· Reflect on the four peer-reviewed articles you critically apprai.docx
- 1. · Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT. · Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection. · Consider the best method of disseminating the results of your presentation to an audience. The Assignment: (Evidence-Based Project) Part 4: Recommending an Evidence-Based Practice Change Create an 8- to 9-slide narrated 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. · Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
- 2. · 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 within the Critical Appraisal Tool Worksheet Template (1-3 slides) Zeinab Hazime Nurs 6052 10/16/2022 Evaluation Table Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research Full APA formatted citation of selected article. Article #1 Article #2 Article #3 Article #4
- 3. Abraham, J., Kitsiou, S., Meng, A., Burton, S., Vatani, H., & Kannampallil, T. (2020). Effects of CPOE-based medication ordering on outcomes: an overview of systematic reviews. BMJ Quality & Safety, 29(10), 1-2. Alanazi, A. (2020). The effect of computerized physician order entry on mortality rates in pediatric and neonatal care setting: Meta-analysis. Informatics in Medicine Unlocked, 19, 100308. https://doi.org/10.1016/j.imu.2020.100308 Elshayib, M., & Pawola, L. (2020). Computerized provider order entry–related medication errors among hospitalized patients: An integrative review. Health Informatics Journal, 26(4), 2834-2859. DOI: 10.1177/1460458220941750 Srinivasamurthy, S. K., Ashokkumar, R., Kodidela, S., Howard, S. C., Samer, C. F., & Rao, U.S. C. (2021). A systematic review is the impact of computerized physician order entry (CPOE) on the incidence of chemotherapy-related medication errors. European Journal of Clinical Pharmacology, 1-9.
- 4. https://doi.org/10.1007/s00228-021-03099-9 Evidence Level * (I, II, or III) I I I I Conceptual Framework Describe the theoretical basis for the study ( If there is not one mentioned in the article, say that here).** None None CPOE-related MEs that resulted from sociotechnical systems– related factors) None Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). Systematic review that involves the search for databases such as EMBASE, MEDLINE, and CINAHL. The focus was to identify published SRs from inception to 12th Feb, 2018. The inclusion criteria was based on full text review of primary evaluation research studies on medication ordering supported by the CPOE integrated with or without CDS. Systematic review using the English literature significant to the effect of CPOE on the mortality rates. The inclusion criteria
- 5. were children of 0 to 18 years; CPOE compared to no CPOE, randomized control or cohort, morality incidence, and the range of publications. The exclusion criteria involved the descriptive and non-English literature. Systematic review search for databases like PubMed and Google Scholar. The inclusion criteria is that the CPOE-associated MEs helps in the critical appraisal and summarizing the greater with text. The studies must involve outpatients, must have evaluated problem as opposed to the clinical or technical issue. Systematic review search of four database from 1 January 1995 until August 2019. The English language studies assessing the impact CPOE on CMEs were chosen as the inclusion and exclusion criteria. Studies assessing several interventions with no non-intervention groups were excluded. Sample/Setting The number and characteristics of patients, attrition rate, etc. No specific setting or sample since the study involved systematic review (clinical setting, i.e. inpatient and outpatient and the emergency department) Systematic review methods with no sample. None since they study involved a systemic review The study was based on systematic review hence no sampling was adopted. Major Variables Studied List and define dependent and independent variables CPOE-Based approach as independent variable and medication ordering as dependent variable CPOE is the independent variable while the mortality rates in the pediatric and neonatal care setting is the dependent variable.
- 6. CPOE is the independent variable while the medication errors amongst hospitalized patients are the dependent variable. The independent variable was the computerized physician order entry (CPOE). The dependent variable was the rates of the chemotherapy-associated medication errors that was impacted on by the CPOE. Measurement Identify primary statistics used to answer clinical questions ( You need to list the actual tests done). Data aggregated into figures and tables. Pooled summary estimates 1 year lag time calculated the citation counts and ratio. The Person correlation of citation counts computed using the AMSTAR scores. The meta-analysis performed using the coefficient interval (CI) and the probability (P) The meta-analysis procedures involve percentages and probability was used. Quality scores used to find out the overall applicability and the effect of studies and to define the eligibility for meta-analysis. Meta-analysis or the random effect model conduced to using R statistical software. Variance estimation or tau-squared performed for the distribution of the true impacts sizes performed using the DerSimonian-Laird estimator. Data Analysis Statistical or Qualitative findings ( You need to enter the actual numbers determined by the statistical tests or qualitative data). AMSTAR scores used to compute Pearson correlation citation counts. Analysis performed using Excel 2016 Percentage, probabilities, and the coefficient interval. Probability and percentages The R-statistical software version 3.6.2 used to perform meta-
- 7. analysis. DerSimonian-Laird estimator. Findings and Recommendations General findings and recommendations of the research CPOE resulted to the significant reduction in the medication errors and the negative effects of the drug events. The recommendation is that future studies need to consider the definition of errors. The future SRs and primary should focused on concerted efforts of building a cumulative evidence on the effectiveness of the CPOE outcomes. CPOE has the ability to offer guidance to physicians. More studies are needed. The interplay that occurs between social and technical aspect is greatly impacting on safe implementation and use. It influences the development of the suitable strategies for the safe and effective CPOE. The recommendation for future research and the new HIT projects is that the organizational leadership must acknowledge the technical abilities along towards implementing safer HIT. The assessment of the sociotechnical factors by use of the eight- dimensional model contributes to safe and effective CPOE implementation. This makes it possible to address the readiness of implementing the CPOE by evaluating the internal culture and development of the policies and procedures that is consistent with the clinical workflow in the presence of change in consideration. There is a consistent decrease in CMEs following the CPOE implementation except for one study that revealed an increase in CME. The recommendation is that the external validity of the studies needs to be gauged since they use different CPOE systems and in diverse settings. Appraisal and Study Quality Describe the general worth of this research to practice.
- 8. 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? The study is important for the capstone project since it shows the impact of CPOE-based medication ordering on safety and the clinical outcomes. The limitation of the study is that the evaluation of the SRs in the overview of SRs was limited by the reporting features of the included SRs. There is also heterogeneity across SRs and which limits the ability to come up with the generalize observations concerning the effectiveness of the CPOE use. Based on this study, CPOE is somehow not directly linked to the drop in the medication errors. The study is important for the capstone project as it confirms the effect of the CPOE in the reduction of mortality rates. The limitation of the study is related to the number of available studies. The study is feasible since CPOE can be implemented to assists in the physician order entry on mortality. The CPOE has the potential to help in the reduction of mortality and improving then prescription process by offering guidance to providers. The implementation of the CPOE helps in the reduction of the medication errors amongst hospitalized clients. There is no mentioning of the limitation and strengths of the study. The feasibility of this study is that it offers solution to addressing the issue of medication errors amongst hospitalized clients. The study is important for the capstone as it reveals how CPOEs impacts on the rates of the chemotherapy associated medication errors. The strength of the study is that studies were taken from different parts of the world thus making it possible to generalize and apply the study. Most of the studies included were single
- 9. center studies. The limitation of the study is all studies used different CPOE systems and in diverse settings. The risk of the study is that there can be improper preparation and the acclimatization this leading to the rise in CME. The feasibility of the study is that CPOE implementation requires multidisciplinary strategy to train and acclimate. Key findings There is no significant relative risk decrease on the hospital mortality or the number of days spent in the facilities. CPOE has the ability to offer guidance to physicians. More studies are needed. The successful identification of the major categories of the CPOE-associated unintended impacts and handling their causes result in the development of the suitable approaches for safer and successful CPOEs. CPOE positively impacts on the chemotherapy-associated medication errors. Outcomes Pooled studies reveal CPOE use leads to the greater reduction in medication errors and the adverse effects of the medication errors. Five cohort studies met the inclusion criteria. Two studies occurred at the pediatric wards and three at PICUs and or NCUS. The analysis reveal a reduction in mortality rate upon implementation of the CPOE. The interplay between the technical and social factors greatly impact on the execution and use. There is a consistent reduction of the CME with implementation of the CPOEs. General Notes/Comments The study is important as it informs about the widespread adoption of CPOEs across world. The overview helps in facilitating evidence-driven decision-making on the future.
- 10. The positive effects of the CPOEs leads to the successful detection and prevention of errors. The CPOEs and tackling the sociotechnical aspect affects the safety of the CPOEs. This is an important approach in improving the effectiveness and safety of CPOEs in the context of the sociotechnical aspects. The adoption and implementation of the CPOE helps in the reduction of CMEs by 81 percent. Part B The best practice that emerged from the research review is the computerized physician order entry (CPOE) system which helps reduce medication errors compared to the paper-based system. According to the results from the systematic review method adopted by the articles, medication errors are preventable. Nevertheless, the lack or poor implementation of the available interventions, such as CPOE, adversely affects the overall outcomes of the patients. The poor implementation practices increase the reported incidences of medication errors (Abraham et al., 2020). Individuals report an extended stay in the hospital as a result of diagnosis with new infections and readmission. Parents of pediatric patients also encounter high medical costs and risk of exposure to preventable nosocomial diseases. The outcomes also impact the providers and organization, leading to low performance in pediatric units. This impacts the hospital's quality performance per the Center of Medicare Services (CME) ranking. The utilization of the CPOE results in reduced medication errors and negative effects of medication errors. The practice leads to a decrease in the reported mortality rates, and the implementation process requires the interplay between the technical and social aspects that positively influence its implementation and use. Implementing the CPOE leads to a
- 11. consistent drop in chemotherapy-associated medication errors. The findings from the study also reveal that the CPOE can ensure that the providers have access to the guidelines regarding medication error reductions. The effective approaches in identifying the major concepts of the CPOE-related unintended effects and addressing their causes lead to developing the appropriate strategies for the safe and successful implementation of the CPOEs (Alanazi, 2020). The use of the CPOE is positively impacting chemotherapy-related medication errors. The study outcomes confirm the importance of CPOE adoption and implementation to reduce the reported cases of medication errors within the pediatric units. Therefore, CPOE- based drug ordering has positive effects in terms of safety and patients. References Abraham, J., Kitsiou, S., Meng, A., Burton, S., Vatani, H., & Kannampallil, T. (2020). Effects of CPOE-based medication ordering on outcomes: an overview of systematic reviews. BMJ Quality & Safety, 29(10), 1-2. Alanazi, A. (2020). The effect of computerized physician order entry on mortality rates in pediatric and neonatal care setting: Meta-analysis. Informatics in Medicine Unlocked, 19, 100308. https://doi.org/10.1016/j.imu.2020.100308 Elshayib, M., & Pawola, L. (2020). Computerized provider order entry–related medication errors among hospitalized patients: An integrative review. Health Informatics Journal, 26(4), 2834-2859. DOI: 10.1177/1460458220941750 Srinivasamurthy, S. K., Ashokkumar, R., Kodidela, S., Howard, S. C., Samer, C. F., & Rao, U.S. C. (2021). A systematic review is the impact of computerized physician order entry (CPOE) on the incidence of chemotherapy-related medication errors. European Journal of Clinical Pharmacology, 1-9.
- 12. https://doi.org/10.1007/s00228-021-03099-9 Critical Appraisal Tool Worksheet Template © 2021 Walden University, LLC 8