NURS FPX 6218 Assessment 1 Proposing Evidence Based Change

Change Proposal Summary Report

Proposing evidence-based change involves a structured approach to identifying the problem, gathering relevant information, and presenting compelling evidence to support a change. The first step is to identify the problem that needs to be addressed. This requires an in-depth understanding of the issue and its root cause. Once the problem has been identified, the next step is gathering relevant information to inform the proposed change. This may involve conducting research, analyzing data, or seeking expert opinion (Halawa et al., 2020). The purpose of this report is to analyze the issue of medication errors in the M Health Fairview Ridges Hospital. Then I will suggest a changed proposal and compare it with two non-USA healthcare systems.

Executive Summary 

Proposed Change

Medication errors in the USA are a significant problem that can harm patients, cause prolonged hospital stays, and increase healthcare costs (Rodziewicz et al., 2022). According to the World Health Organization (WHO), medication errors cause patient harm. They can occur at any stage of the medication use process, from prescribing to dispensing and administration (World Health Organization, 2022). Any step in the medication procedure, from prescription to administration, is susceptible to medication errors. Various factors, including communication gaps, inadequate training, and lack of standardization, can cause them. One aspect of a local or regional healthcare system that could benefit from improvement is medication administration, specifically reducing medication errors (Nguyen et al., 2022).

NURS FPX 6218 Assessment 1 Proposing Evidence Based Change

 According to the Institute of Medicine, medication errors harm at least 1.3 million people annually in the United States, costing the healthcare system billions of dollars (Caboral-Stevens et al., 2020). A study conducted by the Leapfrog Group estimated that medication errors cost the U.S. healthcare system over $20 billion annually, with over 7,000 deaths attributed to medication errors annually (Hydari et al., 2018). In the healthcare facility, M Health Fairview Ridges Hospital, medication errors resulted in allergic reactions, side effects, or interactions with the patient’s other medications. Hospitals should document 90% or more of home medicines, visit medicines, and allergies/adverse reactions in the patient’s medical record (Leapfrog Survey, 2022). The hospital has even declined to show progress, as suggested by the Leapfrog Group (M Health Fairview Ridges Hospital | Ratings | Leapfrog Group, n.d.).

One solution to reducing medication errors is implementing an Electronic Medication Administration Record (eMAR) system in M Health Fairview Ridges Hospital (Leapfrog Survey, 2022). An eMAR is a digital record that tracks and documents the administration of medications in real-time. This system can help reduce the risk of medication errors by ensuring the proper medication is given to the right patient at the right time and dose (Gregory et al., 2021).

Expectations for Improvement 

The research has shown that implementing an eMAR system can significantly reduce medication errors. A study published in the Journal of Medical Systems found that using an eMAR system reduced medication errors by 50% compared to traditional paper-based systems (Chan et al., 2019). Another study published in the American Journal of Health-System Pharmacy found that implementing an eMAR system resulted in a 44% reduction in medication errors (Hanifin & Zielenski, 2020). Therefore, it is reasonable to expect that implementing an eMAR system in a local or regional healthcare system would reduce medication errors, ultimately improving patient safety and outcomes (Gregory et al., 2021).

Desired Outcomes

Desirable outcomes for implementing Electronic Medication Administration Record (eMAR) system in M Health Fairview Ridges Hospital to reduce medication errors include:

1. Improved patient safety
2. Increased efficiency
3. Enhanced communication and coordination
4. Improved compliance (Chan et al., 2019)

NURS FPX 6218 Assessment 1 Proposing Evidence Based Change

The Rationale for the Desired Outcomes

According to a study published in the Journal of Quality and Patient Safety, implementing eMAR systems reduced medication errors by up to 55% (Iqbal et al., 2021). According to a study published in the Journal of the American Medical Informatics Association, eMAR systems improved medication adherence rates by 22% (Moore et al., 2020). Improved adherence leads to better health outcomes and reduced healthcare costs. eMAR systems provide real-time medication administration information, enabling healthcare providers to identify potential errors and take corrective action quickly (Moore et al., 2020).

Who will pay for care?

Several organizations in the United States can provide funding to M Health Fairview Ridges Hospital for implementing Electronic Medication Administration Record (eMAR) systems to reduce medication errors. 

Centers for Medicare & Medicaid Services (CMS)

CMS is a federal agency within the Department of Health and Human Services (HHS) that administers Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). CMS has several initiatives to reduce medication errors, including funding for health I.T. projects that improve medication safety. Eligible organizations can apply for funding through the CMS Health Care Innovation Awards program (Wadhera et al., 2020).

Agency for Healthcare Research and Quality (AHRQ)

AHRQ is a federal agency within HHS that researches to improve healthcare services’ quality, safety, efficiency, and effectiveness. AHRQ has several grant programs that provide funding for projects that improve patient safety, including those focused on reducing medication errors. Organizations can apply for funding through the AHRQ Patient Safety and Medical Liability Reform program (Jue et al., 2019).

The Robert Wood Johnson Foundation (RWJF)

RWJF is a private foundation that funds various health-related initiatives, including those focused on improving medication safety. RWJF has several grant programs that provide funding for projects to reduce medication errors, such as the RWJF Clinical Scholars program (Kelley et al., 2022).

The American Nurses Foundation (ANF)

ANF is a non-profit organization that funds nursing research and education initiatives. ANF has several grant programs that provide funding for improving patient safety, including those focused on reducing medication errors. Organizations can apply for funding through the ANF Nursing Research Grants program (Naegle et al., 2023).

Factors Limiting the Achievement Outcomes

1. Resistance to change can limit the effectiveness of eMAR in reducing medication errors.
2. E-MAR depends on technology; technical issues like system downtime can limit its effectiveness.
3. Lack of training can limit the effectiveness of eMAR in reducing medication errors.
4. Interoperability issues can arise if eMAR systems are incompatible with other healthcare systems, which can limit the effectiveness of eMAR in reducing medication errors (Halawa et al., 2020).

NURS FPX 6218 Assessment 1 Proposing Evidence Based Change

The success of eMAR in M Health Fairview Ridges Hospital depends on overcoming factors such as resistance to change, technical issues, lack of training, and limited interoperability. To optimize healthcare solutions, healthcare organizations must prioritize the education and training of healthcare providers, invest in interoperable technology, and address resistance to change by involving staff in the implementation process (Kelley et al., 2022).

Healthcare System Comparative Analysis

One non-U.S. healthcare system that has successfully implemented an eMAR system is the National Health Service (NHS) in the United Kingdom. The NHS uses the Electronic Prescribing and Medicines Administration (ePMA) system, which includes an eMAR component (Nance et al., 2020). The ePMA system has been shown to reduce medication errors and improve patient safety significantly. The system gives clinicians a real-time overview of a patient’s medication history, including drug interactions and potential allergies, making it easier to identify potential issues and prevent errors (Tolley et al., 2022). A study published in the British Journal of Clinical Pharmacology found that after the implementation of EHRs, there was a significant decrease in medication errors by 83.2% in hospital inpatients in England. The study also reported that the eMAR system significantly reduced the incidence of omitted medications and incorrect dosages (Nance et al., 2020). Many healthcare organizations in the U.K. have adopted it to enhance communication and coordination among healthcare professionals and improve patient safety (Tolley et al., 2022)or NURS FPX 6218 Assessment 1 Proposing Evidence Based Change. 

Another healthcare system that has implemented an eMAR system is the healthcare system in Singapore. Singapore’s healthcare system uses an eMAR integrated with its national electronic health records system (Sharma et al., 2020). The eMAR system has been shown to reduce medication errors and improve patient safety. The system allows clinicians to access a patient’s medication history and allergy information, reducing the risk of adverse drug reactions (Stolic et al., 2022). Numerous healthcare administrations have implemented it to improve communication and harmonization among healthcare experts and improve patient security (Sharma et al., 2020). A study published in the International Journal of Medical Informatics found that implementing eMARs in Singapore’s healthcare system resulted in a 50% reduction in medication errors (Sharma et al., 2020).

Lesson Learned

Lessons learned from these systems include the importance of an integrated and standardized approach to electronic health records. The success of these systems is due in part to integrating the eMAR system with other electronic health record systems, allowing clinicians to access a patient’s complete health history. Additionally, these systems highlight the importance of training and support for clinicians while implementing new technology. Adequate training and support are critical to ensuring clinicians are comfortable using the new system and understand how to use it effectively (Tolley et al., 2022).

These lessons have clear implications for implementing an eMAR system in the United States. To successfully implement an eMAR system, the U.S. healthcare system should focus on creating an integrated and standardized approach to electronic health records. Additionally, the system should provide adequate training and support for clinicians during implementation. By following these lessons, the U.S. healthcare system can successfully implement an eMAR system, reducing medication errors and improving patient safety (Moore et al., 2020).

The Rationale for the Proposed Change

There are many reasons why medication errors occur, including incorrect dosages, drug interactions, and incorrect administration. By using an eMAR system, healthcare providers can reduce the risk of medication errors by providing accurate, up-to-date information about each patient’s medication regimen. The eMAR system provides a real-time, electronic record of medication administration, which healthcare providers can access at any time. This makes it possible to monitor the administration of medications more precisely, which can help spot potential errors before they happen. The system can also alert healthcare providers if a medication is contraindicated if the dosage is incorrect, or if there is a potential drug interaction (Tolley et al., 2022).

Specific Changes Leading to Improvement

An eMAR system can help eliminate errors caused by illegible handwriting, incomplete or incorrect documentation, and misinterpretation of orders. The system prompts the nurse to double-check the medication before administering it, ensuring that the correct medication and dosage are given to the right patient at the right time. An eMAR system can be programmed to provide alerts when a medication is due or when there is a potential error. This helps to prevent missed doses, delayed administration, and overdoses (Hanifin & Zielenski, 2020).

Financial and Health Implications

Using an Electronic Medication Administration Record (eMAR) system can have significant financial and health implications for M Health Fairview Ridges Hospital. Here are some statistics that illustrate these implications:

• Medication errors are estimated to cost the U.S. healthcare system over $20 billion annually (Rodziewicz et al., 2022).
• Implementing eMAR systems has reduced medication errors by up to 70%, resulting in significant cost savings (Kruse et al., 2020). 
• According to a study published in the Journal of Medical Internet Research, implementing eMAR systems can save $2,884 per hospital bed per year (Nguyen et al., 2022).

Health Implications

• Medication errors are a leading cause of patient harm, resulting in an estimated 7,000 deaths annually in the United States (Hydari et al., 2018). 
• EMAR systems have been shown to reduce medication errors and improve patient safety (Nguyen et al., 2022). 
• According to a study published in the Journal of Healthcare Information Management, implementing eMAR systems can result in a 22% reduction in adverse drug events (Hydari et al., 2018).

Not making the proposed change to M Health Fairview Ridges Hospital by not implementing an eMAR system may result in the following financial and health implications:

• Continued medication errors lead to patient harm, which may result in lawsuits and malpractice claims, adding to the already high cost of healthcare (Kruse et al., 2020).
• Increased healthcare costs due to the need for additional treatment and more extended hospital stays resulting from medication errors (Kruse et al., 2020).
• Potential loss of patient trust and confidence in the healthcare system (Nguyen et al., 2022).

Conclusion

In conclusion, implementing an Electronic Medication Administration Record (eMAR) system in M Health Fairview Ridges Hospital can significantly reduce medication errors in healthcare facilities. With its accurate, real-time medication information, eMAR systems can help prevent medication errors due to incorrect dosages, timing, or drug interactions. Additionally, eMAR systems can improve efficiency and communication between healthcare providers, leading to better patient outcomes and increased patient satisfaction.

Appendix

Table 1: Health Care System Comparative Analysis

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