Description
Research Proposal Presentation
This week, you will submit an 8- to 10-minute recorded presentation explaining the key components of your research proposal.
A brief introduction, including your research questions and hypothesis
The significance to nursing
An overview of your literature review
A summary of your design and methodology
Include:
Your sample procedures
Your data collection procedures
An overview of your data analysis plan
Ethical considerations
A summary and conclusion of your research proposal
Due Sunday, 11:59 p.m. (Pacific time)
Points Possible: 150
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In Acute Care Settings, How Does the Use of Electronic Health Records Compared to
Paper-Based Systems Impact Medication Documentation Errors and Patient Safety During
the Last Decade?
Research Proposal
Michelle Caballero
Professor Knapp
West Coast University
February 24, 2024
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Table of Contents
SECTION ONE: INTRODUCTION ……………………………………………………………………………………………… 3
Background and Rationale ………………………………………………………………………………………………………… 3
Problem statement……………………………………………………………………………………………………………………. 4
Objectives of the Study …………………………………………………………………………………………………………….. 4
Research Questions ………………………………………………………………………………………………………………….. 5
Hypothesis ……………………………………………………………………………………………………………………………… 5
Null Hypothesis (H0) ……………………………………………………………………………………………………………. 5
Research Hypothesis (H1) …………………………………………………………………………………………………….. 5
Theoretical Framework …………………………………………………………………………………………………………….. 5
Significance of the Study ………………………………………………………………………………………………………….. 6
SECTION TWO: LITERATURE REVIEW …………………………………………………………………………………… 7
Overview of the Existing Research …………………………………………………………………………………………….. 7
Key Concepts and Theories Relevant to the Study ……………………………………………………………………….. 8
Overview of medication documentation errors …………………………………………………………………………. 8
Evolution of Medication Documentation Systems ……………………………………………………………………. 9
Comparative Studies on Medication Documentation Errors……………………………………………………… 10
Impact of Medication Documentation Errors on Patient Safety Outcomes …………………………………. 12
SECTION THREE: DESIGN AND METHODOLOGY ………………………………………………………………… 13
Definition of Variables …………………………………………………………………………………………………………… 13
Dependent variables ……………………………………………………………………………………………………………. 13
Independent variables …………………………………………………………………………………………………………. 13
Research Design…………………………………………………………………………………………………………………….. 14
Data Collection Methods ………………………………………………………………………………………………………… 14
Data Analysis ………………………………………………………………………………………………………………………… 16
Ethical Considerations ……………………………………………………………………………………………………………. 17
Implementation Plan …………………………………………………………………………………………………………… 18
Participants Recruitment ……………………………………………………………………………………………………… 19
REFERENCES …………………………………………………………………………………………………………………………. 20
APPENDICES ………………………………………………………………………………………………………………………….. 24
Participant Consent ………………………………………………………………………………………………………………… 24
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SECTION ONE: INTRODUCTION
Background and Rationale
Medication documentation is an important aspect of healthcare quality since it enhances
record keeping ensuring that patient medication records are kept for further review and use.
Inaccurate medication history can lead to errors in patient medication since lack of records may
prompt healthcare workers to discontinue therapy, recommence medication that has been ceased,
and inappropriate orders leading to medication-related problems. In the acute care setting,
adequate documentation of patient medication is vital since it helps in maintaining patient
treatment records that are vital in ensuring that the patient gets treatment that aligns with their
needs. However, poor medication documentation is one of the major causes of poor patient
treatment outcomes in the acute care setting. Many healthcare organizations including clinics and
hospitals continue to transition from paper-based documentation systems to electronic health
records systems. Nonetheless, this transition has not been prompt since some hospitals find it
difficult to move from the manual system to the electronic system because of the costs associated
with implementing the electronic system and the resistance to change by employees. Conversely,
the transition to an electronic record system has been proven to have many benefits not only to
the patients but also to the healthcare organization.
The electronic health records system creates seamless, legible, comprehensive, and
enduring records of patient medical history and treatment. Although the transition from paperbased systems to EHRs has significant advantages, it has also introduced a new set of challenges
including errors and other unanticipated consequences that can present safety risks to the patient.
However, when considering the patient safety and medication documentation attributed to the
EHRs, it has been established that the transition from paper-based system to EHRs has
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contributed to a decrease in medication documentation errors, improved patient safety, enhanced
adherence to guidelines, and enhanced safety attitudes among nurses and other healthcare
workforce.
Problem statement
In today’s healthcare environment, the impact of medication documentation on patient
safety is a critical aspect that continues to attract research and investigation. Although there is an
extensive adoption of electronic health records systems (EHRs) coupled with other innovative
technologies within the healthcare environment, a potential gap exists in understanding how
these technologies influence communication, accuracy, and collaborative decision-making
among healthcare providers (McCarthy et al., 2019). In this case, it is imperative to address this
potential gap to help detect the challenges, promote the usability of the nursing medication
documentation system, and develop an evidence-based practice that promotes patient safety
within the ever-changing healthcare environment.
Objectives of the Study
The study objectives will include the following:
1. To examine the impact of transitioning from paper-based medication documentation
systems to EHRs on patient safety outcomes and medication documentation errors in
acute care settings.
2. To identify factors contributing to differences in medication documentation errors and
patient safety outcomes between electronic health record (EHR) and paper-based systems
in acute care settings, including technological advancements, workflow changes, and
staff training initiatives, over the last decade.
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Research Questions
In exploring this topic, the following research questions will guide the study:
1. How does the adoption of electronic health records (EHRs) in acute care settings,
compared to paper-based systems, influence the frequency and types of medication
documentation errors over the last decade?
2. What are the observed trends in patient safety outcomes, including medication-related
adverse events, associated with the transition from paper-based systems to electronic
health records (EHRs) in acute care settings during the past ten years?
Hypothesis
Null Hypothesis (H0)
There has been no significant difference in medication documentation errors and patient safety
outcomes between healthcare facilities utilizing EHRs and those using Paper-based systems in
acute care settings over the last decade.
Research Hypothesis (H1)
The use of EHRs compared to paper-based systems, in acute care settings has led to a significant
reduction in nursing documentation errors and improved patient safety outcomes over the last
decade.
Theoretical Framework
The theoretical framework for this study will draw upon the Technology Acceptance
Model (TAM) and the Systems Theory. It is imperative to note that TAM is an important
information system theory that models how users come to accept a technology. The adoption of
EHRs can be examined from the TAM perspective which looks into the behavioral intentions
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that lead people to accept or reject the technology. With TAM we will be able to understand the
underlying perception and insights in regards to the acceptance and adoption of EHRs within the
healthcare environment, evaluating factors including perceived usefulness and ease of use which
influence the adoption of this technology when compared to paper-based systems. The System
Theory on the other hand will provide a robust perspective in viewing healthcare environments
or organizations as complex systems where a change in one component such as the adoption of
an electronic health records system may have a ripple effect throughout the entire system.
Significance of the Study
Medication documentation is a significant practice within the nursing environment
because it promotes and improves quality care and patient safety within hospital settings.
Accurate and comprehensive documentation of patient health information in an electronic format
is vital and ensures a shared understanding of patient health needs and treatment plans (Bjerkan
et al., 2021). Through effective investigation of this topic, the nursing practice can adequately
identify best practices, promote collaboration, and leverage technology within the healthcare
setting to promote safer healthcare practice, thus improving patient health outcomes and
advancing their commitment to optimal healthcare delivery. Evaluation of how EHRs compared
to paper-based systems impact medication documentation errors and patient safety in acute care
settings will help inform the adoption of EHRs within many healthcare settings. As many
healthcare organizations continue to adopt EHRs, challenges regarding the safety net of EHRs,
and unintended consequences such as new vulnerabilities emerge. However, by developing a
robust understanding of how EHRs promote medication documentation and patient safety,
healthcare organizations will be able to understand the benefits of implementing EHRs within
their systems.
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SECTION TWO: LITERATURE REVIEW
Overview of the Existing Research
Nursing medication documentation is records of nursing care that are planned and given
to patients by qualified nurses within the healthcare environment (Bjerkan et al., 2021). This
documentation is used for various purposes within the healthcare environment such as quality
assurance and the improvement of patient care outcomes. It is a critical aspect of healthcare
provision and serves various purposes such as enhancing communication among healthcare
providers, continuity of care, legal and regulatory requirements, and supporting evidence-based
practice. Adequate nursing documentation is vital in ensuring patient safety, quality of care, and
effective communication between interdisciplinary healthcare teams (Bjerkan et al., 2021).
In the current healthcare environment, accurate and comprehensive documentation of
nursing care plays a critical role in ensuring patient safety, promoting quality healthcare delivery,
and meeting the current regulatory standards. Within the context of nursing documentation, the
documentation of patient medication-related information plays a significant role in patient safety
outcomes (Bjerkan et al., 2021). Medication documentation errors such as inaccuracies in
prescription, dispensing, and administration are critical factors that contribute to adverse events
within healthcare settings that include compromised patient safety as well as increased healthcare
costs.
The literature review, in this case, will synthesize existing knowledge on medication
documentation errors with a focus on acute care settings. Specifically, it will provide a
comparison between electronic health record systems and paper-based systems during the last
decade. Through evaluation of the current state of research, existing gaps, and key findings, the
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review will help contribute to the growing body of evidence on nursing documentation practices.
Moreover, by incorporating a comparative analysis, the research will help uncover the unique
challenges posed by each documentation system and their overarching impact on patient safety.
Key Concepts and Theories Relevant to the Study
Overview of medication documentation errors
According to Tsegaye et al. (2020), medication documentation errors are those errors that
occur due to inaccuracies, omissions, or discrepancies in the recording and documentation of the
patient’s medication-related information. Tsegaye et al. (2020) further noted that these errors can
occur at any stage of the medication process from prescription and dispensing to administration
and monitoring. When it comes to nursing documentation, accurate documentation of patient
medication can mean life or death. Improper medication documentation can have a serious
impact on patient treatment outcomes. Tsegaye et al. (2020) also noted various medication
documentation errors such as sloppy handwriting, prescription errors, dispensing errors,
documentation omission, incomplete documentation, and administration errors. Such errors may
impact patient treatment outcomes because failure to document patient medication can result in
the administration of the wrong drug to the patient.
Bjerkan et al. (2021) in their study on patient safety through nursing documentation
argued that high-quality patient medication documentation in acute care settings is vital in
ensuring the continuity of care, quality of care and patient safety. In their analysis, the authors
noted that new technology has created a new set of opportunities for healthcare workers
particularly to improve patient safety. The introduction of EHRs has enabled nurses to improve
documentation structures to promote increased standardization. While nurses are the primary
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point of contact with patients, ensuring proper medication documentation is vital in improving
quality and patient safety spectrum.
In their study on medication administration errors and their contributing factors,
Wondmieneh et al. (2020) noted that there are many contributing factors to medication
administration errors. One of the primary factors is medication documentation errors whereby
nurses fail to document vital patient treatment information such as medication dosage,
medication timeline, wrong drug, and omission of doses (Wondmieneh et al., 2020). The author
further noted that adequate documentation of the patient medication information is critical in
ensuring that there is a flow of the patient treatment journey that facilitates communication
among healthcare workers.
Evolution of Medication Documentation Systems
The evolution of the medication documentation system highlights the transformative
journey of medication documentation from traditional paper methods to modern methods that are
driven by technology (Shafiee et al., 2022). This transformation has been aimed at enhancing the
efficiency and quality of patient care. Shafiee et al. (2022) noted that nursing documentation has
been historically rooted in handwritten notes and manual records and has continued to transition
into electronic health record systems and other more advanced digital platforms. The continued
evolution of the nursing documentation system has been driven by several factors such as
improved accessibility to patient health records, improved communication between
interdisciplinary teams, and the need to comply with the regulatory standards (Shafiee et al.,
2022).
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Initially, patient medication records were handwritten and stored in paper files which
were so unreliable when it came to the provision of comprehensive patient healthcare (Shafiee et
al., 2022). With the advancement in technology, recording, storage, and sharing of patient
medication records have been eased through the development of electronic health record
systems. Electronic health record system offers numerous advantages to nurses such as real-time
data updates, interoperability, and streamlined patient information retrieval which facilitates a
more comprehensive and interconnected approach to patient care (Shafiee et al., 2022). The shift
in nursing documentation thus signifies a promise for increased efficiency and accuracy in
patient medication documentation. Shafiee et al. (2022) further noted that the ongoing evolution
of the nursing documentation system represents a rapid change in the healthcare landscape with
the need to balance the benefits of technology and patient safety and continuity of care.
Rinne et al. (2023) examined approaches for transition to EHRs and noted that
transitioning to EHRs is a complex organizational change that requires adequate planning and
execution. Many healthcare organizations that transition from paper-based record systems have
the potential to realize improved healthcare outcomes for their patients. According to Rinne et al.
(2023), there are several drivers and motivations for transitioning to EHRs. These drivers include
but are not limited to improving patient treatment outcomes, reducing medication documentation
errors, and improving communication between different providers and interdisciplinary
healthcare teams.
Comparative Studies on Medication Documentation Errors
Patient information is an important asset in healthcare delivery and proper documentation
of this information is vital in the delivery of high-quality patient care. In a study conducted by
Abiy et al. (2018), it was noted that quality nursing documentation is a vital aspect of healthcare
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delivery. However, nursing documentation varies depending on the needs of the patient and the
healthcare organization. In their study, Abiy et al. (2018) noted that utilizing EHRs enhances
patient care by providing a more comprehensive and efficient approach to managing and sharing
patient information. The author further noted that EHRs can also minimize medication
documentation errors by improving the accuracy of patient medication records, making health
information more readable, and enabling Interprofessional healthcare teams to share patient
health information more effectively and dynamically.
Ayatollahi et al. (2009) compared paper-based and computer-based medical record
systems and noted that computer-based medication documentation is vital since it helps nurses
avoid duplication of medication records. The author further noted that EHRs help in increasing
the speed of processing patient medication records during emergencies thus facilitating faster and
more streamlined patient care. Ayatollahi et al. (2009) argued that, in acute care settings,
patients’ past medication records are vital in facilitating faster medication. However, a paperbased recording system cannot facilitate faster retrieval and use of past medication records of
patients. However, EHRs improve access to patient medication records including past
medication, notes, diagnosis, and other critical information that can help in improving clinical
decision-making. In their study, Slyngstad and Helgheim (2022) noted that EHRs facilitate better
decision-making within the acute healthcare setting. The authors further noted that EHRs
improve the legibility of writing by healthcare professionals such as physicians. One of the
challenges of paper-based medication documentation is that it is subject to errors in writing
whereby the nurse or the physicians may compose patient information upon diagnosis in
handwritten notes that can be wrongly read or interpreted based on eligible handwriting. In this
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case, EHRs can help minimize such errors thus reducing errors in dispensing of medication drugs
and providing accurate medication.
Impact of Medication Documentation Errors on Patient Safety Outcomes
Medication documentation errors have an adverse impact on patient safety outcomes
within acute care settings. Emmerich (2023) examined some of the impacts that medication
documentation errors have on patient health outcomes. In his study, he highlighted some of the
medication documentation errors that are common within the acute care setting. These errors
included errors of omission, prescription, dispensing, incomplete documentation, and
transcription errors. These errors have an adverse impact on how acute care patients are handled
by nurses. For instance, prescription errors that result from poor documentation can sometimes
lead to wrong prescriptions particularly when acute care nurses have incomplete or wrong
prescription information of the patient (Emmerich, 2023). According to Tsai et al. (2020),
documentation errors that occur through the use of paper-based documentation often result in
errors in interpretation that can further limit effect diagnosis and treatment of patients within the
acute care setting. However, a reduction in medication errors and adverse events not only
improves patient care within the acute care setting but also reduces the cost involved in the
treatment of patients within the acute care setting (Campanella et al., 2016).
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SECTION THREE: DESIGN AND METHODOLOGY
Definition of Variables
This study will incorporate two important variables namely independent and dependent
variables. An independent variable refers to the factors or conditions that are manipulated or
controlled by the researcher (Herdian et al., 2022). On the other hand, the dependent variable is
the outcome or response variable that the researcher expects to change as a result of the
independent variable. The two variables are related by cause and effect, in other words, when the
independent variable changes, then we expect an effect on the dependent variable (Herdian et al.,
2022). In this research proposal, the independent variables are the use of EHRs and paper-based
systems while the dependent variables are nursing documentation errors and patient safety. This
study will therefore explore how the use of EHRs compared to paper-based systems impacts
medication documentation errors and patient safety in acute care settings.
Dependent variables
–
Nursing documentation errors
–
Patient Safety outcomes (adverse drug events, hospital readmission, length of hospital
stay, patient satisfaction scores. These variables will be measured using metrics and
indicators such as reviewing medical records and incident reports, analysis of
administrative data, administration of patient survey, and direct observation of clinical
processes by the healthcare providers.
Independent variables
–
Electronic Health Record System
–
Paper-based System
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Research Design
The research design for this quantitative study utilizing survey interviews will involve a
cross-sectional approach to data collection. This study aims to examine how the use of electronic
health record (EHR) systems compared to paper-based systems in acute care settings has
impacted medication documentation errors and patient safety over the last decade. The target
population for this study will include healthcare professionals working in acute care facilities
that have transitioned from paper-based systems to electronic health record systems within the
last ten years. Sampling will be conducted through a convenience sampling technique to ensure
representation across different acute care settings including hospitals and clinics.
In this study, quantitative data will be collected through a structured survey instrument.
This instrument will be developed in a way that captures relevant quantitative variables that are
related to the subject matter. This will include variables such as frequency of medication errors
before and after EHRs implementation, perceived patient safety outcomes, and time spent on
medication documentation. The survey will also integrate closed-ended questions with Likert
scales, demographic items, and multiple-choice questions. The survey will be completed
electronically or on paper, depending on the participant’s preferences. There will be a
standardized administration of the survey instrument across all study participants as this is vital
in ensuring uniformity in data collection (Cox et al., 2023). To help avoid response
predispositions, clear guidelines will be highlighted in the survey instrument for participants to
read and understand before beginning to complete the survey.
Data Collection Methods
In this study, data will be collected through structured interviews and surveys. These
methods will ensure that there is consistency in data collection across all study participants. The
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two data collection methods are also reliable because they are designed based on established
standards, and research methodologies, and are piloted ensuring they are clear and relevant to the
research objectives. The two data collection methods are also standardized and documented
which ensures there is consistency in data collection. According to Jain (2021), consistency helps
in minimizing variability in data collection approaches. The consistency also ensures that the
study participants are treated equally and in a similar way further ensuring that data quality is
maintained throughout the study. The measurement tool for this study is reliable because before
they are implemented, they are usually pilot-tested with small samples to help identify any
inconsistency or ambiguity thus enhancing its clarity and relevance.
A structured interview questionnaire will be conducted with clinicians focusing on the
impact of EHRs medication documentation errors and patient safety compared to paper-based
systems. The survey interviews will be developed based on the established measures and
theoretical constructs derived from the TAM theoretical model. The survey will integrate items
evaluating the perceptions of clinicians and healthcare professionals on EHRs their experience
with medication documentation errors, and their perception of patient safety.
The determination of the sample size for this study will be based on the principle of
statistical power and practical feasibility. Considering the exploratory nature of this study and the
need to provide sufficient depth and breadth of analysis, a sample size of 300 participants will be
targeted from 30 acute care facilities across California. A sample size of 300 participants is
appropriate for this study because it will enable the study to achieve the depth and breadth of
analysis. Moreover, as a general rule, a sample size of 300 participants is sufficient to provide an
acceptable margin of error (Serdar et al., 2021). The sample size of 300 participants is also large
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enough to support the study’s comprehensive analysis. The sample size is also feasible within the
constraints of this study’s timeline and resources.
To ensure that the study integrates a valid sample, the research study will incorporate
robust inclusion and exclusion criteria that align with the objectives of this study. In this case, the
study participants will have to meet explicit eligibility criteria such as being employed in an
acute care facility that has transitioned from paper-based systems to EHRs within the last ten
years and have a direct involvement in patient safety and medication documentation process.
According to Sullivan (2011), the validity of structured interviews and surveys as measurement
tools is ascertained through a comprehensive review by experts within the field to ensure that
they are appropriate and align with the objectives of the research study.
Data Analysis
In this study, two important data analysis techniques will be employed. These techniques
will include inferential and correlation analysis. The inferential analysis will be conducted to
help in testing the two hypotheses to help evaluate any perceived or observed differences in
nursing documentation errors and patient safety outcomes between paper-based systems and
EHRs. The inferential analysis will help determine whether the observed differences are
statistically significant (Bzdok & Ioannidis, 2019). The inferential analysis will be conducted
using a t-test to study whether there is any statistical difference between the two groups. The
study will also employ the use of correlational analysis to help understand the relationship
between the underlying variables. For instance, the Pearson correlation coefficient will be used
to determine the correlation between EHRs and nursing documentation or patient safety or the
correlation between paper-based systems and nursing documentation errors. The two types of
analysis will be the most appropriate for this research because they will help determine any
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significant differences between the null and research hypothesis and the correlation between the
study variables (Bzdok & Ioannidis, 2019). A part from aiding in examining the relationship
between the variables, inferential and correlation data analysis techniques are also appropriate
for this study because the study involves quantitative data that will be collected through survey
interview questionnaire. In this case, the inferential and correlation analysis will help integrate
statistical tests in testing the hypothesis; quantify the relationship between the underlying
variables, and derive appropriate and meaningful conclusion from the data.
For the inferential analysis, the significance level will be set at α = 0.05 which is the most
widely used significance level in quantitative research. The significance level of 0.05 indicates
that in the study, there is a 5% chance of incorrectly rejecting the null hypothesis, leading to a
Type 1 error. In this case, when we obtain a p-value of less than 0.05 from our statistical test,
then the result will be considered to be statistically significant and therefore we reject the null
hypothesis. The same will be the case for correlation analysis in which we will consider the
correlation between the variables to be statistically significant if the p-value of the correlation
coefficient is less than 0.05.
Ethical Considerations
An IRB approval will be obtained for the research procedure, participant recruitment, and
interview questions before data collection as a requirement for research involving human
subjects. The participants will be recruited from hospitals and clinics within California, United
States. The recruitment will be conducted through an online survey interview questionnaire to
facilitate convenience. Ethical considerations for this study will prioritize and uphold the
protection of participants’ informed consent, confidentiality, and adherence to legal and
professional standards. Informed consent will be obtained from all the study participants.
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Implementation Plan
Ethics is an important consideration especially when conducting research that deals with
human subjects. In this case, this study will adhere to high standards of ethical consideration. To
ensure that this research is conducted ethically, various measures will be implemented. First, the
study will ensure there is high respect for the potential and enrolled participants (Vanclay et al.,
2013). All individual participants will be treated with respect throughout their participation and
after they participate in the study. This will include respecting their privacy and ensuring there is
high confidentiality when it comes to their p
