1.Identification of an advanced practice nursing issue or practice problem of concern. 2.Design a research question using the PICOT format. 3.A brief literature review and findings related to best practices with at least three scholarly resources cited in APA (6th ed.) format. 4.Plan, Do, Study, Act Process that could be used. 5.Any implications that the investigation might have for nursing practice

Identification of an advanced practice nursing issue or practice problem of concern:

One of the advanced practice nursing issues that has gained significant attention in recent years is the growing prevalence of medication errors in healthcare settings. Medication errors pose a serious risk to patient safety and can lead to negative outcomes such as adverse drug reactions, hospital readmissions, and even death. According to the World Health Organization, medication errors are responsible for causing harm to millions of patients worldwide each year. This issue is of particular concern in advanced practice nursing as advanced practice nurses (APNs) often have prescribing privileges and are directly involved in medication management.

Design a research question using the PICOT format:

In order to address the issue of medication errors in advanced practice nursing, the following research question can be formulated using the PICOT (Population, Intervention, Comparison, Outcome, Time) format:

In adult hospitalized patients (P), does the implementation of a computerized physician order entry system (I) compared to a paper-based system (C) reduce the rate of medication errors (O) within a six-month period (T)?

A brief literature review and findings related to best practices:

A review of current literature on medication errors in healthcare settings reveals several best practices for reducing the occurrence of such errors. One of the most effective interventions identified is the implementation of computerized physician order entry (CPOE) systems. CPOE systems have been found to significantly reduce the rate of medication errors by eliminating illegible handwriting and dosage miscalculations. A study by Kuperman et al. (2003) found that the implementation of a CPOE system led to a 55% reduction in medication errors in a large academic medical center.

Additionally, the use of barcoding technology in conjunction with CPOE has shown promise in further reducing medication errors. A study by Poon et al. (2010) demonstrated that the combination of barcoding and CPOE led to a 41% reduction in medication errors, with a majority of errors related to wrong dosage and wrong frequency of administration. This underscores the importance of implementing multiple interventions to address different types of medication errors.

Another best practice in medication error prevention is the use of standardized medication administration processes and protocols. The Institute for Safe Medication Practices (ISMP) has developed guidelines for safe medication administration, including the standardization of medication administration times, double-checking procedures, and the use of independent double checks for high-risk medications. Implementing these guidelines has been shown to significantly reduce medication errors and improve patient safety (Bates et al., 1998).

Plan, Do, Study, Act (PDSA) process:

In order to implement and evaluate the effectiveness of interventions to reduce medication errors in advanced practice nursing, the Plan, Do, Study, Act (PDSA) process can be used. This quality improvement framework provides a systematic approach to design, implement, evaluate, and refine interventions.

The first step is to identify the problem and gather baseline data related to the rate and types of medication errors. This data can be collected through chart reviews, incident reports, and staff surveys. Once the baseline data has been collected, the next step is to design and implement the interventions, such as the implementation of a CPOE system and standardized medication administration processes. Data should be collected post-implementation to determine the impact of the interventions on medication error rates.

The collected data should then be analyzed and compared to the baseline data. This will help determine whether the implemented interventions have led to a reduction in medication errors. If the interventions have been successful, they can be standardized and further disseminated throughout the organization. If the interventions have not been effective or have led to unintended consequences, they can be modified or new interventions can be proposed and implemented.

The PDSA process allows for continuous improvement and refinement of interventions to reduce medication errors. It is important to involve all stakeholders, including nurses, pharmacists, physicians, and patients, in the process to ensure a multidisciplinary approach to medication safety.

Implications for nursing practice:

The investigation into medication errors in advanced practice nursing has several implications for nursing practice. Firstly, it highlights the importance of implementing evidence-based interventions, such as CPOE systems and standardized medication administration processes, to reduce medication errors and improve patient safety. Advanced practice nurses should advocate for the implementation of these interventions in healthcare settings to protect their patients from harm.

Secondly, the investigation emphasizes the need for ongoing education and training for healthcare professionals involved in medication management. Nurses, in particular, play a critical role in medication administration and must possess the necessary knowledge and skills to minimize medication errors. Therefore, continuing education programs and competency assessments should be in place to ensure nurses are up to date with best practices and guidelines for safe medication administration.

Lastly, the investigation highlights the importance of a culture of safety within healthcare organizations. A blame-free culture that encourages reporting of medication errors and near-misses is essential for identifying system weaknesses and implementing necessary changes. Advanced practice nurses should strive to create a culture of openness and continuous improvement to enhance patient safety in medication management.

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