Critical Appraisal of Strategies to Reduce Medication Error

This study evaluates the strategies to reduce medication error by critically appraising two research papers. The study examines the trustworthiness and validity of the articles and highlights the relevant contribution of the research article towards the management of the clinical issue.

Running head: CRITICAL APPRAISAL
CRITICAL APPRAISAL
Name of the Student:
Name of the University:
Author note:

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Medication error is defined as the failure or catastrophe of the treatment procedure
which result in adverse effect or can harm the patient and their well-being (Parry, Barriball &
While, 2015). Different research were conducted that were used to evaluate the strategies that
can be used to reduce the medication error. The study will focus on the capability of the nurse
to successfully critique the research and adapt best practice to reduce the error (Maugham et
al., 2018).
This study will examine two research papers that have focused on the concept of
medication error and critique the articles by evaluating the trustworthiness and validity of the
article (Connelly, 2016). Lastly, the study will also highlight the relevant contribution of the
research article towards the management of the clinical issue.
The first article will highlight the consequence of electronic health record within the
healthcare setting to enhance the patient safety; a qualitative exploratory study, was
performed by the researcher to identify the benefit of implementing EHR. Hence, the primary
aim of the research was to “discover the consequence of Electronic Health Record (EHR) by
the nurses to enhance patient safety” (Tubaishat, 2019).
In this article, the researcher had adapted qualitative exploratory method by using the
semi-structured interview process with the staff nurses who were working in the hospital.
According to Kieft et al. (2018), exploratory method is best suited for understanding the
perspective of the nurse who are already working the hospital to improve the understanding
of medication error and the individual experience of the nurses. Thematic analysis was
conducted for evaluating the experience shard by the nurse’s during their interview.
From the result, two primary themes were evaluated, where one theme focused on the
enhancements of patient safety due to EHR and the other theme focused on the issues
elevated due to the implementation of EHR. The result exhibited the advantage of

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implementing EHR and the advancement in reducing the clinical error and improving patient
safety (Tubaishat, 2019). Hence, it can be concluded that the issues associated with EHR was
majorly due to in-proper system use or the establishment of poor system that were hampering
patient safety. This research has successfully established that the nurse practising EHR can
facilitate the improvement of patient safety and reduce the rate of clinical error (Adelman et
al., 2019).
The qualitative research paper is assessed by using the theory of validity namely;
internal validity, external validity and measurement validity. According to Huebschmann,
Leavitt, & Glasgow (2019), internal and external validity is used in the research to identify
the trustworthiness and meaning of the study. Internal validity is used to relate how well the
study is executed and external validity is used to relate the applicability of the research
finding among the general population.
Internal validity is stated as the “procedural rigor” used by the researcher in the study
to evaluate the strategy used by the researcher to reduce the risk of biasness that might affect
the result of the study (Xu, Zhang & Zhou, 2019). This study has used diverse approaches to
strengthen the internal validity.
The researcher has included only one vendor of the EHR system in order to minimize
any risk of biasness, as the same system used by different nurses will help the researcher to
identify appropriate result (Tubaishat, 2019). A hand-out was made to explain all the
participating nurses regarding the aim of the research. Semi-structured interview was
performed to strengthen the internal validity associated with the implementation of probing
technique. This technique helped the researcher to collect an in-depth knowledge and
information of the response shared by each individual nurse (Tubaishat, 2019).

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Measurement validity was strengthen by using telephonic interview was conducted as
it was considered as an efficient method of collecting the qualitative data within the nursing
practice. The data was analysed thematically followed by five steps of Creswell and each
themes were cross-checked for minimising any risk of biasness. To strengthen the internal
validity, the trustworthiness was ensured by the researcher by using two different researcher.
The researchers had identified and compared the themes and to increase the reliability of the
study, they have also included citation that will precisely reflect on the perception of
individual nurses (Tubaishat, 2019).
Any type of disagreement was solved by the researcher and different sub-themes were
also identified on the basis of the experience and opinion of the individual nurse. The sub-
themes was used for strengthen the external validity as the identified themes were further
used to enhance the implementation of electronic Health Record (EHR) within daily practice
and patient safety (Tubaishat, 2019).
The second article will highlight the effect of implementing automated dispensing
cabinets (ADC) for medication selection associated with the preparation error in the
emergency department; prospective and direct observational study, was performed by the
researcher to identify the benefit or advantage of implementing automated dispensing
cabinets (ADC) (Burton, 2019). Hence, the primary aim of the study is to evaluate the effect
of automated dispensing cabinets (ADC) on preparation error rate and medication selection
within the emergency department located in the territory teaching hospital (Fanning, Jones &
Manias, 2016).
In this article, the researcher had adapted direct observational and prospective study
that was conducted before and after the intervention. Direct observation was performed for
the nurses completing the preparation and medication selection activities, after and before

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implementing automated dispensing cabinets (ADC) within the emergency department
(Fanning, Jones & Manias, 2016). The research was conducted in territory teaching hospital
with 377 bed in Australia. Total of 89 nurses were included in the research who have already
completed their preparation and medication section activities in the original and novel
emergency department. According to Johnson et al. (2017), observational study was
beneficial for evaluating the difference in the preparation activities and medication selection
for the nurse before and after implementing the automated dispensing cabinets.
The result exhibited that total 2087 preparation activities and medication selection
was observed in the 808 patients before and after the intervention. The successful
implementation or establishment of automated dispensing cabinets (ADC) within the novel
emergency department (ED) exhibited 64.7% of reduction in the preparation error and
medication selection (Fanning, Jones & Manias, 2016). The study also exhibited that after the
implementation of the intervention, all the major medication error was reduced in the
healthcare setting.
The result also stated that after the establishment of the automated dispensing
cabinets, significant effect was observed on the severity or complexity of the medication
error, exhibiting minor reduction in the medication error (Fanning, Jones & Manias, 2016).
Hence, it can be concluded that the implementation of automated dispensing cabinets result in
reduction of preparation activities and medication error, thereby improving the medication
safety within the emergency department of the healthcare setting (Cramer, 2017).
According to Gubbins et al. (2018), the trustworthiness of any research article is best
evaluated by abiding to the four different criteria namely credibility, confirmability,
dependability and transferability. Hence, the researcher has used the above mentioned criteria

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to assess the trustworthiness of the study in reducing medication error (Fanning, Jones &
Manias, 2016).
To identify the credibility of the study, the researcher has adopted the observational
study, where they will directly observe the nurses within the original and the new emergency
department before and after the implementation of automated dispensing cabinets. The
researcher has undertaken the method of convenience sampling for avoiding any risk of
biasness to randomly assign any nurse in the study (Fanning, Jones & Manias, 2016).
Dependability is used to evaluate the repeatable and consistency of the study and is
almost identical to the procedure of reliability (Korstjens & Moser, 2018). The reliability of
this study was evaluated by the researcher through direct observational study as all the
decision and action of the nurses were directly examined by them and they were successful in
locating the medication error. Few nurses were also allocated during the data collection
method to reduce the Hawthorne effect during the observational phase (Fanning, Jones &
Manias, 2016).
Confirmability was also performed by the researcher that is defined as the evaluation
of identifying the method used by the researcher to interpret the data and conclude the study
that will aim to reduce the medication error in the emergency department (Simon & Goes,
2016). The identified data was submitted to the emergency department consultant for
independently evaluating the data and enhancing the confirmability of the research.
Lastly, transferability is used to examine the trustworthiness of the article.
Transferability is defined as the procedure that exhibit the excellence of the research findings
and how the identified research finding can be used in the other researchers of different
context (Hadi & Closs, 2016). The transferability of the study is supported by providing
comprehensive study and participant information. Numerous study sites and various health

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care practitioners participating in the study have also assisted the researcher to enhance the
credibility of the study. The study had various limitation although each limitation was
addressed by the researcher and helped the other researcher to overcome from such barrier
(Fanning, Jones & Manias, 2016).
After the complete examination and evaluation of the research article by critically
appraising the individual article, it was identified that there were multiple barriers that were
inhibiting the best medication administration. The risk of medication error were highlighted
in both the studies, where the researcher have identified different strategies to minimise the
risk of mediation error and enhance patient care and safety. In the first study, the researcher
have focused in exhibiting the beneficial effect of electronic health records towards reducing
the medication error (Tubaishat, 2019). The researcher have also stated how electronic health
records can help the healthcare practitioner or the nurses to effectively care for the patient
and also improve their safety. Whereas, in the second article, the researcher have exhibited
the beneficial effect of automated dispensing cabinets (ADCs) within the emergency
department to improve the preparation activities and mediation error. The implementation of
automated dispensing cabinets (ADCs) will help the nursing professional to enhance the
medication safety for the patient admitted to the emergency department and thereby reduce
the rate of medication error (Fanning, Jones & Manias, 2016). Both the studies were high
credible and reliable to understand the strategies for reducing medication error, although few
limitation were also identified in the study. The researcher have therefore adapted numerous
steps to enhance and ensure the trustworthiness and validity of the research that will help the
readers to use and implement theses findings and aim to enhance their clinical practice and
patient outcome.

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