Evidence Based Project Proposal
Part 1: Introduction
- Summarize the practice issue in need of change providing background information and the perceived significance of the problem
- Describe the specific aims of the project – what improved outcomes do you hope to achieve
- State your question in PICOT format, labeling each part with P-I-C-O-T in parentheses
- Discuss the significance of the issue in terms of poor outcomes, cost, etc.
| Assignment 2 Grading Criteria | Maximum Points |
| Briefly summarized the practice issue or problem providing background information and the perceived significance of the problem. | 10 |
| Discussed the aim of the project – what aspect of practice needs improvement. | 10 |
| Described desired outcomes. | 10 |
| Included a question in PICOT format to drive the literature search for evidence.* | 15 |
| Used current APA style guidelines consistently and accurately. | 5 |
| Total: | 50 |
Sources you might use are:
http://repository.usfca.edu/cgi/viewcontent.cgi?article=1215&context=capstone
http://www.ihi.org/Topics/ADEsMedicationReconciliation/Pages/default.aspx
https://archive.ahrq.gov/research/findings/factsheets/errors-safety/aderia/ade.html
My work from prior weeks so far and with professors comment for further reference:
What piqued your interest about this issue or problem?
What picked my interest in the subject was to find out statistics that show the increase in adverse drug events; and to notice that they are usually the result of medical interventions. The events include medication errors, adverse drug reactions, allergic reactions, and overdoses. ADEs can happen anywhere: in hospitals, long-term care settings, and outpatient settings. In the clinical setting I was able to notice a deficit in patients’ knowledge about medication regime, compliance importance and more. I believe it all comes down to a deficit in education provided by the professionals including, doctors, nurses and all staff in general.
How does it relate to your area of specialization?
As a future Nurse Practitioner, I believe I have a great responsibility over my shoulders in regards to making sure my patients are going home with the essential understanding about their disease process, including treatments and other non-pharmacological options. Furthermore, I believe it is my duty as a NP to recognize educational deficits and try to provide the best care possible integrating my knowledge and additionally adapting to the specific situation and provide an individualized care for my patients.
What gave you the idea that evidence exists to support this change?
There are many researches and studies completed on the subject. I found there are even national action plans that were created for adverse drug event prevention. “A medication error is defined as “inappropriate use of a drug that may or may not result in harm;” such errors may occur during prescribing, transcribing, dispensing, administering, adherence, or monitoring of a drug” (Koh, 2014)
Provide a rationale as to why this will be an evidence-based project to improve outcomes and not generate new evidence (research).
Estimated cost of ADE’s is $200-400 million dollars/year (Agyemang & While, 2010). 20% of harm is r/t medication errors (Health Research and Educational Trust, 2013). 40%-80% of information is forgotten by patients (“Teach-back gives direction”, 2011). Most common ADE’s are linked to Insulin’s, Anticoagulants, and Opioid’s.
References
Agyemang, R., & While, A. (2010). Medication errors: Types, causes and impact on nursing practice. British Journal of Nursing, 19(6), 380-385. Retrieved from: http://www.mendeley.com/research/medication-errors-types-causes-impact-nursing-practice/
Health Research and Educational Trust. (2013). Implementation guide to reducing harm from high-alert medications. Retrieved from: hret-hen.org.
Koh, H. (2014). National Action Plan for Adverse Drug Event Prevention. . Retrieved from U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. : https://health.gov/hcq/pdfs/ade-action-plan-508c.pdf
Teach-back technique improves patient safety. (2001). Patient Education Management, 14(4), 44-45. Retrieved from URL: http://web.ebscohost.com/ehost/detail?vid=4&sid=24811194-c9b1-4c73-9be9-c40875312bbf%40sessionmgr104&hid=126&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&AN=2009546185.
Evidence Based Project-Proposal: Adverse Drug Events
The evidence-based project proposal will focus on adverse drug events as an issue of both clinical and theoretical importance. The rationale behind the topic selection is based on the fact that it encompasses both aspects of an EBP project as well as that of a research project. The project reflects the features of an EBP in that it focuses on a pre-determined setting. The importance of handling adverse drug reactions makes a core topic in clinical practice, additionally justifying the rationale for the project. Furthermore, the successful completion of the project will offer insights on how to solve a practice problem, in this case the adverse drug reactions. Finally, the EBP project will be conducted with strict adherence to ethical principles. On the other hand, the project proposal reflects a research project in that it will rely heavily on previously published literature on the topic for direction and guidance.
The paper will focus on adverse drug events as the issue under discussion. There will be three main interventions that the proposal will seek to pursue, most notably the STOPP and the START intervention techniques (Jordan et al, 2016). On the other hand, Hughes and Blegen (2008) propose nursing education as an essential item in countering and managing adverse drug events. This point is further re-iterated by Jordan, Vaismoradi and Griffiths (2016) in their emphasis on nursing leadership as key in the provision of nursing education and consequently the management of adverse drug events. The expected outcome will be the singling out of a feasible intervention technique that is most applicable in reducing the incidences of adverse drug events.
As a family nursing practitioner, I find this project quite relevant to my role specialization in the family practice setting. Having an in-depth knowledge of drug reactions and mechanisms will go a long way in reducing the occurrence of adverse drug events. In addition, sound knowledge of the various intervention techniques will assist me in knowing what intervention would be best suited to handle an adverse drug event upon occurrence.
References
Keep in mind that this proposal will be developed piece by piece during the course. The assignment this week provides you an opportunity to identify the problem or issue within your specialization that is in need of improvement
Review the grading criteria listed below as you begin this assignment. Note that you must pass all elements in order to move forward with your proposal development. Faculty will provide feedback either approving or asking that you resubmit prior to further development of your project.
For this week’s assignment discuss the following:
- State your idea for your evidence-based project proposal including the rationale as to how it reflects an EBP project vs. a research project
- Very briefly describe the issue you will address, the intervention that you feel has research evidence (this may change later after you complete the literature search), and the expected outcomes
- Discuss how this project is relevant to your role specialization
By Sunday, February 5, 2017, post your paper using APA Style
| Assignment 3 Grading Criteria | Maximum Points |
| Stated the practice issue or problem providing background information and the perceived significance of the problem. | 18/20 |
| Discussed how the clinical issue is relevant to the selected role option. | 18/20 |
| Used APA format with a professional writing style throughout. | 8/10 |
| Total: | 44/50 |
Sheila, Good work! See comments throughout paper. You may want to review what EBP is and how to do an EB project. You will go to the research to find the best practice for your topic.
Problem
Adverse drug events (ADEs) pertain to drug-related injuries that occur due to medical interventions. ADEs highlight the most common cause of injuries resulting from medical care in health facilities (Nobutaka, Mio, Takeshi, Toshiaki, Koichiro, Jin, & Kenji, 2016). Equally, the World Health Organization describes ADEs as injuries related to medical management practices rather than disease complications. These injuries require additional treatment, monitoring, or hospitalization (Lim, Melucci, Rizer, Prier, & Weber, 2016).
Relation to my Area of Specialization
ADEs relate to the specialization of family practice as an advanced nurse practitioner because I will be providing medical information to patients when they are discharged from the hospital, or attend the outpatient clinic for care. This information pertains disease processes, treatment, and non-pharmacological options. Consequently, there is the risk of injuring patients if inaccurate information is provided.
PICOT Question
The PICOT format pertains to a helpful approach that summarizes research questions to facilitate the exploration of the efficiency of a particular therapy (Riva, Malik, Burnie, Endicott, & Busse, 2012). Due to the recent increase in hospital readmissions due to ADEs (P), the best approach for the prevention of ADE’s will be used during patient encounter opportunities (I). Further, closed-ended questions vs. teach-back methods (C) to determine the effectiveness of the strategy. This strategy will result in decreased hospital admissions, enhanced patient satisfaction, and increased medication compliance (O). Finally, this study will be conducted over a period of one year (T).
The Preferred Process Model
The Iowa model for evidence-based practice will be suited to this project. This model seeks to promote quality care by guiding nurses and other health practitioners in making decisions regarding their daily practices that influence patient outcomes (Melnyk & Fineout-Overholt, 2011). Hence, this model will ensure that I make informed decisions when providing medical information to patients.
References
Lim, D., Melucci, J., Rizer, M. K., Prier, B. E., & Weber, R. J. (2016). Detection of adverse drug events using an electronic trigger tool. American Journal of Health-System Pharmacy, 73S112-S120.
Melnyk, B. N. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice (2nd ed.). Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins.
Nobutaka, A., Mio, S., Takeshi, M., Toshiaki, K., Koichiro, W., Jin, N., & Kenji, F. (2016). The epidemiology of adverse drug events and medication errors among psychiatric inpatients in Japan: the JADE study. BMC Psychiatry, 161-8.
Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians. Journal of the Canadian Chiropractic Association, 56(3), 167-171.
Professor comments about above discussion questions.
Sheila, Your topic is good. You should narrow it as much as is possible. From your readings and your research course, you should realize that the PICOT question is one question in one sentence. You should also understand the meaning behind the letters in the PICOT question. P is for population. The P of your question does not describe people. The I (intervention) has you looking to the literature for the best method to prevent an ADE during a 1:1 pt encounter when a new medication is prescribed??? Is that what you are trying to say?? What is the C (comparison)? If you are looking in the lit for evidence, you should not decide what types of education will be best. You need to keep an open mind. The O should be one thing. Stay focused and don’t complicate the process. How will the model ensure you make the informed decisions??
Due to ADE’s, there is an increase in hospital re-admission of the geriatric population (P). Accurate medication reconciliation with patient, including purpose and indication of each medication (I). Current state- frequent discrepancies regarding medication reconciliation (C). Improving patient safety by minimizing medication reconciliation discrepancies at admission, in order for the patient to receive accurate medications at admission, transfer and discharge (O). Finally, this study will be conducted over a period of one year (T).
