Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.

 

Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

• Reflect on the four peer-reviewed articles you critically appraised in Module 4.
• Reflect on your current healthcare organization and think about potential opportunities for evidence-based change.

The Assignment: (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:
  • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
  • An explanation about what you learned from completing the evaluation table (1 slide)
  • An explanation about what you learned from completing the levels of evidence table (1 slide)
  • An explanation about what you learned from completing the outcomes synthesis table (1 slide)
    

    Critical Appraisal Tools Worksheet Template

    Evaluation Table

    Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

    Full citation of selected article	Article #1	Article #2	Article #3	Article #4
    	Ashcroft, D., Lewis, P., Tully, M., Farragher, T., Taylor, D., & Wass, V., Williams, S. D., & Dornan, T. (2015). Prevalence, Nature, Severity and Risk Factors for Prescribing Errors in Hospital Inpatients: Prospective Study in 20 UK Hospitals. Drug Safety, 38(9), 833-843. DOI: 10.1007/s40264-015-0320-x	Carayon, P., Wetterneck, T., Cartmill, R., Blosky, M., Brown, R., & Kim, R., Kukreja, S., Johnson, M., Paris, B., Wood, K. E., & Walker, J. (2014). Characterising the complexity of medication safety using a human factors approach: an observational study in two intensive care units. BMJ Quality & Safety, 23(1), 56-65. DOI: 10.1136/bmjqs-2013-001828	Hines, S., Kynoch, K., & Khalil, H. (2018). Effectiveness of interventions to prevent medication errors. JBI Database Of Systematic Reviews And Implementation Reports, 16(2), 291-296. DOI: 10.11124/jbisrir-2017-003481	Khalil, H., Chambers, H., Sheikh, A., Bell, B., & Avery, A. (2017). Professional, structural and organisational interventions in primary care for reducing medication errors. Cochrane Database System Review, 10 (CD003942). DOI: 10.1002/14651858.CD003942.pub3.
    Conceptual Framework Describe the theoretical basis for the study	The study deduced the reasoning that doctors during their first year of post-graduate training are prone to making disproportionate errors in their prescription.	Safety during medication is a significant issue in healthcare more so in intensive care units (ICUs). Therefore, the complexity of the medication management process is reflected on the convolution of evaluating medication errors and adverse drug events in ICUs.	This study seeks to assess the effectiveness of interventions developed to avert medication error during administration of medication, medication-related death, and medication-related harms among acute care patients.	During primary care, there are adverse events associated with medication and they represent a significant cause of hospital admission and mortality and these events could be as a result of patient going through adverse drug reactions or medication errors and the latter is preventable.
    Design/Method Describe the design and how the study was carried out	The study used pharmacists as their subjects across 20 health facilities over 7 selected days and the data was collected based on the number of checked medication orders, details of the prescribing errors, and the prescriber’s grade.	As part of the study’s methodology, the research has assessed the effect of electronic medical record on the safety and quality across ICUs by having cross-sectional study which has reported on the medication safety before EHR was used in two ICU facilities in a tertiary care under community teaching hospital.	The study considered different systemic reviews which entailed different health practitioners involved in prescription, dispensation, and administration of medication to patients under acute care. Therefore, information regarding this issue will be retrieved from different databases such as the Cochrane Library, Embase, Implementation Reports, MEDLINE, CINAHL, and the JBI Database of Systematic Reviews Web of Science where the researchers would look for theses, MedNar, and ProQuest dissertations. .	The researchers searched through CENTRAL, Embase, MEDLINE, TWO REGISTRIES, and three other websites on 4 October 2016 as well as reference checking, contact with authors to determine further researches, and citation searching.
    Sample/Setting The number and characteristics of patients, attrition rate, etc.	Over the 7-day duration of data collection, pharmacists reviewed 26,019 patients and 124,260 medication orders. Among these data collected, it was found that 10,986 had prescription errors hence making the mean error rate to be at 8.8% for every 100 prescriptions.	The adult ICU entails a 24-bed capacity unit which concentrates on trauma, critical care, and non-cardiac post-surgical care hence making the average stay to be 7.1 days. On the other hand, there is a cardiac ICU with capacity of 18 beds and it is specialized in various cardiac-related care with an average stay of 3.6 days. Therefore, this research evaluated data from 630 subsequent ICU patients admitted and 304 were from the adult ICU between October 2006 and February 2007 whereas 326 were from the cardiac ICU between January and March 2007.	After the search for the relevant publications in the aforementioned sites, the chosen citations will be gathered and uploaded into Endnote and their duplicates removed as two independent reviewers screen the abstracts and titles for evaluation against the inclusion protocol for the assessment.	The research used 30 studies which had 169,969 subjects in assessing the interventions to avert medication errors and 4 studies looked into professional intervention (8266 subjects) whereas 26 subjects discussed the institutional interventions (161,703 subjects). However, the research did not find any study which discussed structural intervention.
    Major Variables Studied List and define dependent and independent variables	The dependent variables for this research include stage of hospitalization when the medication was given to the patient, type of prescription, and the type of prescriber. The independent variable in this study is the severity of the prescribing error.	The dependent variables for this research included potential ADE events, preventable ADE events, as well as non-preventable ADE events The independent variable for this study was the medication safety which entailed evaluation of ICU medication order.	The independent variables for this study include specific details on the interventions, method of review, populations, as well as the result of significance to the review question and particular objectives. The dependent variable is the medication error which the researches seek to assess from different publications.	The independent variables are visit to the emergency department, admission into the hospital, and mortality of the patient. The dependent variable was the natural units which entail the number of subjects within an event per the cumulative number of subjects at follow-up.
    Measurement Identify primary statistics used to answer clinical questions	The research used the logistic regression models which recognized different aspects of predicting the chances of making erroneous prescription as well as its severity.	The data regarding medication safety events were collected using four trained nurse data collectors through a prospective cohort study process whereby the incident was detected by self-report of the nurse data collectors. Therefore, this data collection method entailed review of every ICU medication order through the steps of medication-management process hence seeing the errors and ADEs associated with the order.	Based on the paper chosen for this research, the data will be retrieved by two independent reviewers through a standardized data extraction tool from the JBI SUMARI.	The research used GRADE tool for assessment of certainty of evidence.
    Data Analysis Statistical or qualitative findings	Univariable and multivariable logistic regression models were applied in assessing the possible effect of different variables such as the stage of hospitalization when the medication was prescribed, type of prescription, and the type of prescriber. Multinomial logistic regression model was also used to identify, determine the severity of the prescribing error more so on the aspects which were correlated with a critical or possibly grave error instead of a minor error.	For data analysis, the researchers used the Cohen’s kappa score which had the ability to measure the inter-rater agreement for qualitative data by taking into account the chances of the agreement occurring by chance. This statistical analysis found that scores exceeding 0.97 for the error that occurred, grouped medication error types, grouped the events into single, sequential, or group error events, and it grouped errors at the stage of medication-management process.	The findings which were extracted from these publications were presented in tabular format where they were put in pairs entailing the intervention and its subsequent outcomes. Therefore, the strengths of evidence based on the effectiveness of an intervention was based on three colors whereby green designated an effective intervention, amber stood for no difference or effect compared to a control intervention, and red for a damaging intervention or one which is not effective as the control.	The study included random trials whereby healthcare practitioners offered community-based medical services and they also added interventions within the outpatient facilities connected with the hospital where patients are observed by professionals but they are not admitted. Therefore, the research used interventions which were focused on reducing medication errors resulting in visits in the emergency department, admission into the hospital, and death of the patient. The subjects used in this research were ranging in different age but they all have a history of being prescribed medication.
    Findings and Recommendations General findings and recommendations of the research	Hospitals are faced with issues such as prescription error and this problem is not only evident among the young medical practitioners hence the need to develop an intervention which would improve the safety of patients under the care of all grades of medical professions.	This study found out that medication errors and ADEs among the sampled patients upon their admission was across 1,733 different occurrences whereby 549 of them did not have potential for patient harm and 1,184 were potential and avoidable ADEs. The percentage for significant, serious, and life threatening harm was 38%, 44%, and 18%. Therefore, based on these occurrences, there are various technologies which have been proposed to improve the safety of these patients such as CPOE technology which is considered as a convenient intervention that can alleviate the ordering errors.	The findings table was summarized through GRADEPro GDT software which graded the quality of evidence hence creating the Summary of Findings Table that offered any suitable information such as estimates of relative risk, absolute risk for control and treatment, as well as quality ranking for evidence based on the limitations of a given publication. Therefore, this would create different outcomes such as medication error on a given etiology, medication error-related death, and medication error-related harm.	There is significant diversity based on the type of profession involved and where the research was conducted but majority of the intervention (61%) was one by pharmacists or an amalgamation of them and doctors. Therefore, this review was developed as a way of discussing and evaluating the best way of alleviating medication errors among the primary healthcare practitioners for adult patients.
    Appraisal Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	This research is crucial in validating how medication orders can have errors hence it shades light on this medical issue which has not had much attention over the years and this study can be used in substantiating where the problem lies and as a result, enable the relevant bodies come up with necessary intervention to alleviate the risk for errors and in turn improve the safety of patients.	It is important to understand the intricate nature regarding the vulnerabilities of the management process of medication which is an important issue in developing solutions which will enhance the safety of patients. Therefore, one of the steps deemed necessary in improving safety during medication across ICUs will involve the adoption of electronic health record technology which is equipped with a computerized physician order entry.	Medication safety is important during the process of prescribing, dispensing, and administration of medication. Therefore, it is important to note that the process is complicated based on the number of people involved hence being potential for the occurrence of a given error. The research has recommended more effective and recognized interventions which can be applied in practice hence averting medical error and enhances safety during medication.	The research asserted on the interventions within primary care which would alleviate medication errors hence making a difference to the number of patients hospitalized, died, or visited the emergency room. However, it is important to note that during assessment of different studies, there were reports of bias with only 18 studies showing sufficient hiding of allocation whereas 12 of them reported on sufficient protection from contamination and all of them affected the general influence approximated and the pooled estimate.
    General Notes/Comments	Despite the study focusing on the new medical practitioners, it has comprehensively evaluated the cases of medication error and how this problem can be sorted out across health facilities.	This research has evaluated the extensive effect of medication errors and how adopting computer and electronic technology will be important in alleviating this issue.	This study has reiterated on the essence of having good medication practices as art of upholding patient safety.	This research has deduced that it is important to ensure there is no medication error more so for the primary healthcare facilities because this issue can affect every medical profession.

    Levels of Evidence Table

    Use this document to complete the levels of evidence table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

    Author and yearof selected article	Article #1	Article #2	Article #3	Article #4
    	Ashcroft, D., Lewis, P., Tully, M., Farragher, T., Taylor, D., & Wass, V., Williams, S. D., & Dornan, T. (2015).	Carayon, P., Wetterneck, T., Cartmill, R., Blosky, M., Brown, R., & Kim, R., Kukreja, S., Johnson, M., Paris, B., Wood, K. E., & Walker, J. (2014).	Hines, S., Kynoch, K., & Khalil, H. (2018).	Khalil, H., Chambers, H., Sheikh, A., Bell, B., & Avery, A. (2017).
    Study Design Theoretical basis for the study	The study discusses that medical practitioners who are less experienced have higher chances of making disproportionate errors in their prescription.	The complexity of the medication management process is reflected on the convolution of evaluating medication errors and adverse drug events in ICUs.	This study evaluates the effectiveness of interventions developed to avert medication error during administration of medication, medication-related death, and medication-related harms among acute care patients.	During primary care, there are adverse events associated with medication and they represent a significant cause of hospital admission and mortality and these events could be as a result of patients going through adverse drug reactions or medication errors and the latter is preventable.
    Sample/Setting The number and characteristics of patients	The pharmacists evaluated 26,019 patients and 124,260 medication orders and from the data collected, it was found that 10,986 had prescription errors hence making the mean error rate to be at 8.8% for every 100 prescriptions.	The adult ICU entails a 24-bed capacity unit which concentrates on trauma, critical care, and non-cardiac post-surgical care hence making the average stay to be 7.1 days. Additionally, the research also evaluated the cardiac ICU with capacity of 18 beds and it is specialized in various cardiac-related cares with an average stay of 3.6 days.	The information on medication error was retrieved from different databases such as the Cochrane Library, Embase, Implementation Reports, MEDLINE, CINAHL, and the JBI Database of Systematic Reviews Web of Science where the researchers would look for theses, MedNar, and ProQuest dissertations.	The study searched through CENTRAL, Embase, MEDLINE, TWO REGISTRIES, and three other websites on 4 October 2016 as well as reference checking, contact with authors to determine further researches, and citation searching. Therefore, used 30 studies which had 169,969 subjects in assessing the interventions to avert medication errors.
    Evidence Level * (I, II, or III)	Level III	Level V	Level IV	Level II
    Outcomes	This study is important in validating how medication orders can have errors more so among the new health practitioners hence it can be used to substantiate where the problem lies and as a result, enable the professionals to develop the necessary intervention to eliminate the risk for errors which will improve the safety of patients.	The evidence provided in this study entailed review of every ICU medication order through the steps of medication-management process hence seeing the errors and ADEs associated with the order. Moreover, it is clear that electronic medical records improved the overall safety of the patients under acute care by alleviating cases of wrong medication.	The strengths of this evidence is based on the effectiveness of an intervention which is based an effective intervention, no difference or effect compared to a control intervention, and a damaging intervention or one which is not effective as the control.	There is significant diversity based on the type of profession involved and where the research was conducted hence pointing out the issues existing within different professions when it comes to medication error.
    General Notes/Comments	This study is important in shading light regarding medication errors but it is equally important to conduct more research regarding the reduction of these high-risks errors which can affect the safety of patients.	Medication safety is a complex aspect based on the findings of this study but it is worth noting that they are preventable. Moreover, it is important to note that medication errors are prevalent during order and administration stages hence the need to adopt EHR technology combined with CPOE as a way of improving safety during medication.	The study has highlighted that medication error is one of the main errors which can affect the safety of a patient hence the need to develop approaches which can improve this safety. Additionally, medication errors are mainly caused by human factors thus the need to adopt technology to conduct the process because it will offer more accuracy.	Based on the reviews conducted and analyzed, it is important to have the necessary interventions in primary care so that medical errors can be reduced hence reducing its detrimental effects. Moreover, it would be important to address various organizational and professional interventions prior to the development of evidence-based recommendation.

    * Evidence Levels:

    · Level I

    Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

    · Level II

    Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

    · Level III

    Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

    · Level IV

    Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

    · Level V

    Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

    Outcomes Synthesis Table

    Use this document to complete the outcomes synthesis table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

    Author and yearof selected article	Article #1	Article #2	Article #3	Article #4
    	Ashcroft, D., Lewis, P., Tully, M., Farragher, T., Taylor, D., & Wass, V., Williams, S. D., & Dornan, T. (2015).	Carayon, P., Wetterneck, T., Cartmill, R., Blosky, M., Brown, R., & Kim, R., Kukreja, S., Johnson, M., Paris, B., Wood, K. E., & Walker, J. (2014).	Hines, S., Kynoch, K., & Khalil, H. (2018).	Khalil, H., Chambers, H., Sheikh, A., Bell, B., & Avery, A. (2017).
    Sample/Setting The number and characteristics of patients	The pharmacists evaluated 26,019 patients and 124,260 medication orders and from the data collected, it was found that 10,986 had prescription errors hence making the mean error rate to be at 8.8% for every 100 prescriptions.	The adult ICU entails a 24-bed capacity unit which concentrates on trauma, critical care, and non-cardiac post-surgical care hence making the average stay to be 7.1 days. Additionally, the research also evaluated the cardiac ICU with capacity of 18 beds and it is specialized in various cardiac-related cares with an average stay of 3.6 days.	The information on medication error was retrieved from different databases such as the Cochrane Library, Embase, Implementation Reports, MEDLINE, CINAHL, and the JBI Database of Systematic Reviews Web of Science where the researchers would look for theses, MedNar, and ProQuest dissertations.	The study searched through CENTRAL, Embase, MEDLINE, TWO REGISTRIES, and three other websites on 4 October 2016 as well as reference checking, contact with authors to determine further researches, and citation searching. Therefore, used 30 studies which had 169,969 subjects in assessing the interventions to avert medication errors.
    Outcomes	This study is important in validating how medication orders can have errors more so among the new health practitioners hence it can be used to substantiate where the problem lies and as a result, enable the professionals to develop the necessary intervention to eliminate the risk for errors which will improve the safety of patients.	The evidence provided in this study entailed review of every ICU medication order through the steps of medication-management process hence seeing the errors and ADEs associated with the order. Moreover, it is clear that electronic medical records improved the overall safety of the patients under acute care by alleviating cases of wrong medication.	The strengths of this evidence is based on the effectiveness of an intervention which is based an effective intervention, no difference or effect compared to a control intervention, and a damaging intervention or one which is not effective as the control.	There is significant diversity based on the type of profession involved and where the research was conducted hence pointing out the issues existing within different professions when it comes to medication error.
    Key Findings	Hospitals are faced with issues such as prescription error and this problem is not only evident among the young medical practitioners hence the need to develop an intervention which would improve the safety of patients under the care of all grades of medical professions.	This study found out that medication errors and ADEs among the sampled patients upon their admission was across 1,733 different occurrences whereby 549 of them did not have potential for patient harm and 1,184 were potential and avoidable ADEs. The percentage for significant, serious, and life threatening harm was 38%, 44%, and 18%. Therefore, based on these occurrences, there are various technologies which have been proposed to improve the safety of these patients such as CPOE technology which is considered as a convenient intervention that can alleviate the ordering errors.	The findings table was summarized through GRADEPro GDT software which graded the quality of evidence hence creating the Summary of Findings Table that offered any suitable information such as estimates of relative risk, absolute risk for control and treatment, as well as quality ranking for evidence based on the limitations of a given publication. Therefore, this would create different outcomes such as medication error on a given etiology, medication error-related death, and medication error-related harm.	There is significant diversity based on the type of profession involved and where the research was conducted but majority of the intervention (61%) was one by pharmacists or an amalgamation of them and doctors. Therefore, this review was developed as a way of discussing and evaluating the best way of alleviating medication errors among the primary healthcare practitioners for adult patients.
    Appraisal and Study Quality	This research is crucial in validating how medication orders can have errors hence it shades light on this medical issue which has not had much attention over the years and this study can be used in substantiating where the problem lies and as a result, enable the relevant bodies come up with necessary intervention to alleviate the risk for errors and in turn improve the safety of patients. However, one limitation of this study which turns out to be the bias of the research is that it has focused its case on new doctors but most literature have asserted that medication error is prone to any medical practitioner regardless of their experience.	It is important to understand the intricate nature regarding the vulnerabilities of the management process of medication which is an important issue in developing solutions which will enhance the safety of patients. Therefore, one of the steps deemed necessary in improving safety during medication across ICUs will involve the adoption of electronic health record technology which is equipped with a computerized physician order entry. However, it is important to note that this research invested in significant amount of resources and time towards the nurse data collectors as a prerequisite to ensuring they collected data on medication errors.	Medication safety is important during the process of prescribing, dispensing, and administration of medication. Therefore, it is important to note that the process is complicated based on the number of people involved hence being potential for the occurrence of a given error. The research has recommended more effective and recognized interventions which can be applied in practice hence averting medical error and enhances safety during medication.	The research asserted on the interventions within primary care which would alleviate medication errors hence making a difference to the number of patients hospitalized, died, or visited the emergency room. However, it is important to note that during assessment of different studies, there were reports of bias with only 18 studies showing sufficient hiding of allocation whereas 12 of them reported on sufficient protection from contamination and all of them affected the general influence approximated and the pooled estimate.
    General Notes/Comments	This research has compared the prevalence of prescription error which is common among the first year post-graduate medical practitioners compared to other senior doctors thus deducing the grave nature of this issue.	Technology is important in solving problems such as medication errors which is common in healthcare facilities.	Based on the systematic review, there are various outcomes which can be used to compute medication error.	There are various factors such as the organizational, professional, and structural interventions which are used to find comparison between standard cares hence being crucial in alleviating preventable problems such as medication error.

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