Nursing Assignment: Literature Review On Evidence-Based Nursing Practice

Question

Task:
The aim of this nursing assignment is to demonstrate your understanding of principles of evidence-based nursing practice by completing a literature review to inform nursing practice.

Course objectives being addressed:

CO4. Critically evaluate the skills required to incorporate research findings into nursing practice.

CO5. Apply critical thinking skills and inquiry strategies to search databases and locate credible, clinically relevant research literature.

CO6. Critique research literature using appropriate frameworks and tools.

What you need to do:

Choose three (3) research articles using the databases which provide evidence on single nurse checking of medications and/or double nurse checking of medications in medication administration. Critique the research articles using the frameworks and tools provided in the NURS 3055 course materials. After critiquing the research articles, formulate recommendations for practice about how to integrate the findings to the nursing practice in relation to safe nursing administration of medications.

Answer

Introduction
As discussed in the nursing assignment, medical administration can be considered as the major responsibility of registered nurses. Registered nurses are educationally prepared, professionally responsible, and morally accountable for fulfilling their roles safely. Thus, it is the duty of the nurses to identify, commit and report the errors related to the medication. The challenges of safely administering are encountered by the nurses on a regular basis while delivering healthcare for patients. The nurses are taught about safe administration with the help of different frameworks and concepts (Martyn, Paliadelis, and Perry, 2019). Accurate and safe medication is a vital and potentially challenging nursing accountability. Medication administration requires various skills such as understanding medications, how the medications work, and the side effects of the medications. Vital nursing considerations are also involved in medical administrations such as good decision-making abilities and clinical judgment.

This assessment focuses on the discussion and critical analysis of the pieces of literature related to the single and double-checking of nurses. The search plan that has been used for locating the research articles has been discussed in this assessment. It has also been discussed in this study paper how the chosen pieces of literature are relevant to the questions or aim of the literature review. Three articles have been chosen and critically analysed with the help of the framework for critiquing a systematic review.

Aim of the literature review
The aim of this assessment is to establish the understanding of values of evidence-based nursing practice by conducting a literature review for informing nursing practice. The significance of the process of single and double-checking by registered nurses in medical administration will also be incorporated in the aims of this literature review.

Questions for the literature review

• What are single and double-checking methods used by registered nurses?
• What are the concepts of single and double-checking?
• How is single and double-checking important for medical administration?
• Why double-checking is considered to be vital in the case of medication administration?

Search plan used in locating three (3) research articles
The search plan that has been used for selecting the articles for this literature review is secondary searching for the relevant articles related to the topic. Various keywords have been used for conducting the search, such as single checking, double-checking, single checking, double-checking drug administration, and many more. Various websites such as Google Scholar, NCBI have been used for searching for relevant articles that provide vital information about the topic. The search resulted in almost 11-12 articles, out of which the three most relevant articles have been chosen.

Literature Review

Article 1

The Method of Checking Medications Prior To Administration: An Evidence Review (Athanasakis, 2015)
The first article that has been chosen for critiquing in this specific section has every material and content relevant to the research topic and can be able to bring the author with the desired outcomes. With the help of a specific framework provided in NURs 3055, the article has been analyzed further to achieve a good analyzed result. Since the question was about the single and/or double medication checking practice and this article has addressed both the term where the method of checking medications previous to administration has been discussed. It has been found that the author has utilized an appropriate kind of paper to address the given topic where a descriptive design has been used. An evidence-based review has been conducted to gather and appreciate the research evidence regarding the method of both medications checking preceding to their administration.

Figure: Literature search strategy

(Athanasakis, 2015)

Moreover, since it was an evidence-based review article and has included all the significant, appropriate studies have been included. In that case, the bibliography or the references the article has provided is mostly from 2005 to 2014 which is appropriate since all the articles have discussed either single or double medication checking practice. Most of the articles in the references list provided in the article are published and conform to the reliability for proceeding with the research. In addition to that, each article is published in the English language that appears to be comfortable in reading and reviewing the projected content. As projected in the above image it is evident that the articles that have been used in this particular article have been analyzed thoroughly through a search framework and makes the author choose only significant and reliable resources to conduct the further study. Such practices make sure the quality of the content maintains its standard and provides a viewer with reliable and authentic information from the research project. All the reference articles adhere to the inclusion standard which was exploited to retrieved possible new studies which were not possibly retrieved in the initial stage of the search plan.

Furthermore, it can be said that the author has considered the rigor of the studies which has been recognized because the result that has been obtained has not been affected in any way. In order to maintain the quality, the author has undertaken a literature search plan for multiple platforms such as PUBMED, Science-direct, CINAHL, and BRITISH NURSING database where interpreted data has been used i.e., both qualitative and quantitative. The final result that has been obtained from this article was displayed clearly which signifies the article as a whole. The presented findings of this article were clustered in different categories such as single-double checking, case of the checking application, advantages, and disadvantages of checking, medication flaws, etc. All the findings that have been presented in the above-mentioned categories clearly display the final findings.

The result that has been reported by the systematic review has been identified clearly and mentioned in the last paragraph as a conclusion. It has been reported that single and double-checking both act as a method that considers the safety of both the patients and the nurses. It has been found that double-checking is an appropriate measure that supports safe medication practice for the associated patients without encouraging any errors during the entire procedure. And even if the error occurs it can be reduced accordingly through this process. The result suggested that double-checking medication practices need to be identified as a regular routine in each of the clinical procedure instead of just taking individual action. In order to incorporate of checking method in the clinical nursing practice, it is very essential to identify and consider factors that hinder the efficiency of the associate nurses and the ones that ease its overall effectiveness.

Article 2

Nurses’ Preferences of Single or Double Checking of Drug Administration: A Focus Group Study by Ting et al., (2020)
Single and double-checking by the nurses are considered to be a vital part of nursing responsibilities as the majority of the medication duties are executed by the registered nurses. Medication errors can occur in any stage of the treatment and it has a high possibility of occurring during administration. The process of double-checking involves verification of the same information by two individuals while single checking consists of verification of the information by a single person. The article focuses on a specific research question, that is, which drug administration method is preferred by the registered nurses, the single or the double-checking. The study design of the article is qualitative research using a focus group. Six nurses were chosen for conducting an interview and they were asked about their preferences related to the drug administration processes of single checking and double-checking of the medications. The lack of the habits of the nurse for double-checking or independent checking of the drugs before the process of drug administration has also been covered in the article.

The data collection method of the study was the interview of the focus group. The participants were asked questions about their experience of medical administration, their preferences between single and double-checking drug administration, the impact of the methods on the safety of the patients, and the impact of the processes on medication errors. It can be said that the study used relevant studies related to the topic of the research. Manual coding has been used to explore the preferences of medication administration. The quality of the included studies is significantly maintained in the article. The interviews were recorded word to word and were transmitted to a document immediately after the interview session. The transcriptions of the documents were re-evaluated by the participants to ensure that the quality of the answers was maintained exactly as it were. The population of the study was 6 participants from the Sime Darby Hospital at Subang Jaya, Petaling Jaya, Malaysia (Ting et al., 2020). It can be said that the population of the study was relatively smaller. A bigger population would have helped the researchers to identify and analyze more detailed information about the subject of research.

The results and findings of the study have been reported in a detailed description. The themes that affect the preferences of the candidates have been discussed in detail in the article. The four main themes that have been identified are education and training, documentation, patient safety, and manpower. It has been stated by the participants that patient safety is one of the vital aspects of the profession as it impacts directly the reputation of the nurses and the overall nursing community is being represented by it (Ting et al., 2020). Thus, double-checking of the drugs is vital as it has a significant impact on patient safety. It can be stated that the overall results and findings of the study imply that almost every 6 participants preferred the double-checking process of drug administration as it ensured patient safety and the safety of the overall reputation of the nursing community. The double-checking procedure provides more safety measures than the single checking process but it must also be considered that the monitoring of the patient after the medication is important even if the medication is being provided after double-checking. Thus, it can be said that double-checking process has been mentioned as more effective compared to the single checking process (Ting et al., 2020).

Article 3

Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses' experiences by (Schwappach, Pfeiffer and Taxis, 2016)
The chosen research article is "Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses’' experiences" and this article focused on the question regarding how frequently do nurses find errors in terms of double-checking procedures for chemotherapy administration. A total of 274 nurses participated in the survey and the significance of this article is based on the fact that medication errors can lead to severe consequences for cancer patients. In addition to that, the ISMP's (Institute for Safe Medication Practices) recommendation about the implementation of the double-checking procedure has been used (Schwappach, Pfeiffer, and Taxis, 2016). The outcome considered in this article also aligns with the research question that aims to identify the occurrence of identifying errors in terms of conducting double-checking procedures.

The authors of this article have addressed the review question to a large extent but the article did not focus on the independence level of the checks. On the other hand, the study design chosen for this article has been a cross-section survey that consisted of qualified nurses who work for the oncology departments of 3 hospitals. Therefore, the study design can be considered appropriate based on the objective of the study. Overall, the survey design has been based on field testing.

This article has used bibliographic databases of “PubMed” and “PMC free article”, which can be considered as highly relevant studies. However, the article has solely relied on only two referencing sites and this could have been widened to make the research even more relevant or accepted. In addition to that, this article did not use non-English language studies that can make it difficult to communicate or relate certain findings of the study to the objectives. Overall, non-published articles were also not used as a part of the study, which also makes the article relevant for double-checking procedures.

It has been observed that the authors performed an adequate analysis based on considering the quality of the studies. In addition to that, the quality of the study conducted for this article has been based on peer-reviewed journal articles that have covered the topic of double-checking procedures for chemotherapy administration (Schwappach, Pfeiffer and Taxis, 2016). However, one limitation associated with the quality of this study is based on the fact that DC procedures in certain units have not been analyzed for quality. In the context of nursing, DC is an immensely popular procedure among the nurses who work in the oncology department.

In the context of the chosen article, the results of the studies were combined and this can prove to be effective in terms of determining the effectiveness of the study. Since the article is based on analyzing the error occurrence that gets identified during double-checking of chemotherapy medications. It is a well-known fact that the results obtained from the study based on the responses from the nurses need to be combined so that a wider perspective of the desired results can be identified (Schwappach, Pfeiffer, and Taxis, 2016). Therefore, it was completely reasonable to combine the results included in the study as it generated an in-depth understanding of the error occurrence in chemotherapy administrations.

The outcomes specified in the systematic review were based on the fact that the interplay between interruptions and DC in terms of workflow resulted in nurses reporting frequent interruptions, especially at the infusion units. In addition to that, the outcomes also indicated that a majority of the 68 respondents reported that were severe medication errors. However, the same majority of the respondents also stated that the errors could have been prevented based on a thorough double-check. Overall, the results of the systematic review were reported comprehensively because the responses of all the participants were considered.

The relevancy of the research article in terms of addressing aims or research questions
The first article covers the concepts of single-check administration as well as double-checks administrations for the purpose of explaining the effectiveness of each administration procedure. It has been observed that the results of the article indicate that double-checking administration is considered to be highly effective in terms of ensuring the effectiveness of medication administration. Therefore, this article addresses the research questions of why double-checking is considered to be vital in terms of medical administration.

The second article is similar to the first article but the number of participants used for this study is significantly less. The findings or outcomes of the second article suggest that double-checking administration is more effective for ensuring safety in terms of clinical administration practices.

The third article has focused on chemotherapy administrations and the results are related to the aims or questions related to the literature review as it extensively considered the response of each nurse who has participated in the study.

Recommendation
After the analysis of the above three articles in the systematic review, it has been found that in comparison double-checking medication has been found to be most appropriate than single-checking to be considered and implemented in the clinical sector. Therefore, the two specific strategies that have been taken in this particular section have considered a double-checking medication in the clinical sector.

Conduct double-check independently: It has been reported that conducting double-check independently has been one of the effective approaches in a clinical sector that are conducted by another qualified person. The most advantageous aspect is that it reduces the risk of confirmation bias which can possibly occur when the same person checks again and again(ISMP, 2019). It can be said that they likely will see exactly the same what they want to see even after detecting errors. In an independent double-checking practice there will be a need for two different individuals that work separately and work accordingly as per their responsibility without knowing another person’s result. Though the chances of not detecting the errors can be predicted however the time that it will take will be longer which could be its disadvantage that delays in coming to the conclusion(Koyama et al., 2020).

Normalize the process and provides tools: It is evident that in the clinical sector each process and practice the management implements in its organization has a direct impact on the health of the patient along with its associate staff. Thus, there should be proper planning and strategies for implementation and maintaining the entire process(Hewitt, Chreim, and Forster, 2015). While talking about double-checking medication an organization can normalize the entire process and provides its staff with appropriate tools which can help them in conducting double-checking process effectively. In this scenario, each staff responsible for double-checking medication will be informed and trained so that possibility of errors can be avoided. However, the disadvantage of implementing this strategy could be a time-consuming process and some of the staff may not find the tolls appropriate and familiar(Schwappach, Taxis, and Pfeiffer, 2018). To make each individual understand the entire process and make them familiar with the new identified tool will be needing extra effort and time. However, it is suggested because once the staff gets familiarized with the new tools it will be easier to father conducted the desired double-checking medication effectively.

Conclusion
In the end, it can be concluded that the chosen three articles for this report have generated a clear understanding of the concepts of single-check medication administration and double-checking medication administrations. It has been analyzed from this report that double-checking administrations can prove to be highly effective in terms of identifying and minimizing errors related to medication administrations. The nursing professionals participating in the studies of the chosen journal articles have expressed their interest in terms of double-checking medication administrations based on the fact that the safety of the patients does not get compromised in terms of double-checking administrations.

In addition to that, this report has also highlighted the importance of safe nursing medications as even the slightest of errors can lead to severe consequences in terms of patient outcomes. The relevancy of each article chosen for this research is based on the fact that all of the articles solely focus on obtaining outcomes related to single-checking and double-checking medications.

References
Athanasakis, E. (2015). The Method of Checking Medications Prior To Administration: An Evidence Review. [online] Available at: http://internationaljournalofcaringsciences.org/docs/32_32-Athanassakis_review_8_3.pdf [Accessed 22 Mar. 2022].

Hewitt, T., Chreim, S. and Forster, A. (2015). Double-checking: a second look. Journal of Evaluation in Clinical Practice, [online] 22(2), pp.267–274. Available at: https://dx.doi.org/10.1111%2Fjep.12468 [Accessed 22 Mar. 2022].

ISMP (2019). Independent Double Checks: Worth the Effort if Used Judiciously and Properly. [online] Institute For Safe Medication Practices. Available at: https://www.ismp.org/resources/independent-double-checks-worth-effort-if-used-judiciously-and-properly [Accessed 22 Mar. 2022].

Koyama, A.K., Maddox, C.-S.S., Li, L., and Bucknall, T. (2020). Effectiveness of double-checking to reduce medication administration errors: a systematic review. [online] ResearchGate. Available at: https://www.researchgate.net/publication/342336630_Effectiveness_of_double_checking_to_reduce_medication
_administration_errors_a_systematic_review [Accessed 22 Mar. 2022].

Martyn, J.-A., Paliadelis, P. and Perry, C. (2019). The safe administration of medication: Nursing behaviors beyond the five rights. Nursing assignment Nurse Education in Practice, [online] 37(37), pp.109–114. Available at: https://s1106788.stacksdiscovery.com/sites/default/files/safe%20med%20admin%20for%20112_0.pdf [Accessed 22 Mar. 2022].

Schwappach, D.L.B., Taxis, K. and Pfeiffer, Y. (2018). Oncology nurses‘ beliefs and attitudes towards the double-check of chemotherapy medications: a cross-sectional survey study. BMC Health Services Research, [online] 18(1). Available at: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-2937-9 [Accessed 22 Mar. 2022].

Ting, G.H., Xufen, W., Li, L.H., Wen, O.L., Choo, L.S., Suchi, U. and Dioso, R.I. (2020). Nurses’ Preferences of Single or Double Checking of Drug Administration: A Focus Group Study. Biomedical Journal of Scientific & Technical Research, [online] 24(4). Available at: https://biomedres.us/pdfs/BJSTR.MS.ID.004081.pdf [Accessed 22 Mar. 2022].