Reducing Medication Errors in Acute Wards through CPOE Training for Nurses

NURS2006 SUPPLEMENTARY ASSESSMENT
Clinical Practice Improvement Project Report
Student Name, FAN and ID:
Project Aim:
Title- Provide training to nurses on the use of Computerized Provider Order Entry (CPOE) in acute
wards, for preventing and/or reducing rates of medication errors.
Aim- The aim of the project can be categorised in the form of SMART goals:
S- Provide CPOE training to nurses
M- Enhanced awareness and knowledge among nurses and subsequent reduction in medication
error rates
A- Increased nursing competence and enhanced patient safety
R- Nurses working in acute wards will be selected
T- One month of training
Background and Evidence that the issue is worth solving:
Medication errors refer to preventable and avoidable proceedings that are responsible for causing or
leading to unsuitable medication usage, and subsequent patient harm ,while administration of
medications are in control of healthcare professionals, or consumers (Cloete 2015). Medication
errors are commonly associated with professional practice that typically comprises of medicine
prescribing, communicating orders, product packaging, labeling, and nomenclature, dispensing,
compounding, distribution, monitoring, and use (Wittich, Burkle and Lanier 2014). Evidences also
elaborate on the fact that at times, such medication errors ensue as a consequence of systemic
problems, other than poor performance by doctors, nurses and other healthcare providers. Typically
medication errors affect only a solitary patient at a time, thus they are considered as isolated events,
and little attention is drawn the problems that ensue (Hayes et al. 2015).
Incidence of medication errors is a matter of growing concern owing to the fact that medication
errors account for 2-3% of hospital admissions in Australia. Additionally, improving medication
safety has been recognized as a key area of emphasis by the Australian Commission on Safety and
Quality in Health Care, facilitated by WHO regional campaign and Australian Government
Department of Health. Findings from literature also suggest that errors associated with wrong
administration of medication among hospitals occur in 9% cases, besides errors occurring in
discharge summary documentation, with rates of 2 error/patient (Roughead, Semple and Rosenfeld
NURS2006 Supplementary Assessment for Semester Two, 2018. 1

2016). Manias et al. (2014) opined that medication errors occurred at a rate of 6.58 cases/1000 bed
days, with the most common types of errors comprising of dose omission (n = 341, 12.4%), and
overdose (n = 579, 21.0%). Some of the chief contributing factors were identified to be
communication difficulties across clinical settings (n = 929, 33.7%), and lack of adherence to
procedures and polices (n = 617, 22.4%).
Keers et al. (2013) investigated the factors, which contribute to the onset of errors in medication
management and suggested that slips and breaks were the major testified unsafe deeds, followed by
knowledge-based errors and deliberate defilements. Furthermore, error-provoking circumstances
that influenced medication errors encompassed insufficient written message (prescriptions,
transcription, documentation), difficulties with drugs supply and storing (pharmacy provision errors
and stock management), workload, patient factors (obtainability, acuity), equipment problems
(access, functionality), fatigue and stress among staff, and distractions during medicine
administration. According to Lu et al. (2013) insufficient knowledge among nurses is one major
factor that leads to medication errors, which results in severe health consequences. This was also in
accordance with Sanghera et al. (2007) who elaborated on the fact that frequent interruptions
during drug administration and poor communication were some of the factors that led to such
errors. Moreover, organisational factors governing these errors were namely, absence of clarity for
checking drug administration, lack of feedback, and practice of administering drugs without
complete medication orders. In addition, the standard 6 also makes it imperative for all nurses to
deliver nursing practice in an appropriate and safe manner, with the aim of accomplishing their
agreed goals and responding to the needs of their service users (NMBA 2014). Besides, the nurses
are also accountable to the people seeking care services, for their actions, behaviours and decisions,
including documentation. This calls for the need of preventing and/or reducing incidence of
medication errors in healthcare settings.
Relevance of Clinical Governance to your project
Clinical governance refers to the framework that is used by the NHS organisations for remaining
accountable for bringing about continuous improvement in the quality of their services, and
fostering an environment where excellence in clinical care flourishes (Van Zwanenberg and Edwards
2018). In other words, clinical governance comprises of several procedures and principles that have
the primary objective of promoting patient safety, by reducing errors within healthcare settings. The
operations are typically controlled by governing bodies that adopt appropriate strategies for the
easy delivery of care services in a manner that enhances wellbeing of the patients. The four pillars of
clinical governance that are relevant to the realm of preventing medication errors by training the
nurses are as follows:
1. Professional development and management- This pillar encompasses conducting a
surveillance of the management of healthcare professionals and the changes that are
required to be made in the setting, for achieving the intended objectives. The CPI project will
NURS2006 Supplementary Assessment for Semester Two, 2018. 2

involve the adoption of reward and punishment strategies for the nursing staff working in
acute wards, who are found to successfully use CPOE and thus medication error, and those
who fail in doing so, respectively.
2. Clinical Risk- This pillar is precisely concerned with enhancing the safety and quality of
healthcare services delivered to patients, by recognising the opportunities and
circumstances that are responsible for putting the patients at risk of harm. In this case, the
pillar will assess the risk factors related with medication errors and the instances when they
can occur (Office of Safety and Quality in Healthcare 2016).
3. Consumer value- This pillar focuses on the need of increasing responsiveness to all
consumers. In this CPI tool, the pillar would place an emphasis on being more responsive to
monitor the wellbeing of the patients
4. Clinical performance and evaluation- This pillar is typically concerned with delivery of
services and also determines the efficiency of healthcare practitioners. This pillar will
determine whether the nurses have increased their knowledge on CPOE implementation
and are able to reduce rates of medication error.
Key Stakeholders:
Stakeholders refer to the individuals who are primarily affected by the actions, policies and
objectives of an organisation. The major stakeholders in this CPI tool are given below:
 Physicians- The physicians will have the responsibility of electronically entering instructions,
which are vital for the treatment of patients. They will also educate the nurses with the help
of PowerPoint presentation, on the potential benefits of CPOE use, in relation to medication
errors, prevention of duplicate entries and billing.
 IT personnel- They will provide hands-on training to the nurses on the usage of CPOE in an
efficient manner, and associated terminologies.
 Hospital authorities- They will sanction adequate funds for the education program, and will
also provide remuneration to the IT personnel, for conducting the training sessions.
 Nurses- They will be subjected to the training program that will focus on CPOE
implementation methods. The knowledge and awareness of the nurses will be analysed,
before and after implementation of the training program, with the aim of determining the
effectiveness of the program.
CPI Tool:
According to the NSW Health (2019), CPI signifies for Clinical Practice Improvement Training
Program. This training program helps the healthcare professionals to address any prevailing
healthcare problems which are negatively affecting the health and well-being of the patients. In
NURS2006 Supplementary Assessment for Semester Two, 2018. 3

order words, it can be said that the CPI tool helps in improving the overall quality of life and the
process of care (NSW Health 2019). The methodology once under the assistance of this training
program can be easily applied under numerous clinical settings. This ensures increase in the level of
patient’s safety and quality of care. The training also helps in improving the level of knowledge of
the healthcare professionals along with bringing proficiency in their skills.
PDSA is a CPI tool. PDSA is an abbreviated form of Plan, Do, Study and Act cycle. According
to the guidelines of the NSW Government (2018), the importance of PDSA is it helps to narrow down
the focus and can be easily implement over any small work field in order to bring continuous
improvement. Plan (P) helps in the identification of the principal measures of the project and the
tasks which are assigned against it along with the expected outcome. In relation to the chosen CPI
topi, the P is to introducing computerised physicians based order entry (CPOE) system under the
acute care settings and training the nurses to handle that system in order to decrease the chances of
the medication error. Do (D) stage deals with the subsequent implementation of the agreed plan
under pro-active approach in order to reduce targeted healthcare concern (NSW Health 2019). Here
target healthcare concern is medication errors under the acute care settings and the intervention
that will be implemented is introduction of CPOE and subsequent training of the nurses. The training
will be given under the acute care settings. Both hands on training and inter-active process through
power-point presentation will be undertaken. Study (S) signifies the study process which will be of
one month of the training session followed by review of the overall outcomes of the training process
like increase in the level of knowledge acquisition and skills of the nursing professionals. The review
will be done through MCQ in order to study the increase in the level of the knowledge of the nursing
professionals. The reduction in the medication error after training of the nursing professional will be
done through comparing the medication error data with the baseline data and the data after one
month of training. Act cycle (A) deals with development of the new standards of practice like skills in
using CPOE and it will be based o taking feedbacks from the nursing professionals in order to bring
refinement of the training process in the near future (NSW Health 2019).
PEPPA overview was developed to provide APN (Advanced Practice Nursing) researchers and
the healthcare professionals in order to guide and promote optimal development in the scope of
practice. Here P (population) is the first step of the framework which deals with the identification of
the priority population for the CPI program (Advance Practice Nursing 2019). The main population
that is selected for this CPI project include the nursing professionals who are working under the
acute care settings. This is because, the incident rate of the medication errors are higher among the
NURS2006 Supplementary Assessment for Semester Two, 2018. 4