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NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit NR

Improvement Plan Tool Kit

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit NR

The purpose of creating this tool kit is to provide nurses with an additional resource containing important information pertinent to emergency medicine. This tool kit will focus on a few key areas specific to emergency medicine and attempt to fill knowledge gaps and provide refreshers for those that need it. This effort aims to create a safer environment for patients and lower the number of adverse drug reactions (ADE) in the emergency department. This tool kit is organized into the following categories, which have been identified as key areas contributing to the reduction of ADEs:

  1. Conducting a Successful Quality Improvement (QI) Initiative
  2. Must Know Emergency Medications
  3. Safe Medication Administration Practices
  4. Effective Communication to Reduce Medication Errors
  5. Organizational Changes to Improve Patient Safety

Annotated Bibliography

Conducting a Successful Quality Improvement (QI) Initiative

Martyn, J. A., Paliadelis, P., & Perry, C. (2019). The safe administration of medication: Nursing behaviours beyond the five-rights. Nurse education in practice37, 109–114. https://doi.org/10.1016/j.nepr.2019.05.006

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit NR

When attempting a QI initiative, management must first collect data on the current processes to determine working and problem areas. This study from 2019 follows nurses from the start to the end of their shift to determine how the “five rights” of medication administration are used in practical day-to-day practice in the hospital setting. The study determined that there are times when all five rights may not be applicable and other times when nurses need to go beyond the five rights in practicing safe medication administration. The article navigates some of the complexities seen in contemporary healthcare settings that require the nurse to respond to specific patient circumstances to maintain safety.

Chartier, L. B., Stang, A. S., Vaillancourt, S., & Cheng, A. (2018). Quality improvement primer part 2: executing a quality improvement project in the emergency department. CJEM20(4), 532–538. https://doi.org/10.1017/cem.2017.393

While QI is a tool used across various industries and organizations, its application must be based on the department’s specific needs in which it is being implemented. This 2018 article focuses on implementing a QI initiative specific to the emergency department, making it highly relevant to our department’s purposes. The article systematically goes through the process, creating a theme and walking the strategy through implementation and observation. The tool also discusses how the ED can use the Plan-Do-Study-Act (PDSA) cycle to monitor and tweak the QI process for the best outcomes. In regards to safe medication administration, this article focuses on improving getting antibiotics to septic patients promptly.

Di Simone, E., Giannetta, N., Auddino, F., Cicotto, A., Grilli, D., & Di Muzio, M. (2018). Medication Errors in the Emergency Department: Knowledge, Attitude, Behavior, and Training Needs of Nurses. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine22(5), 346–352. https://doi.org/10.4103/ijccm.IJCCM_63_18

This study was conducted in 2018 with 103 participants to determine which elements or gaps in nursing can lead to increased medication errors (ME). The study covered training needs, behavior, and overall attitudes during the medication administration process in the ED. The study results determined that nurses required the proper knowledge, needed positive attitudes, and behaved according to set protocols to maintain safe medication administration. Additionally, due to the increasing number of new drugs and technology that continues to arise, nurses need to keep their knowledge base updated regularly.

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit NR

Must Know Emergency Medications

Chang P, Elias T. Open Airway Procedural Sedation. [Updated 2021 Aug 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574521/

This article from 2021 focuses specifically on open airway procedural sedation (OAPS), a standard procedure done in almost all emergency departments (ED) across the country. OAPS allows providers to procedurally sedate their patients to perform simple tasks such as laceration repairs and joint reductions. This article thoroughly discusses intra-operative issues, risk factors, and best practices for assisting with an OAPS. The typical medications used are reviewed thoroughly, with doses stated for each patient type. Mistakes during OAPS have led to patient death when careful the medicines administered are not carefully considered.

Byrd LB, Asuka E, Martin N. Antidotes. [Updated 2021 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539884/

The emergency department (ED) is typically where patients first show up during a drug overdose. Additionally, the ED is also a place where unintended drug overdoses can occur due to various reasons, such as a lack of patient history and wrong dosage calculations. Therefore, registered nurses must know the antidotes for the most common drugs. It is also good practice to have the antidote drug in hand when administering a medication that could potentially cause an ADE. This article from 2021 covers in detail some of the most common medicines that patients tend to overdose on and their antidotes mechanism of action.

Umerah Co, Momodu II. Anticoagulation. [Updated 2021 Dec 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560651/

Anticoagulants are commonly administered in the emergency department for patients with carrying conditions. Understanding the differences, benefits, and risks of the various forms of anticoagulants can play a role in preventing ADEs and MEs. This 2021 article covers the indications for specific types of anticoagulants and their potential side effects. Additionally, it covers the common signs and symptoms of an ADE due to one of these medications and proper lifesaving interventions. Various testing methods to determine efficacy are also discussed, making this a must-read article for all ED nurses that administer anticoagulants.

Safe Medication Administration Practices

Hanson A, Haddad LM. Nursing Rights of Medication Administration. [Updated 2021 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560654/

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit NR

When it comes to safe medication administration practices, medication administration’s “five rights” often come to mind. This article reinforces these rights, which are a focal point of all accredited nursing programs across the US. The report dives deep into the history of why these rights were compiled, how they have been used, and provides significant examples of how they can prevent ADEs. This article serves as an important reminder as to why nurses must never forget to verify these rights as routine as it may seem as they may seem.

Kauppila, M., Backman, J. T., Niemi, M., & Lapatto-Reiniluoto, O. (2021). Incidence, preventability, and causality of adverse drug reactions at a university hospital emergency department. European journal of clinical pharmacology77(4), 643–650. https://doi.org/10.1007/s00228-020-03043-3

This ED-specific medication error study takes a broad look at the incidence, preventability, and causality of ADEs in the ED. This study determined that most ADEs have common causes and happen with similar medications. These findings shed some light on focusing on a specific area that may need improvement instead of a broad-stroke approach. This study’s medicines were defined based on an anatomical therapeutical chemical (ATC) system. The study determined that medications in the same ATC categories often led to the most serious ADEs and extended hospitalizations. This article should remind nurses handling drugs in these classes to pay extra attention to their safety processes.

Millichamp, T., & Johnston, A. (2020). Interventions to support safe medication administration by emergency department nurses: An integrative review. International emergency nursing49, 100811. https://doi.org/10.1016/j.ienj.2019.100811

This study analyzed current research and compiled the safest interventions to reduce ADEs specific to the ED. To do this, the researchers systematically went through five databases to extract only the most pertinent data regarding effective ME reduction in the ED. The outcome is a task-specific compilation of practical interventions that management can implement via a QI plan that, in theory, will reduce the occurrences of ADEs in emergency medicine settings.

Effective Communication to Reduce Medication Errors

Hettinger, A. Z., Benda, N., Roth, E., Hoffman, D., Iyer, A., Franklin, E., Perry, S., Fairbanks, R. J., & Bisantz, A. M. (2020). Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication. The Journal of emergency medicine58(4), 581–593. https://doi.org/10.1016/j.jemermed.2019.10.035

The ED is a unique setting compared to other hospital units since EMTLA rules and regulations govern them. Due to this, there are typically a few MDs or advanced providers always present in the ED. This presence creates an environment where providers and nurses communicate more than is typical for the average floor. This communication is often carried out at the bedside, and providers tend to place many verbal orders. This scenario creates a lot of opportunities for errors to occur. This journal tackles this problem by providing ten best practices for improving communication between nurses and providers in the ED setting. The article recognizes the unique communication errors seen in the ED and tackles the provides tangible best practice solutions that nurses can quickly implement.

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit NR

Blackburn, J., Ousey, K., & Goodwin, E. (2019). Information and communication in the emergency department. International emergency nursing42, 30–35. https://doi.org/10.1016/j.ienj.2018.07.002

This article looks at communication methods used in the emergency department when communicating with patients. Due to the fast-paced and focus-based providence of care in the ED, there is often a communication breakdown between patient and provider. Providers and nurses are often time-pressured in the ED, leading to bare-bones communication resulting in missed diagnoses and poor collection of patient history. This article acknowledges this issue, discusses how staff can improve communication in the ED, and covers the importance of ensuring that holistic discussions occur.

Organizational Changes to Improve Patient Safety

Moukarzel, A., Michelet, P., Durand, A. C., Sebbane, M., Bourgeois, S., Markarian, T., Bompard, C., & Gentile, S. (2019). Burnout Syndrome among Emergency Department Staff: Prevalence and Associated Factors. BioMed research international2019, 6462472. https://doi.org/10.1155/2019/6462472 

The COVID-19 pandemic created much-needed awareness regarding ED nurses’ role in healthcare and the burnout many of them face. This article takes a deep dive into the issues leading to this phenomenon, emphasizing excessive workload and high demands. The study concluded that ED nurses were the most susceptible group to burnout of all the departments in a hospital setting. The study analyzes the root causes of this issue and provides important data regarding how this burnout affects patient outcomes and safety. Knowing this information, management is provided with steps to improve working conditions and reduce burnout and nurse turnover.

Amaniyan, S., Faldaas, B. O., Logan, P. A., & Vaismoradi, M. (2020). Learning from Patient Safety Incidents in the Emergency Department: A Systematic Review. The Journal of emergency medicine58(2), 234–244. https://doi.org/10.1016/j.jemermed.2019.11.015

The authors of this article conducted a systematic review of patient safety incidents across various emergency departments and compiled a list of the most common findings. These findings provide management with an opportunity to systematically review the data and identify patient safety risks in their own EDs. The article emphasizes that a critical component to reducing errors is encouraging participation in error reporting with no retaliation. Understanding the causes and solutions to shared safety issues provides a necessary framework for management to build and implement a successful QI plan.

References

Martyn, J. A., Paliadelis, P., & Perry, C. (2019). The safe administration of medication: Nursing behaviours beyond the five-rights. Nurse education in practice37, 109–114. https://doi.org/10.1016/j.nepr.2019.05.006

Chartier, L. B., Stang, A. S., Vaillancourt, S., & Cheng, A. (2018). Quality improvement primer part 2: executing a quality improvement project in the emergency department. CJEM20(4), 532–538. https://doi.org/10.1017/cem.2017.393

Di Simone, E., Giannetta, N., Auddino, F., Cicotto, A., Grilli, D., & Di Muzio, M. (2018). Medication Errors in the Emergency Department: Knowledge, Attitude, Behavior, and Training Needs of Nurses. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine22(5), 346–352. https://doi.org/10.4103/ijccm.IJCCM_63_18

Chang P, Elias T. Open Airway Procedural Sedation. [Updated 2021 Aug 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574521/

 Byrd LB, Asuka E, Martin N. Antidotes. [Updated 2021 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539884/

Umerah Co, Momodu II. Anticoagulation. [Updated 2021 Dec 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560651/

Hanson A, Haddad LM. Nursing Rights of Medication Administration. [Updated 2021 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560654/

Kauppila, M., Backman, J. T., Niemi, M., & Lapatto-Reiniluoto, O. (2021). Incidence, preventability, and causality of adverse drug reactions at a university hospital emergency department. European journal of clinical pharmacology77(4), 643–650. https://doi.org/10.1007/s00228-020-03043-3

Millichamp, T., & Johnston, A. (2020). Interventions to support safe medication administration by emergency department nurses: An integrative review. International emergency nursing49, 100811. https://doi.org/10.1016/j.ienj.2019.100811

Hettinger, A. Z., Benda, N., Roth, E., Hoffman, D., Iyer, A., Franklin, E., Perry, S., Fairbanks, R. J., & Bisantz, A. M. (2020). Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication. The Journal of emergency medicine58(4), 581–593. https://doi.org/10.1016/j.jemermed.2019.10.035

NURS FPX 4020 Assessment 4 Improvement Plan Tool Kit NR

Blackburn, J., Ousey, K., & Goodwin, E. (2019). Information and communication in the emergency department. International emergency nursing42, 30–35. https://doi.org/10.1016/j.ienj.2018.07.002

Moukarzel, A., Michelet, P., Durand, A. C., Sebbane, M., Bourgeois, S., Markarian, T., Bompard, C., & Gentile, S. (2019). Burnout Syndrome among Emergency Department Staff: Prevalence and Associated Factors. BioMed research international2019, 6462472. https://doi.org/10.1155/2019/6462472 

Amaniyan, S., Faldaas, B. O., Logan, P. A., & Vaismoradi, M. (2020). Learning from Patient Safety Incidents in the Emergency Department: A Systematic Review. The Journal of emergency medicine58(2), 234–244. https://doi.org/10.1016/j.jemermed.2019.11.015

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