Implementation, Research Paper Example

This proposal will be discussing an implementation plan and evaluation plan in the critical care unit addressing the problem of serious medication errors and its adverse effects to patients.  Implementation of eMAR and nurses’ adoption of the system will reduce medication errors and prevent harm to the patient.  The adoption of eMAR among critical care nurses plays a significant role in the promotion of patient safety.

Section D: Implementation Plan

Overall Plan for Implementing the Proposed Solution

The use of eMAR and nurses’ adoption of the system plays a critical role in the health care delivery system.  Nurses will complete a survey regarding eMAR and their attitude concerning its use. According to Poon et al. (2010), the use of eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events.  According to DeYoung, VanderKooi, & Barletta (2009), the implementation of bar-code medication administration significantly reduced the number of wrong administration time errors in an adult medical ICU.

The adoption of eMAR among critical care nurses is gradual for each nurse.  If there is something implemented and it is an easy process to learn, normally there is little negative feedback from personnel.  However, nurses become frustrated with technology when it is slow, imperfect, or generally does not fit into their normal workflow process (Murphy, 2011).  Each nurse has to adapt to the new system at his or her own pace and having nursing staff trained in its use who are willing to be used as support personnel will help in the transition of the use of eMAR in the critical care unit.  The use of eMAR in the critical care unit will significantly decrease medication errors and enhance medication administration accuracy.

Resources needed

Four eMAR carts will be leased for this project and two specialists will be included (one each for day and night shift) to assist with proper training of personnel.  The eMAR method will be evaluated for the two-month period and afterward things will return to their previous state unless administration sees fit to implement this at the end of the testing period. Because of the constant observation and feedback that will be given, the hospital administration will have a good idea if this system is working better than the previous manual method for workflow in the critical care unit.

Methods for monitoring solution implementation

Implementation of eMAR in the critical care unit of the hospital will take place over a two- month period.  This will be on a trial basis and the observations and surveys will be used to assess whether or not the hospital will benefit from an institutional implementation as well as how cost- effective this could be over time.

Change theory

Lippett’s phase of change theory is applicable to this proposal.  It will be implemented to carry out this transition.  His theory basically consists of seven steps, which are: the diagnosis of a problem, assessment of the motivation and capacity for change, assessment of the resources for change, the choice of changing object, the role of each person in the change, maintenance of the change via feedback and communication from the parties involved, and the gradual termination of the previous method after the complete change has occurred (Kritsonis, 2005).  The surveys will be qualitative in nature and will consist of open-ended questions to allow for feedback from employees as to how they found the project helpful to them during their daily routine or if perhaps there was something they felt should be adapted to better suit their particular institution.

The elements of Lippitt’s change theory are important to nursing and are applicable in many circumstances. The first, diagnosing the problem, is the most essential. It is where the need for change is officially made public in order for a decision to be made about where to go from this point. In assessing motivation, the second element, the supervisors want to ensure the employees who are going to be involved in the change are going to be willing to comply with this change. It is important to find out if there is going to be an issue such as budgeting that might cause the project to last longer than expected (Kritsonis, 2005).

The third element, the change agent, is important because this person or group of individuals must be able to handle the task at hand and must have the motivation to engage others as well. Element four, a written plan, should always be included with a change and should include detailed steps with deadlines and time frames as well as responsibilities. This will help the process move faster. The role of the change agent should also be decided. This should be made public and clear so everyone understands and there is no miscommunication (Kritsonis, 2005).

The change should be maintained and consistently monitored to track the progress of the change. This is where communication is vital and a breakdown of communication can cause the project to fail. The final element is termination of the helping relationship. This finality is a good thing because it means the change was successful and the change agent is no longer needed. All policies have been put into place and rules have been implemented (Kritsonis, 2005).

Feasibility of the implementation plan

The implementation plan is feasible because the original method of patient charting and medication administration will not be interrupted. Nurses will use the manual recording method as well as the electronic method during this project and no harm will be brought to the patients in the critical care unit during eMAR implementation. If extra nursing personnel are needed, overtime shifts may be scheduled as necessary to ensure a smoother workflow and decrease the stress levels during this time.

The following are some costs that will arise during the process of implementing this plan.

eMAR Budgetary Considerations

• Pre-Implementation Costs
• Connectivity
• Data Security
• Actual cost of system
• Maintenance and technical support
• Training
• Conversion from paper
• Future uses

Corporate Budget

• Infrastructure upgrades
• Mobile carts for computers (laptops and scanners)
• Thermal printers for pharmacy
• Meditech software upgrades

Facility Budget

• Operational costs for bar coding medications
• Fixtures or changes to pharmacy
• Staff time for planning, testing, developing, training
• Printers for armbands
• Travel for site visits

Section E: Evaluation Plan

Outcome Measures

Fifteen nurses in the critical care unit will be surveyed as part of this proposal in addition to the anonymous random observations concurrently collected.  The surveys will be passed out after the two-month period of testing the eMAR procedure and the nurses will be asked to complete the surveys and place in a box in the break room.  The surveys will be qualitative in nature due to the fact they were open-ended questions to assess if the implementation of eMAR might be a good choice for this hospital based on the assessment of the critical care unit.

The survey will consist of six questions pertaining to the nurses’ use of the eMAR devices and their comments regarding adaptation to the machines and attitudes thereof.  A copy of the questions is attached.  The hope is that the implementation of eMAR will benefit the nurses after the initial learning curve has been mastered.  Thus, the eMAR is expected to be beneficial to the nursing staff as well as cost- effective for the hospital.

The information collected from critical care nursing staff participants will be used as a baseline to assess what small changes, if any, will be needed for the machines to be a valuable asset to the hospital.  If the survey will be successful, any necessary small adaptations may be made to the machines to personalize them specifically according to the hospital’s specifications. This will help other units with implementation if the project moves forward.

Validity, reliability and sensitivity

The questionnaire submitted to the nurses who were trained on the use of the eMAR will be anonymous, so this would essentially help with the validity and reliability issue because there should be no worries of negative implications if a nurse is not happy with the experience and feels the need to voice her opinions about it. Also, because the box for submission of the questionnaires is located in a place where employees are able to submit the questionnaires without personally handing them to another individual, there will be even more comfort to be honest and withhold nothing when asked about the experience of training on the eMAR. The questionnaire is also sensitive in reference to its information obtained because the qualitative design is specific to this project and there is ample opportunity presented for nurses to explain any negative or positive experiences they might have had while learning the eMAR.

Evaluation Data collection

Time, fiscal, and personnel resources needed for evaluation

Each nurse will be instructed in the mechanics of the machine, all of the basic functions, the proper way to input patient data, the correct sequence in which to chart information, and how to relay messages to and from the pharmacy to ensure orders were delivered accurately.  In addition to this, the manual method will also be used concurrently as it had been in the past so that no patient’s safety will be compromised.  All observation results will be recorded on a chart and notes will be made, as needed, pertaining to events during the observation.  Team management tools, schedule management tools as well as a specific budget set aside for the evaluation of staff is mandatory for the success of the evaluation process.

Feasibility of the Evaluation Plan in the Work Setting

This is a feasible plan because the original method of patient charting and medication administration will not be interrupted; therefore, no harm will be brought to any patient due to the study.  Only one unit will be included in the study because only the critical care unit will be assessed, so there will only be 15 employees involved in the training, and this will not cause a problem in the budget for the hospital because of the work schedule maintained in the unit.

Conclusion

The use of eMAR in the critical care unit is significant in promoting patient safety.  The adoption of eMAR among critical care unit nurses will reduce medication errors and enhance medication accuracy. If the project is deemed successful, hospital administration will immediately begin implementation of the eMAR within the entire institution.  The efficacy of eMAR will decrease medication mistakes and improve medication administration safety.  This technology enables critical care nurses to provide safe, effective, and quality of care to patients.

References

DeYoung, J. L., VanderKooi, M. E., & Barletta, J. F. (2009). Effect of bar-code-assisted medication administration on medication error rates in an adult medical intensive care unit. American Journal of Health System Pharmacy, 66(12), 1110-1115. doi:10.2146/ajhp080355

Kritsonis, A. (2004-2005). Comparison of Change Theories. International Journal of Scholarly Academic Intellectual Diversity, 8(1), 1-7.

Murphy, J. (2011). Leading from the Future: Leadership Makes a Difference during Electronic Health Record Implementation. Frontiers of Health Services Management, 28(1), 25-30.

Poon, E., Keohane, C., Yoon, C., Ditmore, M., Bane, A., Levtzion-Korach, O., Moniz,

T., Rothschild, J.M., Kachalia, A. B., Hayes, J., Churchill, W. W., Lipsitz, S., Whittemore, A. D., Bates, D. W., &Gandhi, T. K. (2010). Effect of bar-code technology on the safety of medication administration. The New England Journal of Medicine, 362(18), 1698-1707. Retrieved from EBSCOhost.

Appendix

• What are your thoughts of using eMAR?
• What initial problems did you have during the testing phase of the eMAR?
• What do you feel was the most important attribute of the eMAR?
• Do you believe the eMAR to be a safer way of administering medications than any other previous method? Why or why not?
• What would you change if anything about the eMAR?
• What other comments do you have about the eMAR?