Electronic health records and medication errors Capstone
Electronic health records (EHRs) have been used widely in hospital settings. EHR systems entail the electronic patient “chart” and normally include various functionalities such as computerized provider order entry (CPOE), medical device interfaces, and laboratory and imaging reporting (Han et al., 2016). EHR systems aim to create seamless, systematic and enduring documentation of the medical history and treatment of patients. EHR systems have been shown to assist in preventing medical errors through flagging of the possible drug interactions and/or adverse reactions (Han et al., 2016). This paper aims to perform research on the efficacy of electronic health records in minimizing and preventing medication errors. By addressing this topic, to minimize and prevent medication errors, the ensuing patient harm due to medication errors in healthcare settings will also be addressed…
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Instructions
Evidence Base Practice Project Paper
In Week 9 Students will submit a formal project proposal using APA format. The paper should include all topics below and while your paper will be in APA format an example to emulate is on page 344 of your Melynk text.
- Introduction
- The Spirit of Inquiry Ignited
- The PICOT Question Formulated
- Search Strategy Conducted
- Critical Appraisal of the Evidence Performed
- Evidence Integrated with Clinical Expertise and Patient Preferences to Inform a Decision and Practice Change Implemented
- Outcome Evaluated
- Project Dissemination
- Conclusion
PAGE 344 OF THE MELYNK TEXT BELOW
step 0The Spirit of Inquiry Ignited
Major depressive disorder is a treatable medical illness. Despite a prevalence of 12.8% of the U.S. population aged 12 to 17 years (SAMHSA, 2016) with major depressive disorder or depressive symptoms that impair their functioning, less than 25% of depressed adolescents receive the evidence-based treatment they need. In outpatient mental health settings, advanced practice psychiatric nurses conduct comprehensive psychiatric evaluations with adolescents; spend time learning about their strengths, symptoms, and struggles; and establish and implement treatment plans. For teens with symptoms of depression, their day-to-day life can be a painful struggle. Typically, parents come to the practice feeling helpless and wanting the best most active treatment to help their child feel less depressed and function better. We, as psychiatric advanced practice registered nurses (APRNs), know that the most robust treatment for depression in adolescents involves psychotherapy (which historically has been in 50-minute “hours”) and medication (if indicated). Many psychiatric APRNs now practice in settings where there has been a shift to brief 20- to 30-minute medication visits with patients, because of agency requirements to see an increasing number of patients each work day. APRNs are expected to adhere to the clinic schedule while providing the best evidence-based care to our young patients. Often we do not know how to bridge the gap between what the research indicates is best practice for treatment of depression in teens and what is happening in practice. This led me to wonder about whether it would be possible to deliver evidence-based cognitive behavioral therapy (CBT) and improve treatment outcomes for depressed adolescents within the limitation of 30-minute medication evaluation appointments. I needed to use the evidence-based practice (EBP) process to find out. electronic health records and medication errors Capsone.
step 1The PICOT Question Formulated
In depressed adolescents (P), how does CBT (I) compared to other psychotherapy interventions (C) improve depressive symptoms (O) over a 3-month period (T)?
step 2Search Strategy Conducted
The Cochrane Database of Systematic Reviews (CDSR) was searched first with the keywords adolescent, depression, treatment effectiveness evaluation, and psychotherapy. A systematic review by Watanabe, Hunot, Omori, Churchill, and Farukawa (2007) was found that reviewed studies of psychotherapy effectiveness for children and adolescents with depression. Next, MEDLINE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using the same keywords. The search also included the National Guidelines Clearinghouse for practice guidelines to treat depression in adolescents (Cheung et al., 2007). Both level I and level II evidence studies (Melnyk & Fineout-Overholt, 2014) were found in the search process. electronic health records and medication errors Capsone
step 3Critical Appraisal of the Evidence Performed
Rapid critical appraisal checklists were used to evaluate the validity, reliability, and applicability to practice (Melnyk & Fineout-Overholt, 2015) for each of the studies found from the search. The systematic review by Watanabe et al. (2007) supported CBT and interpersonal psychotherapy as effective treatments for adolescents with depression. In the search of PsycINFO and other databases, several meta-analyses of randomized controlled trials (RCTs), including one conducted by McCarty and Weisz (2007), supported CBT as an effective treatment for depressed adolescents. One of the RCTs, The Treatment of Adolescent Depression Study (TADS) by March, Hilgenberg, Silva, and TADS Team (2007), was a landmark 13-site RCT that compared (1) CBT, (2) placebo, (3) antidepressant medication (fluoxetine), and (4) a combination of fluoxetine and CBT. The study determined the superior effectiveness of the combination of CBT and fluoxetine in the acute and continuation treatment of adolescent major depression.
The level I evidence, the strongest level of evidence to guide practice, found a systematic review and a meta-analysis of RCTs that tested the efficacy of CBT for adolescent depression. Level II evidence was also found in the TADS RCT, which is the strongest study design for controlling extraneous or confounding variables (Melnyk & Fineout-Overholt, 2011) and supported that CBT is a very efficacious treatment for adolescent depression. In the studies included in the meta-analysis, individual CBT sessions were 60 minutes long. Group CBT programs for adolescents were also included in the meta-analysis.
Cited CBT treatment manuals for depressed adolescents in the studies were reviewed for their applicability to brief sessions. In these treatment manuals, the authors recommended individual CBT sessions of 60 minutes duration. For this project, a CBT-based intervention entitled Creating Opportunities for Personal Empowerment (COPE; Melnyk, 2003) was selected because it included all of the components identified in the literature that comprise effective CBT interventions for depressed adolescents. electronic health records and medication errors Capsone. The manual for each of the seven COPE sessions is concise, and the COPE intervention is usable in 30-minute sessions. The seven CBT-based skill-building sessions in COPE had been previously embedded into a 15-session healthy lifestyle intervention for adolescents that was delivered in required high school health courses, but it had not yet been evaluated in a community health setting (Melnyk et al., 2007, 2009). Therefore, the purpose of this EBP change project was to implement and evaluate the outcomes of delivering COPE to teens in a community mental health clinic.
step 4Evidence Integrated With Clinical Expertise and Patient Preferences to Inform a Decision and Practice Change Implemented
The plan for this project based on the evidence found was to translate evidence-based CBT into brief 30-minute sessions and assess its feasibility and outcomes with 12- to 17-year-old clinically depressed adolescents treated at a community mental health center in a small, rural town in the southwestern United States.
When adolescents are seen in community mental health practices and diagnosed with moderate to severe depression, the usual treatment is antidepressant medication. Antidepressants are an effective treatment to relieve symptoms of depression, but the evidence strongly supports the combination of antidepressant medication and CBT as the most effective treatment plan. In terms of patient preferences and values, many parents who bring their adolescents for treatment do not want medication as part of the treatment plan. However, some families feel that pharmacologic treatment will provide the most rapid relief for their child’s depressive symptoms. The advanced practice psychiatric nurse, with education and skills in both psychotherapy and pharmacology, can provide evidence from current literature and her own practice and encourage parents and teens to share experiences, concerns, and questions related to the acceptability of various treatment options. It is helpful to provide the families with written handouts to take home, such as the American Academy of Pediatrics’ (AAP) “Evidence-based Child and Adolescent Psychosocial Interventions” (2011, revised 2012, 2017-2018) PDF handout electronic health records and medication errors Capsone. Together, the advanced practice nurse and the family can establish a mutually agreed upon treatment plan. With the implementation of this project, informed consents by parents and teen assents were signed. None of the families seen for initial psychiatric evaluation of their adolescent declined the COPE cognitive behavioral skills building intervention when it was explained, reviewed, and offered as an option.
A pre- and postintervention outcomes evaluation was used. Fifteen adolescents aged 12 to 17 years, who came for intake to the community mental health center and presented with significant depression, were enrolled in the project. All of the adolescents, along with their parents, agreed to receive COPE, which was presented in seven 30-minute sessions scheduled at weekly intervals. They also agreed to fill out project-related outcome measures both before and after the COPE seven-session intervention. The measures included the Beck Youth Inventory, which has five subscales (anxiety, anger, depression, self-concept, and destructive behavior), a personal beliefs scale, a COPE content quiz, and a form that asked for demographic data about the teen and family electronic health records and medication errors Capsone. The parents and teens were both given post-COPE evaluation forms to fill out anonymously to provide feedback regarding their experiences with the COPE intervention.
step 5 Outcomes Evaluated
All 15 teens enrolled completed all seven sessions of COPE. Adolescents reported significant decreases in depression, anxiety, anger, and destructive behavior as well as increases in self-concept and personal beliefs about managing negative emotions (Lusk & Melnyk, 2011a). Evaluations indicated that COPE was a positive experience for teens and parents (Lusk & Melnyk, 2011b). It was concluded that COPE is a promising brief CBT-based intervention that can be delivered within 30-minute individual outpatient visits. With this intervention, advanced practice nurses can work within busy outpatient practice time constraints and still provide evidence-based treatment for the depressed teens they manage.
step 6Project Outcomes Successfully Disseminated
This project was presented at national conferences and was published. The COPE intervention is now standard practice for treating depressed and anxious teens. Other psychiatric and pediatric advanced practice nurses in community mental health and pediatric primary care settings as well as schools across the country are now being trained in using COPE to prevent and treat depressed and anxious adolescents. Further studies and evaluation projects have continued to show positive outcomes with the cognitive behavioral skills building COPE intervention, including decreases in depression, suicidal ideation, and anxiety; improvements in self-esteem; and increases in healthy lifestyle behaviors (Hart, Lusk, Hovermale, & Melnyk, 2018; Hickman, Jacobson, & Melnyk, 2014; Kozlowski, Lusk, & Melnyk, 2015; Melnyk et al., 2013, 2015; Melnyk, Kelly, Jacobson, Arcoleo, & Shaibi, 2013; Melnyk, Kelly, & Lusk, 2014; Ritchie, 2011). A recent study published in the AAP journal Pediatrics (Dickerson et al., 2018) showed that a CBT delivered in a primary care setting is a cost-effective way to treat adolescents with depression declining antidepressants and the CBT intervention can be brief and still deliver long-term benefits in terms of cost and clinical outcomes. electronic health records and medication errors Capsone. The COPE intervention is increasingly being used in schools and colleges as well as primary care clinics to assist all youth who are coping with current life stressors.
References
Capstone: Electronic Health Records and Medication Errors
Introduction
Electronic health records (EHRs) have been used widely in hospital settings. EHR systems entail the electronic patient “chart” and normally include various functionalities such as computerized provider order entry (CPOE), medical device interfaces, and laboratory and imaging reporting (Han et al., 2016). EHR systems aim to create seamless, systematic and enduring documentation of the medical history and treatment of patients. EHR systems have been shown to assist in preventing medical errors through flagging of the possible drug interactions and/or adverse reactions (Han et al., 2016). This paper aims to perform research on the efficacy of electronic health records in minimizing and preventing medication errors. By addressing this topic, to minimize and prevent medication errors, the ensuing patient harm due to medication errors in healthcare settings will also be addressed. electronic health records and medication errors Capsone.
The Spirit of Inquiry Ignited
The problem of medication errors within healthcare settings and the consequent patient harm has persisted for a long time. Medication errors are among the leading medical errors. Medication errors refer to the preventable incidence that may lead to inappropriate use of medication or cause patient harm (Mekonnen et al., 2018). Medication errors are among the major threats to patient safety within healthcare organizations. Evidence indicates that medication errors among inpatients can be as high as 5.3% and medication errors are the key contributing factors to adverse drug events (ADEs) (Jember et al., 2018). ADEs lead to patient harm that includes events such as health complications; death; a prolonged period of hospital stay; hospital readmission; increased healthcare costs; and reduced patient satisfaction. Medication errors may include wrong dosage, erroneous prescriptions, interactions with other medications, etc (Mekonnen et al., 2018) electronic health records and medication errors Capsone. These medication errors can be prevented using electronic health record systems. Electronic Health Record systems can assist in preventing medication errors by highlighting possible medication interactions as well as adverse reactions. The EHR system can also notify regarding any drug-drug or drug-food interaction and also review for allergies and preceding documentation about adverse reactions to a specific medication, therefore, avoiding a medication error (Han et al., 2016). It is also possible for physicians and other healthcare providers to fast search for any medication, side effects, proper dose and route of administration, as well as medications’ contraindications using the EHR database.
With the implementation of an EHR system in healthcare organizations, it is possible to prevent medication errors and the associated adverse outcomes. electronic health records and medication errors Capsone.
The PICOT Question Formulated
PICOT: In patients admitted to a psychiatric institution that converted from paper charting to electronic health records (P), does the implementation of electronic health records (I) compared to paper charting (C) decrease medication errors (O) within 6 months of its implementation (T).
Search Strategy Conducted
An exhaustive and comprehensive systematic search was conducted to identify research studies addressing the impact of electronic health records (EHRs) in the prevention and minimizing medication errors. Various databases such as PubMed, CINAHL, JAMA, Wiley Library and Web of science were searched electronically. Also, the search was performed on the South University Library. Only research articles that were relevant to the study topic (electronic health records and medication errors) and supported the PICOT were included. The key terms used during the search included “electronic health records” “EHRs” and “medication errors”.
Critical Appraisal of the Evidence Performed
A literature evaluation table was utilized to evaluate the reliability, validity, and applicability of the retrieved evidence to practice. The literature from all the selected studies supported that prescribing errors are the most serious types of medication errors and that effective management of medications using electronic health record systems can significantly reduce medication errors, and particularly prescribing errors. The findings from Al-Sarawi et al (2019) indicate that electronic management of medications significantly reduces medication errors, and especially prescribing errors electronic health records and medication errors Capsone. Similarly, the findings of the study conducted by Vaidotas et al (2019) study support the use of electronic Medical Records in the emergency department in reducing the rates of medication errors. The study by Loguidice, (2014) also shows that electronic health records within long term care facilities lower the rates of medication errors. Hodgkinson et al (2017) also established that implementing an electronic prescribing system significantly reduced the rate of prescribing errors in the population of the study. The findings of Priya et al (2017) also supported the hypothesis that an electronic auditing tool plays a big role in lowering the rate of medication errors. The literature from all the selected studies shows that the use of electronic health record systems can significantly reduce medication errors, and particularly prescribing errors.
Evidence Integrated with Clinical Expertise & Patient Preferences to Inform a Decision & Practice Change Implemented
The basis for this project’s plan is the search and location of evidence regarding the impact of electronic health records on medication errors. There are numerous reliable studies and clinical expertise on the research topic that will shed light on the effect of EHRs in reducing and preventing medication errors. All the organizational healthcare workers will undergo upskilling training on the use of electronic health record systems. The training will be conducted both online and live. All healthcare workers will be required to undergo training. A multidisciplinary approach will be used to implement the change using Lewin’s change model. Lewin’s change model stipulates that a change is achieved using three steps that include unfreezing, change, and lastly freezing. Lewin’s change model is effective in implementing a change mentality among organizational workers and creating awareness about the change benefits (Mahmood, 2018). Clinical guidelines and professional standards from the relevant organizations will be reviewed and their input integrated into this project electronic health records and medication errors Capsone.
The topic regarding the use of EHRs to prevent and reduce medication errors is very relevant and important for the organization, healthcare providers, and patients as well. This is because EHR technologies are effective in preventing medication errors as the EHR system highlights possible adverse interactions and drug interactions (Han et al., 2016).
A multidisciplinary team approach will be used during the implementation of the project and it will be very important to search, retrieve, identify, and critically assess the relevant studies for the project. As earlier indicated, all healthcare workers in the organization must attend training on the use of EHRs, particularly regarding medications. All participants will be awarded a certificate of completion. The data about the rate of medication errors will be to collect pre and post-training to evaluate the impact of the training and implementation of the EHR system in reducing and preventing medication errors.
Outcome Evaluated
The outcomes of the project will be evaluated by analyzing the rate of medication errors before and after the implementation of the electronic health record system and the training of the healthcare workforce in the organization. This will be performed using the organizational web-based reporting system for medication errors. This is a system for reported medication errors within the organization. The organization healthcare workforce and particularly the pharmacists, physicians and the nursing staff will be required to dutifully report any medication error without any fear of being victimized and in a nonpunitive environment. The resulting adverse event from the medication error will all be reported. Therefore, the reporting should include the date, time and type of the medication error, as well as a description of the incident and the severity of the harm. The rate of medication errors will be analyzed before and after the implementation of the EHR system and the training. The reduced rate of medication errors will indicate the efficacy of the EHR system in reducing medication errors (Curtis et al., 2018). These findings are consistent with previous studies that indicate that EHR systems are effective in preventing and reducing medication errors.
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Project Dissemination
The findings from this project will be disseminated and shared with all organizational stakeholders, including external stakeholders. The findings will be posted on the organizational website that is accessible to all internal stakeholders in the organization. In addition, the findings from this project will be published and presented in national conferences and other professional organizations. A summary of the findings will also be printed on brochures and leaflets that will be distributed to all organizational workers and flyers pinned in the organizational board rooms and other strategic locations within the organization. As the findings are disseminated, all relevant stakeholders will be encouraged to give out their opinions about the findings and any necessary improvement for integration to the findings. electronic health records and medication errors Capsone.
Conclusion
The project focuses on the implementation of electronic health records in a mental health institution to reduce medication errors. Various databases such as PubMed, CINAHL, JAMA, Wiley Library and Web of science were searched electronically to locate the relevant evidence for this project. The retrieved and reviewed evidence indicates that electronic health records system is effective in preventing and lowering the rate of medication errors in healthcare organizations. A multidisciplinary approach will be used to implement the change using Lewin’s change model. To know the impact of the project, the data regarding the rate of medication errors before and after the implementation of a health records system will be collected and analyzed. The findings will be disseminated to all organizational stakeholders through reports, organizational websites, and presentations of the findings in conference forums.
References
Al-Sarawi F, Polasek T, Caughey G & Shakib S. (2019). Prescribing errors and adverse drug reaction documentation before and after implementation of e-prescribing using the Enterprise Patient Administration System Fares. Journal of Pharmacy Practice and Research, 1(49), 27–32 electronic health records and medication errors Capsone.
Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2017). Translating research findings to clinical nursing practice. Journal of clinical nursing, 26(5-6), 862–872. https://doi.org/10.1111/jocn.13586
Han, J. E., Rabinovich, M., Abraham, P., Satyanarayana, P., Liao, T. V., Udoji, T. N., … & Martin, G. S. (2016). Effect of electronic health record implementation in critical care on survival and medication errors. The American journal of the medical sciences, 351(6), 576-581.
Hodgkinson, M., Larmour, I., Lin, S., Stormont, A., & Paul, E. (2017, April 1). The impact of an integrated electronic medication prescribing and dispensing system on prescribing and dispensing errors: a before and after study. Journal of Pharmacy Practice and Research, 47(10), 110-120. doi: 10.1002/jppr.1243
Jember, A., Hailu, M., Messele, A., Demeke, T., & Hassen, M. (2018). The proportion of medication error reporting and associated factors among nurses: a cross-sectional study. BMC nursing, 17, 9. https://doi.org/10.1186/s12912-018-0280-4.
Loguidice, C. (2014, July 10). Using Electronic Health Records to Reduce Medication Errors in Long-Term Care. Annals of Long Term Care, 22(8), 22-29. doi:https://eds-b-ebscohost-com.su.idm.oclc.org/eds/detail/detail?vid=4&sid=29fde5e8-ba50-4a83-8076-77bd34d4d33d%40pdc-v-sessmgr05&bdata=JnNpdGU9ZWRzLWxpdmU%3d#AN=107816281&db=rzh electronic health records and medication errors Capsone
Mahmood T. (2018). What models of change can be used to implement change in postgraduate medical education?. Advances in medical education and practice, 9, 175–178. https://doi.org/10.2147/AMEP.S160626
Mekonnen, A. B., Alhawassi, T. M., McLachlan, A. J., & Jo-anne, E. B. (2018). Adverse drug events and medication errors in African hospitals: a systematic review. Drugs-real world outcomes, 5(1), 1-24.
Priya, K., Thottumkal, A., Warrier, A., Krishna, S., & Joseph, N. (2017, October 5). Impact of the electronic prescription audit process to reduce outpatient medication errors. Indian Journal of Pharmaceutical Sciences, 79(6), 1017-1021. doi:https://eds-b-ebscohost-com.su.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=1&sid=29fde5e8-ba50-4a83-8076-77bd34d4d33d%40pdc-v-sessmgr05
Vaidotas, M., Yokota, P. K. O., Negrini, N. M. M., Leiderman, D. B. D., Souza, V. P. D., Santos, O. F. P. D., & Wolosker, N. (2019). Medication errors in emergency departments: are electronic medical records an effective barrier? Einstein (São Paulo), 17(4). electronic health records and medication errors Capsone
