Description
While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone project change proposal, the literature review enables students to map out and move into the active planning and development stages of the project.
A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the PICOT question from the earlier “PICOT Question” template and information from the “Literature Evaluation Table” assignment to develop a review.
Using eight peer-reviewed articles, write 750-1,000-word review that includes the following sections:
Introduction section (including PICOT Question)
A summary of the purpose of the studies
A comparison of sample populations
A synthesis of the studies’ conclusions (when looking at all of the studies together, group the conclusions by themes )
A summary of the limitations of the studies
A conclusion section, incorporating recommendations for further research
You are required to cite a minimum of eight peer-reviewed articles to complete this assignment. Sources must be published within the past 5 years, appropriate for the assignment criteria, and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
Unformatted Attachment Preview
PICOT Question
Student Name:
Faculty Name:
PICO(T) Question: Use the PICOT question developed in Topic 3 Discussion Question 1 and refine it as needed based on feedback
received.
Medication Errors in Long Term Facilities such as Rehabilitation/ Nursing homes
PICO(T) Question Template
P
Population
Long-term care facility residents such as residents of rehabilitation/nursing homes for
instance elderly residents, who are vulnerable to medication errors.
I
Intervention
C
Comparison
Medication reconciliation process as a nursing practice intervention.
Medication reconciliation and current medication management practices in long-term
facilities comparison.
© 2023. Grand Canyon University. All Rights Reserved.
O
Outcome
Decreasing of the medication errors and adverse drug events in the long-term facilities
patients.
T
Timeline
Implementation of the medication reconciliation process within 6 months, and evaluation of
the outcomes after 1 year.
PICOT Question
In long-term facility residents such as rehabilitation and/or nursing home patients who are at a high risk for medication errors or
problems, what is the relationship between the medication reconciliation process (I) and current medication practices in long-term
facilities (C) in terms of reducing medication errors and adverse drug events (O) over a period of 1 year (T)?
Problem Statement
Medication errors in long-term facilities, such as rehabilitation/nursing homes, are a huge risk to the patient’s safety and welfare.
Such errors can lead to adverse drug events, hospitalizations, and even death. At present, medication management practices in most
of these facilities might not be sufficient for reducing and/or preventing medication errors. An evidence-based nursing intervention
is important to implement to efficiently solve this problem and ensure safe medication delivery (Rusli et al., 2023). The issue of
medication errors in long term care requires to be dealt with for the safety and security of the people vulnerable.
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Population
Subjects of interest comprise long-term facility residents including rehab/nursing home residents who are at risk of medication
errors. For these kinds of patients they are usually elderly ones, suffer from multiple chronic diseases, and have functional and
cognitive weaknesses that increase the risk of medicine error or problems.
Nursing Intervention
The offered nursing intervention is the initiation of a medication reconciliation process. Medication reconciliation comprises of
comparing the current medication orders of a patient with all the medications he/she has been taking and identifying any
discrepancies for their resolution (Syyrilä, Vehviläinen & Härkänen, 2021). It is implemented to guarantee precise medication
orders, avoid medication mistakes, and enhance the safety level of patients.
Comparison
The medication management practices in long-term institutions frequently occur with minimal or inconsistent medication
reconciliation processes, which in turn increases the chances of medication errors. The nursing intervention of implementing a
formal medication reconciliation process enables a more systemic and holistic approach to medication management, which thereby
decreases the likelihood of medication error.
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Outcome
The anticipated outcome of the medication reconciliation process implementation is a decrease in medication errors and adverse
drug events among long-term care facility residents. Performing medication reconciliation and resolving any discrepancies leads to
an improved medication administration process which ultimately leads to reduction of the risk to the patients from possible harm
(Rungvivatjarus et al., 2020). The goal of this intervention is to enhance patient safety and avoid adverse drug reactions which will
have positive outcomes for long-term care residents.
Time Frame
The execution of the proposed solution which includes the implementation of the medication reconciliation process will be
performed within a period of 6 months. The allotted period enables for the required planning, training, and implementation of the
new process. After implementation, the effectiveness of the intervention in preventing medication errors and adverse drug events
will be evaluated within a period of one year. The timeframe gives adequate time to collect and examine data to evaluate the effects
of the intervention and make any necessary modifications for improvement.
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References
Rungvivatjarus, T., Kuelbs, C. L., Miller, L., Perham, J., Sanderson, K., Billman, G., … & Fisher, E. S. (2020). Medication
reconciliation improvement utilizing process redesign and clinical decision support. The Joint Commission Journal on Quality
and Patient Safety, 46(1), 27-36.
Rusli, K. D. B., Tan, A. J. Q., Ong, S. F., Speed, S., Lau, Y., & Liaw, S. Y. (2023). Home‐based nursing care competencies: A
scoping review. Journal of Clinical Nursing, 32(9-10), 1723-1737. https://doi.org/10.1111/jocn.16169
Syyrilä, T., Vehviläinen-Julkunen, K., & Härkänen, M. (2021). Healthcare professionals’ perceptions on medication communication
challenges and solutions–text mining and manual content analysis-cross-sectional study. BMC Health Services Research, 21,
1-19. https://doi.org/10.1186/s12913-021-07227-0
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Literature Evaluation Table
Student Name:
Faculty Name:
Finalized PICOT Question: In long term care facilities (P) how does the application of medication error prevention strategies (I)
compared to no strategies (C) improve nurse awareness, knowledge levels, and behaviors during medication preparation and
administration (O) in a three month period (T)?
Literature Search Strategy Employed: Article search was conducted in four main databases: PubMed, Medline, Cochrane, and
Scopus. These databases were selected based on the fact that they contain scholarly articles on health and medical-related subjects.
The search process made use of different keywords, including medication reconciliation, medication errors, long-term facilities,
elderly patients, and medication error prevention. Boolean operators were used to combine the variables and achieve more refined
results.
Criteria
APA Reference
All peer-reviewed journal articles
should be current (published
Article 1
Article 2
Article 3
Kuppadakkath, S. C.,
Koprivnik, S., Albiñana- Liou, W. S., Huang, S.
Bhowmik, J., Olasoji,
Pérez, M. S., LópezM., Lee, W. H., Chang,
M., & Garvey, L.
Sandomingo, L.,
Y. L., & Wu, M. F.
© 2023. Grand Canyon University. All Rights Reserved.
Article 4
Uhlenhopp, D. J.,
Aguilar, O., Dai, D.,
Ghosh, A., Shaw, M., &
Criteria
Article 1
within the last five years) and
closely related to the PICOT
question developed earlier in this
course. Include the GCU
permalink, or working link used
to access the article.
(2023). Nurses’
perspectives on
medication errors and
prevention strategies in
residential aged care
facilities through a
national
survey. International
Journal of Older People
Nursing, 18(6), e12567.
https://onlinelibrary.wil
ey.com/doi/10.1111/opn
.12567
Purpose/Aim of Study
Research questions
(Qualitative)/Hypothesis
(Quantitative)
Article 2
Taboada-López, R. J., &
Rodríguez-Penín, I.
(2020). Improving
patient safety through a
pharmacist-led
medication reconciliation
program in nursing
homes for the elderly in
Spain. International
journal of clinical
pharmacy, 42(2), 805812.
https://doi.org/10.1007/s1
1096-020-00968-8
To study factors that
To identify and classify
contribute to medication medication errors during
errors and prevention
transition care in a
strategies based on
nursing home
nurse perceptions
What strategies can be
used to reduce
medication errors
among older persons
living in residential care
facilities?
Were there significant
reconciliation errors
during transition care in
elderly nursing homes?
2
Article 3
Article 4
(2021). The effects of a
pharmacist-led
medication review in a
nursing home: A
randomized controlled
trial. Medicine, 100(48).
https://www.ncbi.nlm.ni
h.gov/pmc/articles/PMC
9191564/
Mitra, C. (2020).
Hospital-wide
medication reconciliation
program: error
identification, costeffectiveness, and
detecting high-risk
individuals on
admission. Integrated
Pharmacy Research and
Practice, 195-203.
https://www.ncbi.nlm.nih
.gov/pmc/articles/PMC75
68630/
To determine the effect
of a medical
reconciliation program
on error identification
The aim of the study
was to undertake an
intensive review of
pharmaceutical care for
elderly patients in
Taiwan.
Are there differences in
medication
reconciliation between
the intervention and
control groups
What are the factors that
increase the likelihood of
occurrence of a
medication discrepancy?
Criteria
Article 1
Design
Type of quantitative or type of
qualitative study design
Setting
Where did the study take place?
What type of setting – inpatient,
outpatient, etc.?
Sample
Number and characteristics of
participants
Quantitative –
descriptive design
Methods
Interventions/Instruments
Registered nurses
participated in a survey
to examine their
opinions on causative
factors for medication
errors and possible
interventions.
Analysis
How were the data that were
collected analyzed?
Exploratory factor
analysis is used to
examine the most
relevant causes of
medication errors based
on participant responses
Selected residential care
facilities for elderly
persons in Australia
140 registered nurses
working in aged care
residential facilities
Article 2
Article 3
Article 4
Quantitative Longitudinal study
design
Five elderly nursing
homes in the Ferrol area
in Spain
Randomized control
trial design
Quantitative –
Descriptive
Long-term care facility
in Taiwan, China
Tertiary care hospital in
the US
2123 Transitions were
examined involving 981
patients from the five
nursing homes
Medical reconciliation
was undertaken by
examining the medical
history of patients over a
period of time.
80 patients aged above
65; intervention group
(42) and control group
(38)
Participants were
randomly divided into
control and intervention
groups, where the
potential for
inappropriate
medication was
examined against the
number of drugs
prescribed.
ANOVA analysis was
used to study differences
between the two groups
in terms of the potential
for inappropriate
medications
817 participants with a
median age of 60.4 years
Analysis was conducted
in two steps: Descriptive
statistics involving mean,
median, and frequencies
and Chi-square analysis
testing association
between transition type
and reconciliation errors.
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The study involved
pharmacy technicians
examining medication
histories to determine the
effectiveness of error
medication
reconciliation.
Logistics regression was
undertaken to determine
possible associations
between the occurrence
of medication error and
patient characteristics.
Criteria
Article 1
Article 2
Article 3
Article 4
Outcomes/key findings of the
study and implications for nursing
practice (Summary of study
results)
Recommended
strategies for reducing
medication errors
include medication
safety alerts, medication
process improvement,
and effective reporting.
Reconciliation errors
were found in 30% of
patients, which is an
indication of the harm
that patients in the long
term are exposed to
The potential of
inappropriate
medication was 74.3%
and was higher among
the intervention group.
This shows the need for
undertaking
reconciliation for the
drugs.
I recommend the
researcher to adopt the
article
The study applies an
RCT design to show
how pharmaceutical
care may result in
medication errors,
making it appropriate
for the study.
The likelihood of
medication errors was at
50% and was affected by,
among others, age,
gender, and risk alert/risk
medication.
Recommendations of the
Researcher
I recommend the
researcher to adopt the
article
Explain how this article
The study is in the
supports your proposed
context of medication
PICO(T) question and Capstone error prevention
Change Project.
strategies, making it for
answering the PICOT
question.
I recommend the
researcher to adopt the
article
The study is specific to
medications in long-term
care in elderly care
homes and, therefore, is
appropriate for the study.
I recommend the
researcher to adopt the
article
The article examined the
effectiveness of a
medical reconciliation
program, making it
appropriate for answering
the PICOT question.
Criteria
Article 5
Article 6
Article 7
Article 8
APA Reference
(include the GCU permalink or
working link used to access the
article)
Koprivnik, S.,
Albiñana-Pérez, M. S.,
López-Sandomingo, L.,
Taboada-López, R. J.,
& Rodríguez-Penín, I.
(2020). Improving
patient safety through a
Ceschi, A., Noseda, R.,
Pironi, M., Lazzeri, N.,
Eberhardt-Gianella, O.,
Imelli, S., … & Ferrari, P.
(2021). Effect of
medication reconciliation
at hospital admission on
Holland, R., Bond, C.,
Alldred, D. P., Arthur,
A., Barton, G., Birt, L.,
… & Wright, D. (2023).
Evaluation of
effectiveness and safety
of pharmacist
Baughman, A. W.,
Triantafylidis, L. K.,
O’Neil, N., Norstrom, J.,
Okpara, K., Ruopp, M.
D., … & Simon, S. R.
(2021). Improving
medication reconciliation
4
Criteria
Purpose/Aim of Study
Research questions
(Qualitative)/Hypothesis
(Quantitative)
Design
Type of quantitative or type of
qualitative study design
Setting
Article 5
Article 6
Article 7
Article 8
pharmacist-led
medication
reconciliation program
in nursing homes for the
elderly in
Spain. International
journal of clinical
pharmacy, 42(2), 805812.
https://doi.org/10.1007/s
11096-020-00968-8
30-day returns to
hospital: a randomized
clinical trial. JAMA
Network Open, 4(9),
e2124672-e2124672.
https://jamanetwork.com/
journals/jamanetworkope
n/fullarticle/2784184
independent prescribers
in care homes: a cluster
randomized controlled
trial. BMJ, 380.
https://doi.org/10.1136/
bmj-2022-071883
with comprehensive
evaluation at a Veterans
Affairs skilled nursing
facility. The Joint
Commission Journal on
Quality and Patient
Safety, 47(10), 646-653.
https://doi.org/10.1016/j.j
cjq.2021.06.001
To quantify and classify
medication
reconciliation errors
taking place during the
transition of care
between nursing homes
and health outcomes.
What is the relationship
between error frequency
and transition type?
To assess the impact of
medication reconciliation
at hospital admission on
patient-centered health
care outcomes.
To investigate the
effectiveness, safety,
and cost-effectiveness of
pharmacy-independent
prescribers in care
homes.
To evaluate the quality
improvement approach to
improve medical
reconciliation in a skilled
nursing facility
In what ways does
medication reconciliation
result in improved patient
outcomes?
What is the
effectiveness and safety
of independent
prescribers in care
homes?
Quantitative – RCT study Clustered randomized
control design
What are the quality
improvement approaches
to improve medical
reconciliation in a skilled
nursing facility?
Exploratory
Two teaching hospitals in Care homes across
Southern Switzerland
England, Northern
Ireland
Department of US
Veteran Affairs
Quasi-experimental
Five elderly nursing
homes in Ferrol (Spain)
5
Criteria
Where did the study take place?
What type of setting – inpatient,
outpatient, etc.?
Sample
Number and characteristics of
participants
Article 5
2123 elderly patients
Article 6
Article 7
Article 8
Forty-nine triads and
882 residents where the
treatment group had an
independent pharmacist.
Randomization
112-bed department of
US veterans Affairs
Quantitative analysis
Qualitative analysis
There was a fall rate per
person at every six
months for prognostic
variables. There was an
improvement in the
quality of life for
hospitalized admissions.
There was a fall in risk
ratio for the intervention
group as compared to
the control group.
I recommend the
researcher to adopt the
article
Baseline assessments
indicated that medication
reconciliations are errorprone, resulting in
medication discrepancies.
Methods
Interventions/Instruments
Prospective Descriptive
study
Analysis
How were the data that were
collected analyzed?
Quantitative data
analysis
Outcomes/key findings of the
study and implications for nursing
practice (Summary of study
results)
Reconciliation errors
were found in almost
30% of patients.
1702 patients aged 85
years or older were
prescribed to more than
ten medications
Study participants were
randomized with an
intervention group
receiving medical
reconciliation.
Time-to-event analysis
and analysis of means
were conducted to
compare the two groups
Medication reconciliation
affected post-discharge
outcomes for patients
Recommendations of the
Researcher
I recommend the
researcher to adopt the
article
I recommend the
researcher to adopt the
article
6
Survey
I recommend the
researcher to adopt the
article
Criteria
Article 5
Article 6
Article 7
Article 8
Explain how this article
supports your proposed
PICO(T) question and Capstone
Change Project.
The findings of the
study indicate the
importance of
reconciliations to
medical errors,
signposting the value of
including a pharmacist
during transition to help
minimize medication
errors.
The article contains clear
information on the
effects of medication
reconciliation, making it
appropriate for answering
the PICOT question.
Intervening with
medical prognosis with
a pharmacist is likely to
reduce admission rates
due to a reduction in
medical errors.
The study demonstrates
the importance of
specialized nursing
professionals in
mitigating unintentional
medical errors that pose
potential risks to patient
safety.
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