Using Evidence Based Practice to Improve Medication Administration among Nurses

This essay discusses the use of evidence based practice to improve medication administration among nurses and reduce medication errors. It covers the five steps of EBP and provides guidelines for nurses to implement EBP in their clinical practice.

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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Introduction
Registered nurse plays a vital role in medication administration. In a complex and hectic
hospital environment, it is a demanding task for them to accomplish the task without any adverse
drug events. Despite increased availability of tools and technology to reduce such errors, high
rate of medication administration errors continue to be a major burden for the health care system
(Barak et al., 2018). Medication administration is a core responsibility of nurses and they often
get involved in medication administration error because of complex mixture of demands (patient
demands, physical environment, technical devices and institutional policies). This depicts how
medication administration is a challenging job for nurses (Pirinen et al., 2015). Nurses are
seriously affected by medication error related incidences and the perspective of nurse shows such
errors occur mainly due to poor communication, staff rotation, workload and unclear medication
order (Hammoudi, Ismaile & Abu Yahya, 2018). Hence, to promote patient safety and reduce
involvement in medication error cases, there is a need to make nurses aware about the best
strategy to complete medication administration process despite barriers and interruptions. This
essay aims to improve the knowledge and practice related to medication administration among
nurse by using the steps of evidence based practice (EBP). The discussion will give an insight
into the methods by which EBP can support nurse to improve their clinical skills related to
medication administration and enhance patient safety.
Use of the EBP process to improve nursing practice
Research evidence on nurse’s involvement in medication errors suggest that several
disruptions and barriers in clinical environment increase the risk of medication administration for
nurse (Hammoudi, Ismaile & Abu Yahya, 2018). The essay acknowledges the potential of EBP

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in improving this practice issue and finding best interventions to reduce incidence of such errors.
EBP is the process used to integrate best research evidence with clinical expertise and patient
values (LoBiondo-Wood & Haber, 2017). These three components define any clinical decision
and the five steps of the EBP plays a role in improving practice related challenges. In case of the
nursing practice issue of nurse’s engagement in medication administration error, the five steps of
the EBP process can help find strong evidence regarding the best interventions to prevent
medication errors and promote patient safety.
Formulating the research question:
The first step of the EBP process involves formulation of an answerable research
question. In the context of nursing practice, questions are triggered by challenges or confusion
during specific patient encounters or while performing any routine nursing responsibility. The
need for information in the area of prevention, diagnosis, prognosis and therapy helps to create a
clinical question (Doody & Bailey, 2016). Hence, these questions can be addressed from
different angles such as diagnosis, etiology, prevention and experience. The issue of nurse’s
engagement in medication administration error aims to identify preventive steps to reduce such
patient safety risk for patient. Hence, the question that can help to find evidence for preventing
medication error include:
‘How can nurse’s skill be adjusted to reduce the risk of medication administration error?
PICOT format can be used to create a searchable research question as it defines the
population, intervention, comparison, outcome, and time frame (Meyer, 2017). For this research
question, the population include nurses, intervention includes best interventions to prevent

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medication errors, outcome includes reduction in medication errors and comparison includes
current best practice steps.
Finding or searching for the best available evidence:
The second step of the EBP process is to search for the best evidence that answers the
question. This can be done by developing specific search terms that helps in performing search in
renowned databases. The PICOT question gives clue for identifying key words or phrases. Use
of combination of search terms using MESH and specific search criteria or limitation helps in
developing effective search strategy. Limits can be set on final search for language like English
and publication date (Fineout-Overholt, 2016). The key search terms that can be used to find out
best evidence includes ‘medication error’, ‘medication safety’, ‘medication administration error’,
‘nursing practice’ and ‘patient safety’. The search for articles can be done in database like
PubMed and Cochrane Library and the search limits for publication date can be used to find
articles published within seven years only. Other recommended source of evidence may include
National Guideline and professional nursing practice standards related to medication safety. The
five papers that provide strongest evidence regarding preventing medication administration
errors among nurse includes the study by Hewitt, Tower and Latimer, (2015), Berdot et al.
(2016), Risør, Lisby and Sørensen (2018), Westbrook et al. (2017) and Hayes et al. (2017).
Critically appraising the research evidence:
After the selection of articles for review and practice improvement, the next step is to
critically appraise the evidence. This is necessary to ensure that the resource found is valid,
relevant, reliable and applicable to the clinical question. Some simple question that can help a
nurse or reviewer to understand validity of the research evidence includes ‘Are the results of the

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study valid?’, ‘Are the results of the study important’ and ‘Can the results help me improve
patient care?’. The answer to the first question can be gained by evaluating whether the research
method is rigorous or not and whether reliable and valid instruments has been used to measure
research outcome or not. Hence, answer to this question can become an indication of validity of
the research. The second question can be answered by assessing whether the research approach
adapted is suitable for the aim of the study or not. This form of assessment can help nurse clarify
whether the evidence is reliable for resolving their practical issue or not. The third question is
significant as it gives idea regarding the applicability of the research evidence in clinical
practice. The assessment regarding cost-effectiveness, benefits and risk of the intervention
presented in the study can give idea regarding this question. Therefore, after searching for
articles related to interventions for preventing medication administration related error, the above
three questions can help to appraise evidence and identify validity, reliability and applicability of
the work for nursing practice (Gray, Grove & Sutherland, 2016). Use of evidence based grading
tools like the Clinical Appraisal Skills Programme (CASP), Joanna Briggs Institute (JBI) and the
Appraisal of Guidelines for Research and Evaluation can aid in critically appraising and
interpreting research evidence too (Buccheri & Sharifi, 2017).
Integrating the evidence with clinical expertise and patient value:
According to the registered nurse standards of practice, research evidence alone does not
support nurse in engaging effective nursing practice. Instead, this depends on respecting patient
values (standard 2) and complying with policies, guidelines and other standards relevant to the
context of practice (standard 1) (Nursing and Midwifery Board of Australia, 2017). Hence, after
identifying the best intervention to prevent medication administration error, the next step will be
to compare and contrast the evidence with respect to clinical expertise, current skills for the

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intervention and impact on patient values. There is a need to analyze whether the new
intervention identified can be easily adapted in practice or any cost or organizational barriers
may hinder implementation of the EBP. This step is crucial to understand the feasibility of
interventions and ensure that practice change can be appropriately achieved (Ioannidis, 2016).
Evaluating the outcome:
This step is essential to evaluate the success of the EBP and its role in bringing practice
change and positive change in patient outcomes. Nurses who are adapting specific intervention
following the critical appraisal of research evidence can monitor and evaluate changes in
outcome for certain period. This will help them to understand whether the intervention was
appropriately used to influence nursing practice or any change is needed to achieve better
outcomes in the future. When similar results as reported in research study are not found, then
monitoring patient’s outcome can help to identify the reason for such outcomes. Hence, the
overall process of professional development and nursing practice improvement is achieved
through the EBP. If nurses are successful in getting desired outcome (reduction in medication
administration errors), then they can take the step to share their experience and knowledge with
other colleagues as per professional code of conduct. This is essential to reduce practice gap and
self-assess performance in clinical practice.
Conclusion:
To conclude, the use of the steps of the EBP to bring changes in nursing skills and reduce
their engagement in medication administration errors suggest that EBP is a beneficial strategy to
reduce practice gap, improve clinical skills and improve patient safety outcomes. The use of the
five steps of formulating research question, searching for research evidence, critically appraising

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the research evidence, integrating findings with clinical expertise and patient values and
evaluating outcomes are crucial to identify best ways to resolve nursing practice issues. It is
essential that nurse follow this step in their clinical practice to fulfill the professional expectation
of using best available research evidence to provide safe and quality care. The essay provides
proper guidelines for nurse to implement EBP and use it for practice improvement.

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References:
Baraki, Z., Abay, M., Tsegay, L., Gerensea, H., Kebede, A., & Teklay, H. (2018). Medication
administration error and contributing factors among pediatric inpatient in public hospitals
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Berdot, S., Roudot, M., Schramm, C., Katsahian, S., Durieux, P., & Sabatier, B. (2016).
Interventions to reduce nurses’ medication administration errors in inpatient settings: a
systematic review and meta-analysis. International Journal of Nursing Studies, 53, 342-
350.
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Doody, O., & Bailey, M. E. (2016). Setting a research question, aim and objective. Nurse
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Gray, J. R., Grove, S. K., & Sutherland, S. (2016). Burns and Grove's The Practice of Nursing
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Hammoudi, B. M., Ismaile, S., & Abu Yahya, O. (2018). Factors associated with medication
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Risør, B. W., Lisby, M., & Sørensen, J. (2018). Complex automated medication systems reduce
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