ic al w ar d s of a t er ti ar y ca re ac ad em ic h os p it al w it h a b ed c ap ac it y of 5 00 28 6 (i n te rv en ti on ), 30 1 (c on tr ol ) P h ar m ac is t- le d m ed ic at io n re co n ci li at io n (P L -M R ) T ot al n u m b er o f p re ve n ta b le A D E s (r ev ie w o f el ec tr on ic h ea lt h r ec or d a n d p at ie n t in te rv ie w ) C on tr ol : 59 p re ve n ta b le A D E s (0 .2 0 p re ve n ta b le A D E s/ p at ie n t) 1 6\% In te rv en ti on : 27 p re ve n ta b le A D E s (0 .0 9 p re ve n ta b le A D E s/ p at ie n t) 9 .1 \% , p = 0 .0 08 S ev er it y of p re ve n ta b le A D E s S er io u s C on tr ol : 22 s er io u s p re ve n ta b le A D E s In te rv en ti on : 7 se ri ou s p re ve n ta b le A D E s, p = 0 .0 09 S ig n if ic an t C on tr ol : 36 s ig n if ic an t p re ve n ta b le A D E s In te rv en ti on : 20 s ig n if ic an t p re ve n ta b le A D E s, p = 0 .0 41 B at ra e t al .2 2 (U S ) P ro sp ec ti ve m ed ic al r ec or d re vi ew In p at ie n t w ar d s of 62 7- b ed t ea ch in g h os p it al 18 6 ad m is si on s fo r 10 5 p at ie n ts w it h H IV P h ar m ac is t- le d m ed ic at io n re co n ci li at io n (P L -M R ) N u m b er o f p at ie n ts w it h p re sc ri b in g er ro rs ( ch ar t re vi ew ) R et ro sp ec ti ve c h ar t re vi ew s: 2 89 /4 16 t ot al a d m is si on s (3 5. 1\% ) In te rv en ti on : 31 /1 86 t ot al a d m is si on s (1 6. 7\% ) N o p- va lu e re p or te d B ec ke tt e t al .2 3 (U S ) P ro sp ec ti ve ra n d om is ed , n on - b li n d ed s tu d y P at ie n ts a d m it te d to o n e of t w o ge n er al m ed ic in e fl oo rs o r on e ge n er al s u rg er y fl oo r 41 ( in te rv en ti on ), 40 ( co n tr ol ) P h ar m ac is t- le d m ed ic at io n re co n ci li at io n (P L -M R ) M ed ic at io n d is cr ep an ci es id en ti fi ed ( ch ar t re vi ew , p at ie n t an d f am il y in te rv ie w ) C on tr ol : 45 In te rv en ti on : 71 , p = 0 .0 74 N o d en om in at or t er m id en ti fi ed B oo ck va r et a l.2 4 (U S ) C lu st er - ra n d om is ed co n tr ol le d t ri al A n in p at ie n t u n it o f an u rb an v et er an af fa ir h os p it al w it h r es p on si b le sp ec ia lt ie s of m ed ic in e, s u rg er y or p sy ch ia tr y 18 6 (i n te rv en ti on ), 19 5 (c on tr ol ) P h ar m ac is t- le d m ed ic at io n re co n ci li at io n (P L -M R ) M ed ic at io n d is cr ep an ci es ( p re sc ri p ti on c ov er ag e p la n r ev ie w , p at ie n ts , f am il y m em b er s, p ro vi d er s in te rv ie w s) C on tr ol : 3. 0 m ea n n u m b er o f m ed ic at io n d is cr ep an ci es /1 95 t ot al n u m b er o f p at ie n ts M ea n 3 .0 , S D 2 .4 In te rv en ti on : 3. 2 m ea n n u m b er o f m ed ic at io n d is cr ep an ci es /1 86 t ot al n u m b er o f p at ie n ts M ea n 3 .2 , S D 2 .6 , p = 0 .4 52 A D E s: 3 7 p at ie n ts ( 9. 7\% ) h ad 4 1 A D E s w it h t em p or ar y sy m p to m s. N o d if fe re n ce s b et w ee n g ro u p s (O R 1 .0 , 9 5\% C I, 0 .4 9– 2. 1, p = 0 .9 64 ) C ad m an e t al .2 5 (U K ) P il ot r an d om is ed co n tr ol le d t ri al F iv e ad u lt m ed ic al w ar d s of a h os p it al 96 ( in te rv en ti on ), 10 2 (c on tr ol ) P h ar m ac is t- le d m ed ic at io n re co n ci li at io n (P L -M R ) U D s (c h ar t re vi ew , g en er al p ra ct it io n er a n d p at ie n t n ot es ) A d m is si on : C on tr ol : 3. 0 p er p at ie n t 30 9 U D s in 1 02 p at ie n ts In te rv en ti on : 2. 80 p er p at ie n t 25 5 U D s in 9 6 p at ie n ts ( h ow ev er o n e p at ie n t d id n ot r ec ei ve t h e in te rv en ti on ) R em ai n ed a t d is ch ar ge C on tr ol : 2. 71 p er p at ie n t 26 8 U D s in 9 9 p at ie n ts In te rv en ti on : 0. 02 p er p at ie n t 2 U D s in 9 1 p at ie n ts N o p- va lu e re p or te d U n p la n n ed r ea d m is si on a t 3 m on th s C on tr ol 3 7 (3 6. 6\% ) p at ie n ts In te rv en ti on 3 0 (3 1. 6\% ) p at ie n ts L en gt h o f h os p it al s ta y C on tr ol : 10 9. 3 h ( 95 \% C I 8 7. 0 to 1 37 .3 ) In te rv en ti on 9 9. 6 (9 5\% C I 7 6. 59 t o 12 9. 63 ) (C on ti nu ed ) https://journals.sagepub.com/home/taw E Manias, S Kusljic et al. journals.sagepub.com/home/taw 5 R ef er en ce (c ou n tr y) S tu d y d es ig n S et ti n g N u m b er o f p at ie n ts In te rv en ti on t yp e Ty p e of m ed ic at io n e rr or a n al ys ed ( m et h od o f d at a co ll ec ti on f or m ed ic at io n e rr or s) , ef fe ct o f in te rv en ti on o n m ed ic at io n e rr or r at e T on g et a l.2 6 (A u st ra li a) U n b li n d ed , c lu st er ra n d om is ed , co n tr ol le d s tu d y G en er al m ed ic al u n it o f an a d u lt m aj or r ef er ra l h os p it al 43 1 (c on tr ol ), 4 01 (i n te rv en ti on ) P h ar m ac is t- le d m ed ic at io n re co n ci li at io n (P L -M R ) P at ie n ts ’ d is ch ar ge s u m m ar ie s w it h a t le as t on e m ed ic at io n e rr or ( p re sc ri b in g er ro rs ) (d is ch ar ge s u m m ar y) C on tr ol : 26 5/ 43 1 p at ie n ts ( 61 .5 \% ) In te rv en ti on : 60 /4 01 p at ie n ts ( 15 \% ), p < 0 .0 1 S ev er it y of e rr or s C on tr ol : in si gn if ic an t 50 ( 18 .9 \% ), l ow 8 6 (3 2. 5\% ), m od er at e 81 ( 30 .6 \% ) h ig h 3 6 (1 3. 6\% ), ex tr em e 12 ( 4. 5\% ) In te rv en ti on : in si gn if ic an t 20 ( 33 \% ), l ow 2 2 (3 7\% ), m od er at e 12 ( 20 \% ), h ig h 5 ( 8\% ), ex tr em e 1 (2 \% ), p < 0 .0 1 IT -M R A ll is on e t al .2 7 (U S ) R et ro sp ec ti ve m ed ic al c h ar t re vi ew o f p re -p os t in te rv en ti on M ed ic al s et ti n gs o f a te rt ia ry h os p it al 10 0 (p re - in te rv en ti on ), 1 00 (p os t- in te rv en ti on ) E le ct ro n ic d is ch ar ge m ed ic at io n re co n ci li at io n t oo l (I T -M R ) P at ie n ts w it h a t le as t on e d is ch ar ge a n ti b io ti c m ed ic at io n e rr or ( p re sc ri b in g er ro r) (c h ar t re vi ew ) P re -i n te rv en ti on : 23 /1 00 p at ie n ts P os t- in te rv en ti on : 11 /1 00 p at ie n ts N o p- va lu e re p or te d T ot al n u m b er o f d is ch ar ge m ed ic at io n e rr or s P re -i n te rv en ti on : 30 /4 5 to ta l n u m b er o f er ro rs P os t- in te rv en ti on : 15 /4 5 to ta l n u m b er o f er ro rs N o p- va lu e re p or te d S m it h e t al .2 8 (U S ) P re –p os t q u as i- ex p er im en ta l st u d y G en er al m ed ic in e, ge ri at ri cs , ca rd io lo gy in p at ie n ts 31 7 (p re - in te rv en ti on ), 2 43 (p os t- in te rv en ti on ) IT -M R D is ch ar ge m ed ic at io n e rr or s (p re sc ri b in g er ro rs ) (e le ct ro n ic m ed ic al r ec or d a n d c h ar t re vi ew ) P re -i n te rv en ti on : 64 5 er ro rs /3 49 0 m ed ic at io n v ar ia n ce P os t- in te rv en ti on : 35 9 er ro rs /2 82 3 m ed ic at io n v ar ia n ce , p < 0 .0 01 C li n ic al ly im p or ta n t m ed ic at io n e rr or s (w it h p ot en ti al f or s er io u s or l if e- th re at en in g h ar m ) P re -i n te rv en ti on : 9/ 64 5 er ro rs ( 1. 4\% ) P os t- in te rv en ti on : 11 /3 59 e rr or s (3 .1 \% ), p = 0 .1 0 M ed ic at io n r ec on ci li at io n b y tr ai n ed m en to rs S ch n ip p er e t al .2 9 (U S ) Q u al it y im p ro ve m en t st u d y M ed ic al o r su rg ic al u n it s ac ro ss 5 h os p it al s, n o co n tr ol u n it s at h os p it al s it es 4 a n d 5, n o in te rv en ti on u n it s at h os p it al si te 1 85 7 (c on tr ol ), 7 91 (i n te rv en ti on ) L oc al im p le m en ta ti on of m ed ic at io n re co n ci li at io n b es t p ra ct ic es P ot en ti al ly h ar m fu l d is cr ep an ci es in a d m is si on a n d d is ch ar ge o rd er s p er p at ie n t (c h ar t re vi ew ) R es u lt s re p or te d a s m ea n n u m b er o f er ro rs p er p at ie n t S it e 1: d id n ot im p le m en t th e in te rv en ti on . S it e 2: C on tr ol u n it s P re -i m p le m en ta ti on : 0. 98 P os t- im p le m en ta ti on : 1. 32 In te rv en ti on u n it s P re -i m p le m en ta ti on : 1. 00 P os t- im p le m en ta ti on : 0. 88 S it e 3 C on tr ol u n it s P re -i m p le m en ta ti on : 0. 17 P os t- im p le m en ta ti on : 0. 23 In te rv en ti on u n it s P re -i m p le m en ta ti on : 0. 30 P os t- im p le m en ta ti on : 0. 18 S it e 4 an d s it e 5: d id n ot h av e co n tr ol u n it s at b as el in e. N o p- va lu e re p or te d Ta b le 1 . ( C on ti n u ed ) (C on ti nu ed ) https://journals.sagepub.com/home/taw 6 journals.sagepub.com/home/taw Therapeutic Advances in Drug Safety 11 R ef er en ce (c ou n tr y) S tu d y d es ig n S et ti n g N u m b er o f p at ie n ts In te rv en ti on t yp e Ty p e of m ed ic at io n e rr or a n al ys ed ( m et h od o f d at a co ll ec ti on f or m ed ic at io n e rr or s) , ef fe ct o f in te rv en ti on o n m ed ic at io n e rr or r at e C D S S H er n an d ez e t al .3 0 (F ra n ce ) B ef or e an d a ft er ob se rv at io n al s tu d y 66 -b ed o rt h op ae d ic su rg er y u n it o f a 70 0- b ed t ea ch in g h os p it al 11 1 (p re -C P O E ), 8 6 p at ie n ts ( p os t- C P O E ) C P O E w it h a le rt s fo r d ru g- al le rg y ch ec ki n g, th er ap eu ti c d u p li ca ti on s, d os e- ra n ge a n d a ge - b as ed c h ec ki n g, an d d ru g– d ru g in te ra ct io n s. N o m en ti on o f C D S S P re sc ri b in g er ro rs ( d ir ec t d is gu is ed o b se rv at io n ) P re -i n te rv en ti on : 47 9/ 15 93 p re sc ri b ed d ru gs ( 30 .1 \% ) P os t- in te rv en ti on : 33 /1 38 8 p re sc ri b ed d ru gs ( 2. 4\% ), p < 0 .0 00 1 D is p en si n g er ro rs P re -i n te rv en ti on : 43 0/ 12 19 o p p or tu n it ie s (3 5. 3\% ) P os t- in te rv en ti on : 44 9/ 14 07 o p p or tu n it ie s (3 1. 9\% ), p = 0 .0 7 A d m in is tr at io n e rr or s P re -i n te rv en ti on : 20 9/ 12 22 o p p or tu n it ie s (1 7. 1\% ) P os t- in te rv en ti on : 20 0/ 14 13 o p p or tu n it ie s (1 4. 2\% ), p < 0 .0 5 M il an i e t al .3 1 (U S ) P ro sp ec ti ve in te rv en ti on P at ie n ts w it h ch ro n ic k id n ey d is ea se a d m it te d w it h a cu te c or on ar y sy n d ro m e to m ed ic al w ar d 33 ( in te rv en ti on ), 47 ( co n tr ol ) C P O E w it h al er ts a n d C D S S fo r ch oi ce o f m ed ic at io n , d ru g d os in g b as ed o n cl in ic al r is k, p at ie n t w ei gh t, c al cu la te d cr ea ti n in e cl ea ra n ce a n d co n se n su s gu id el in es A d ve rs e d ru g ev en ts ( C h ar t re vi ew ) C on tr ai n d ic at ed m ed ic at io n s C on tr ol : 8/ 47 p at ie n ts ( 17 \% ) In te rv en ti on : 0/ 33 p at ie n ts ( 0\% ), p = 0 .0 1 In -h os p it al b le ed in g C on tr ol : 10 /4 7 p at ie n ts In te rv en ti on : 3/ 33 p at ie n ts , p = 0 .1 2 90 -d ay m or ta li ty C on tr ol 7 ( 15 \% ), In te rv en ti on 4 ( 12 \% ), p = 0 .5 0 L en gt h o f st ay C on tr ol m ea n 9 .1 , S D 1 0. 2 In te rv en ti on m ea n 4 .8 , S D 4 .0 , p = 0 .0 1 P et ti t et a l.3 2 (U S ) R et ro sp ec ti ve si n gl e ce n tr e, p re - p os t in te rv en ti on st u d y P at ie n ts a d m it te d to a 8 11 -b ed ac ad em ic m ed ic al c en tr e w h o co n ti n u ed on a n ti re tr ov ir al th er ap y 16 7 (p re - in te rv en ti on ), 1 31 (p os t- in te rv en ti on ) C P O E w it h a le rt s to d ru g- in te ra ct io n s an d in fo rm at io n on m ed ic at io n gu id el in es . N o m en ti on o f C D S S P re sc ri b in g er ro rs ( ch ar t re vi ew ) P re -i n te rv en ti on : 84 /1 67 p at ie n ts ( 50 .2 \% ) P os t- in te rv en ti on : 37 /1 31 p at ie n ts ( 28 .2 \% ), p < 0 .0 1 S h aw ah n a et a l.3 3 (P ak is ta n ) P ro sp ec ti ve r ev ie w st u d y V ar io u s w ar d s of h os p it al , t h re e m ed ic al w ar d s in o n e te ac h in g h os p it al N ot a va il ab le P ap er b as ed ve rs us e le ct ro n ic p re sc ri b in g w it h n o al er ts o r C D S S su ch a s ch ec ks o n d ru g in te ra ct io n s or a ll er gi es P re sc ri b in g er ro rs ( ch ar t re vi ew ) (n o n u m er …  Improving Hand-off Report Student Names Team Name and First/Last Names of Participants Problem  Report (timing and hand off errors):  The unit manager of a medical surgical unit has observed that change of shift report takes greater than 45 minutes.  In addition, staff has complained that their peers do not include vital data (IV sites, dressing sites, DVT prevention measures….) in report leading to errors, leave patients in disarray, and leave tasks incomplete.  Our task is to propose a change that will address these issues.  Report (timing and hand off errors:  Unit managers observed that there was miscommunication between staff during shift report.  Often times leaving out important patient information as well as taking a significant amount of time to relay the information. Our goal it to offer a change that will address these issues.  Now here is our SWOT analysis starting off with Derrick talking about the strengths. Majka  Communication failures compromise patient treatment, care quality, and safety. It also leads to medical errors, the third leading cause of deaths in the United States (Ghosh, et all., 2015) The varying parties and large amount of complex information included in patient handoff reports frequently contribute to informational gaps and omissions in the handoff report that can lead to sentinel events and patient hard (Staggers & Blaz, 2013) Research has identifed handovers as a risky time in the care process, when information may be lost, distorted or misinterpreted (Borowitz et al 2008, Owen et al. 2009, Philibert 2009) Report (timing and hand off errors):  The unit manager of a medical surgical unit has observed that change of shift report takes greater than 45 minutes.  In addition, staff has complained that their peers do not include vital data (IV sites, dressing sites, DVT prevention measures….) in report leading to errors, leave patients in disarray, and leave tasks incomplete.  Your task is to propose a change that will address these issues.  Increase of errors during patient hand-off report leading to missed information and incomplete tasks  Hand-off report time is taking a greater deal of time  Our task is to implement the use of SBAR as the standard hand-off report between shifts in order to reduce errors and decrease the time spent giving report.  2 SWOT Strengths: Multidepartment focus addressing handoff report problems(Robins et al., 2017) Solutions shorten time taken in report while increasing quantity of pertinent information. (Stewart & Hand, 2017) SBAR is supported by the Joint Commision (Stewart & Hand, 2017) Proven error reduction due to use of SBAR tool. (Stewart & Hand, 2017) SBAR is an evidence-based hand-off tool (Eberhardt, 2014) Weakness Use of the tool requires education to reduce user error (Stacey Eberhardt 2014) Medical personnel have personal bias on giving report (Ghosh et al.,  2018) Some staff are unreceptive to change (Robins & Dai, 2017). Evaluating execution of report can be affected by observer bias (Robins & Dai, 2017) Opportunities SBAR is inexpensive as a tool and will earn its cost in education by the reduction of sentinel events (Stewart, 2017) Improve patient handoff by implementing an evidence-based handoff tool in SBAR format  (Eberhardt, 2014) For continued nursing education in standardizing hand-off report (Ghosh et al., 2018). Threats Due to the variety of the change-of-shift reporting process, the findings of the study may not be applicable across similar settings (Ghosh et at., 2018). Some staff are unreceptive to change (Robins et al., 2017). Evaluating execution of report is subject to observer bias (Drach-Zahavy, 2014)  Small sample sizes from 2 studies: only one randomized control study (Stewart, 2017) Strengths: Multidepartment focus on addressing problems with handoff report (Robins et al., 2017) Solutions manage to shorten time taken to give report while increasing the amount of pertinent information given in that time frame. (Stewart & Hand, 2017) SBAR is supported by the Joint Commision (Stewart & Hand, 2017) Error reduction due to use of SBAR tool. (Stewart & Hand, 2017) SBAR is an evidence-based hand-off tool (Eberhardt, 2014) Weakness (Wendy)  Use of the tool requires education for all staff to reduce user error (Stacey Eberhardt 2014) Medical personnel have personal bias on how they want to give report (Ghosh et al.,  2018) Healthcare worker disinterest in changing how they give report. (Robins et al., 2017). Subjective approach to measuring a handover’s strategies might be subject to bias, as participants may behave differently in the presence of an observer. Opportunities (ashley)  SBAR is inexpensive as a tool and will earn its cost in education by providers by the reduction of sentinel events (each of which carries a high expense). (Stewart, 2017) Improve patient handoff by implementing an evidence-based handoff tool in Situation Background Assessment Recommendation (SBAR) format  (Eberhardt, 2014) For continued nursing education in standardizing hand-off report (Ghosh et al., 2018). Threats (Alma) Due to the variety of the change-of-shift reporting process, the findings of the study may not be applicable across similar settings (Ghosh et at., 2018). The acuity of patient injury and medical history can increase the amount of time for patient hand-off (Robins, 2017). Small sample sizes from 2 studies: only one randomized control study (Stewart, 2017) and sample size of 200 handovers in 5 wards in another study(Drach-Zahavy, 2014) 3 Assessment  Inefficient communication during hand off report is a challenge to patient care. (Ghosh, et al., 2018)​ Communication error given during report increases risk of poor patient outcomes. (Stewart, 2017) ​ Hand off communication between medical personnel leads to an increase in medication errors, incomplete tasks, disorder, and eventually poor patient outcomes (Robins et al., 2015)​ According to The Joint Commission, communication errors have been among the top three leading root causes of reported sentinel events every year since 2004. (Stewart, 2017) The information we had gathered from our assessment on giving report overall was -  1. Poor communication leads to poor patient outcome  2. The Joint Commission has stated communication errors has been the top 3 leading root causes of unanticipated major events in the healthcare setting that results in death or serious physical or psychological injury to a client which require immediate investigation by the health care facility since 2004 3. And now we will be talking about our Diagnosis. Goal should comes from assessments (SMART (MEASURABLE)) Assessment will be bullet points of why is this a problem  Specific, measurable, attainable, realistic, timely All RNs and assistive personnel will attend 1 or more in-services on the use of SBAR handoff report within three weeks. During the same three week period, charge nurses and nursing management will include SBAR teaching in pre-shift meetings, encouraging staff to begin to practice using the SBAR template during report.  Following the three week introduction of SBAR to the staff, SBAR will be implemented on the unit for a trial period of 1 month with the goal of receiving ideas of how we can improve it from the staff at the end of the 1 month period.  At the end of the one month period, staff nurses and assistive personnel will be invited to discuss their experiences with SBAR, as well as any ideas they have to improve it, during pre-shift meetings, down-time during their shift, or via email with the nurse manager. 15 days into the trial month, as well as at the end of the trial month, the nurse manager will personally solicit input regarding SBAR from harvest nurses on the unit. At the end of the 1 month trial period, metrics on sentinel events, falls, nosocomial infections, and other communication errors will be compared with the month prior to SBAR implementation and to the same month in the previous year. During the second month, a new SBAR form that includes select suggestions from staff will be used by those staff members while other staff members continue to use the known SBAR report. Communication errors, sentinal events, falls, nosocomial infections, et al will be compared between the two systems.  Majka  4 Diagnosis Lack of standardization in report Communication Barriers (Stewart & Hand, 2017)  Communication practices learned by various career stages of nurses (promise, momentum, harvest)  Different individual communication styles Gaps in knowledge regarding lack of standardized reporting A lack of standardization in report increases risk of error and poor patient outcomes 5 S.M.A.R.T. Goal Use an evidence-based standardized hand-off report tool to reduce report times to less than 45 minutes while reducing report-based errors by 20\% within 6-month period.  Precontempemplation: Nurse manager goes to charge nurses, harvest nurses, and harvest support staff with the SBAR template and asks them to sit with it for one week. He or she will ask for feedback from these individuals about implementing it on the unit.  Contemplation: Harvest nurses and support staff, and charge nurses spend a week with the SBAR template and consider its strengths, weaknesses, and or simply form an opinion around it.   Preparation: nurse manager introduces in-services on SBAR and charge nurses begin introducing the template during pre-shift meetings.  Action: Nurses and support staff begin using the template during all hand-off reports for a one month period. Nurse manager seeks input from harvest staff on ways to improve the system and attempts to include their input on a trial period, thereby extending the practice of the original SBAR for another month with most staff, and offering a personalization to those interested in improving the system.  Maintenance: Nurse manager compares statistics from the same time period one year ago, to the same length of time prior to using the SBAR report, and the data from the SBAR report compared with the modified SBAR report and presents the data to the staff at a staff meeting. At the meeting the nurse manager encourages public input and opinions on the SBAR report. If there is resistance, the manager asks that SBAR be continued in practice for a 3 month period in which he or she will personally receive report from individuals on their patients – helping those nurses who need it with ways to be more succinct. At this point, the report will have been used in practice for 5 months and will have become habit for many of the staff.  Alma  6 Full-Range Leadership Model/Theory Definition: Focuses on the behavior of leaders towards the workforce in different work situations. (Marquis & Huston, 2011) Three sub-types Transactional Transactions between leaders and followers Leaders promote compliance to standard SBAR method through rewards and punishments Transformational Identifies needed change, inspires, and executes change Emphasize the importance of reducing errors in patient hand-off through application of SBAR. Our goal is to enhance quality of care and thorough communication. Laissez-faire No standard rules  Used when nursing staff and PCTs are efficient with and advocating use of SBAR Full Range Leadership: Promise, Momentum, Harvest Wendy Transactional: Promoting buy-in from nurses and PCTs through encouragement of ideas and discussion while also increasing of stakeholder support of the SBAR method Theory should apply to what we are trying to accomplish  this is how we plan to use this leadership style because.... Why is this theory important for our outcome? Using more then one theory, where is it applicable?  7 Plan Following the three-week introduction of SBAR to the staff, SBAR will be implemented on the unit for a trial period of one-month with the goal of receiving ideas of how we can improve it from the staff at the end of the one-month period.  At the end of the one-month period, staff nurses and assistive personnel will be invited to discuss their experiences with SBAR, as well as any ideas to improve it, during pre-shift meetings, down-time during their shift, or via email with the nurse manager. 15 days into the trial month, as well as at the end of the trial month, the nurse manager will personally solicit input regarding SBAR from harvest nurses on the unit. At the end of the one-month trial period, metrics on sentinel events, falls, nosocomial infections, and other communication errors will be compared with the month prior to SBAR implementation and to the same month in the previous year. During the second month, a new SBAR form that includes select suggestions from staff will be used by those staff members while other staff members continue to use the known SBAR report. Communication errors, sentinel events, falls, nosocomial infections, et al will be compared between the two SBAR report templates at the end of a one-month trial. 8 3 Weeks RNs and assistive personnel to attend 1 or more in-services on SBAR handoff report  Following in-service, SBAR teaching in pre-shift meetings, encouraging staff to begin to practice using the SBAR template during report.  1-month trial SBAR will be implemented on the unit for a trial period with the goal of receiving ideas of how we can improve it from the staff at the end of the one-month period.  15 days into the trial month/ after the trial month Nurse manager will personally solicit input regarding SBAR from harvest nurses on the unit. Post 1-month trail Staff invited to discuss their experiences with SBAR, to share ideas to improve it Second trial(1 – 3 months) New SBAR form that includes select suggestions from staff will be used. Communication errors, sentinel events, falls, nosocomial infections, et al will be compared between the two SBAR report templates at the end of a one-month trial. Then again at the end of three months.  Metrics on sentinel events, falls, nosocomial infections, and other communication errors will be compared with the month prior to SBAR implementation and to the same month in the previous year. References Drach-Zahavy A ; Hadid N. Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift. J Adv Nurs. 2015; 71: 1135-1145 Ghosh, K., Curl, E., Goodwin, M., Morrell, P., & Guidroz, P. (2018). An Exploratory Study on how to Improve Bedside Change-of-Shift Process: Evidence from One Hospital Using Technology to Support Verbal Reporting. HICSS. Marquis, B.L., & Huston, C.  (2011). Leadership roles and management functions in nursing: Theory and application (9th ed).  Lippincott, Williams, Wilkins.  ISBN: 978-1-4963-4979-8 Robins, H., & Dai, F. (2015). Handoffs in the Postoperative Anesthesia Care Unit: Use of a Checklist for Transfer of Care. AANA journal, 83 4, 264-8. Stewart, Kathryn R., SBAR, communication, and patient safety: an integrated literature review (2016). Honors Theses. https://scholar.utc.edu/honors-theses/66