NR 528 Module 4 Assignment; Synthesis of Evidence, Assignments of Health sciences

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Synthesis of Evidence Chamberlain University College of Nursing NR-528: Leading and Managing Evidence-Based Change in Nursing

Synthesis of Evidence It is a daily practice for emergency departments (ED) to deliver care to patients who are critically ill and in need of life-saving care. A medication error can be a deadly mistake in this type of chaotic environment and, unfortunately, occurs more frequently than one would assume. Errors in administering medication are a common source of illness and death in acute care environments, and they can lead to extended hospitalizations (Kerari & Innab, 2021). High-alert critical medications, commonly given to patients in the ED, must be monitored and delivered correctly to ensure patient safety. Heparin is a medication commonly administered to patients within the ED. When a patient is started on a heparin infusion, the nurse must pay close attention to the heparin infusion protocol, which gives specific titration guidelines in response to the results of the patient's bloodwork. This protocol, widely used in many hospitals, must be followed closely and is very time-specific. When nurses make titration errors, miss timed lab draws, and make protocol errors, the patient is ultimately the one whose health is affected. Errors like those listed above are easily made in a high-acuity and high-stress department such as the ED. A clinical practice question has been formed to assist with maintaining and following the heparin nurse-driven protocol. In emergency department patients receiving heparin infusions, does implementing a standardized spreadsheet for heparin infusions, compared to the current practice without a standardized spreadsheet, reduce the number of heparin infusion errors over two months? A search was executed using Chamberlain University's online library to find correlated scholarly articles to assist in answering the question posed. Keywords used for the search

Inadequate communication during the nursing shift handover and memory lapses have been

identified as factors leading to mistakes in supervising therapeutic heparin treatments (Johnson et al., 2018). Medication errors, especially errors with Heparin, can cause detrimental effects on the patient, including death. Up to 10% of all medications given in the ED have an error attached to them, which can be caused by associated factors, including critical medications, patient acuity levels, and continual patient turnover (Millichamp & Johnston, 2020). Medication errors can occur at any given time during a patient's admission. However, the high stress of the ED can cause nurses to overlook important factors, which can cause unfortunate harm to the patient. One study showed that the human factor accounted for over 53% of anticoagulant errors, with 12.5% being from the nurses not correctly following the protocol (Dreijer et al., 2018). In another study, anticoagulants, such as Heparin, were the most common medication improperly administered to patients, with a rate of over 41% (Hosseini-Marznaki et al., 2020). The articles connect the importance of handoff communication and medication administration within the ED. Each article provided clear and succinct information regarding the ramifications of subpar handoff communication protocols and procedures, as well as information regarding the high probability of patient harm when medications are not appropriately administered within the ED. Some articles rely heavily on prior research regarding handoff communication and medication administration errors, including Heparin in the ED. One noteworthy aspect is the need for more ED-specific research concerning handoff communication and medication errors. In conclusion, handoff communication is essential to reducing medication errors within the ED. The ED is a continually busy and chaotic department in a hospital that cares for critically ill patients. Caring for critically ill patients tests a nurse mentally, physically, and emotionally.

References Desmedt, M., Ulenaers, D., Grosemans, J., Hellings, J., & Bergs, J. (2020). Clinical handover and handoff in healthcare: A systematic review of systematic reviews. International Journal for Quality in Health Care , 33 (1). https://doi.org/10.1093/intqhc/mzaa Dreijer, A. R., Diepstraten, J., Bukkems, V. E., Mol, P. G., Leebeek, F. W., Kruip, M. J., & Van den Bemt, P. M. (2018). Anticoagulant medication errors in hospitals and primary care: A cross-sectional study. International Journal for Quality in Health Care , 31 (5), 346-

352. https://doi.org/10.1093/intqhc/mzy Galatzan, B. J., & Carrington, J. M. (2018). Exploring the state of the science of the nursing hand-off communication. CIN: Computers, Informatics, Nursing , 36 (10), 484-
353. https://doi.org/10.1097/cin. Hosseini-Marznaki, Z., Pouy, S., Salisu, W. J., & Emami Zeydi, A. (2020). Medication errors among Iranian emergency nurses: A systematic review . Epidemiology and Health , e2020030. https://doi.org/10.4178/epih.e Johnson, C., Miltner, R., & Wilson, M. (2018). Increasing Nurse-Driven Heparin Infusion Administration Safety: A Quality Improvement Initiative_. Medsurg Nursing, 27_ (4), 243-
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Kerari, A., & Innab, A. (2021). The influence of nurses’ characteristics on medication administration errors: An integrative review. SAGE Open Nursing , 7 ,

237796082110258. https://doi.org/10.1177/ Millichamp, T., & Johnston, A. N. (2020). Interventions to support safe medication administration by emergency department nurses: An integrative review. International Emergency Nursing , 49 , 100811. https://doi.org/10.1016/j.ienj.2019. Shahid, S., & Thomas, S. (2018). Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care – A narrative review. Safety in Health , 4 (1). https://doi.org/10.1186/s40886-018-0073- Webster, K. L., Keebler, J. R., Chaparro, A., Greilich, P., Fagerlund, A., & Lazzara, E. H. (2022). Handoffs and teamwork: A framework for care transition communication. The Joint Commission Journal on Quality and Patient Safety , 48 (6-7), 343-
237796082110259. https://doi.org/10.1016/j.jcjq.2022.04. Williams, S. R., Sebok-Syer, S. S., Caretta-Weyer, H., Katznelson, L., Dohn, A. M., Park, Y. S., Gisondi, M. A., & Tekian, A. (2023). Patient handoffs and multi-specialty trainee perspectives across an institution: Informing recommendations for health systems and an expanded conceptual framework for handoffs. BMC Medical Education , 23 (1). https://doi.org/10.1186/s12909-023-04355-