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Errors In Medication Process: Frequency, Type, And Potential

“Errors in the Medication Process: Frequency, Type, and Potential” article is written by Marianne Lisby, Lars Peter Nielsen and Jan Mainz published in International Journal for Quality in Health Care (IJQHC) Vol. 17 No. 1 in the year 2005 through Oxford University Press. IJQHC is an international peer-reviewed scholarly journal addressing research, policy, and implementation related to the quality of health care and its outcomes. Issued every two months and includes contributions from representatives of all health professionals such as doctors, nurses, quality assurance professionals, managers, politicians, social workers, therapists, and researchers. It is clinical focus on the quality and safety of care for populations and patients worldwide. Target audience includes researchers, bedside clinicians, quality representatives, administrators, policymakers, educators, as well as students. This article was published in the year first quarter of 2005 however was accepted for publication in the in third quarter of 2004.

This paper is studied in detail, examining its title, abstract, methods, results, discussion, and its relevance to clinical practice in nursing.

BACKGROUND

The topic of the article is interesting, catching the attention of the reader. Authors have clearly defined the topic and is according to the phenomenon of the study and it is clearly giving the direction and vision of article. The topic of the article discusses the problem, but doesn’t highlight anything about the setting and population of the study. According to Polit and Beck (2006), “The research topic should suggest the research problem and the study of population” (p.68), In the title it is said errors in the medication process, which stage of the process is not highlighted and therefore it may happen that the indented audience of this article would not be attracted and did not get readers attention.

According to Burns & Grove (1999) “Abstract range from 100 to 250 words and usually includes the study purpose, design, setting, sample size, major results and conclusion.” ( p.47). In this article the abstract contains approximately 268 words as authors have developed clear and concise that conveys the critical information about their study and abstract clearly states the objective, study design, setting, sample size, method, finding, and conclusion. An interesting feature of the abstract was the main outcome measure which defines the overall intent of the study and its impact.

The problem statement is clearly define in the beginning of the article and it does mention about the magnitude of the medication error in hospital however the size of the hospital is not focused by the author because the more the admission the extended is the problem of medication error which is obviously highlighted by the authors in the following sentence. According to Burns & Grove (1999) “A research problem is a situation in need of solution, improvement, or alteration or a discrepancy between the way things are and the way things ought to be" (p 66). The significance of the problem and the need of the study is defined in the introduction part of the article on pg 15. The problem is researchable and the data can be analyzed but it might be difficult for the researcher to keep the reliability of the study because of too many variables. The problem is significant to nursing, as nurses are responsible for the patient care and the medication administration. The information on the problem is clearly mentioned but the heading of the introduction is not mention in the article. Perhaps the authors only talks about errors in medication process in general terms and it seems that researcher interest was not in define the route; maybe they wanted to keep it simple for this study. Only a little information is documented by the author and haven not provided the background although they have well supported their idea of investigation with literature.

There is no separate portion of literature review. The researcher has given very brief, concise and logical literature review throughout the article. According to Burns & Grove (1999) “The literature is reviewed to summarize knowledge for use in practice or to provide a basis for conducting a study” (p.104). All the studies are form different researches and are in different settings. The writer has referred almost thirty articles and makes the most of it. All the research material presented in this article was ranging from 1953-2002 and the recent articles were not taken into account. . The documentation of all the sources are complete, clear, very well paraphrased. All the sources in citation were in footnote numbers. The relationship of the problem to previous research is clear. The writer has given varying rage of opinions but the scope of the articles is limited to one direction.

In this article the purpose statement of the study is definitely mentioned at the end of the introductory comment that they wanted to perform a systemic, valid and detailed investigation of frequency, type and potential clinical consequences of medication error inn more stages including discharge summaries. It would be better if the authors would have defined stages too and not just written “more stages”.

The objective and the purpose of the study were similar with one another complementing the relationship making very clear for the reader and avoiding confusion. According to Polit & Beck (2003) “A statement of purpose identifies the key study variables and their possible interrelationships, as well as the nature of the population of interest” (p.74). The researcher has mentioned that the study was conducted in medical and surgical wards of the Arhus University Hospital, Denmark but the size of the hospital was not defined. The data was collected from the January to April 2003. Author has not comprehensively defined the inclusive and exclusive criteria of the participants except for the age limit under the sub heading of the method. The researcher has given the main outcome measure in the abstract clearly defining the relationship between two variables; total error detected with the opportunities for error. Well it was under the heading of hypothesis however total errors detected was an independent variable and opportunities for error was a dependent variable. According to Polit & Beck ( 2003 ) “Hypothesis is the prediction about the relationship between two or more variables” (p.77).In this article author has given definition of medication error, adverse drug events and has separated adverse drug reaction as an exclusion criteria for this study.

DESIGN

The design authors used was cross sectional study using three methods to detect errors which is from direct observation, unannounced control visit and documentation reviews. Burns & Grove (1999) stated that “a research design is a blue print for conducting a study that maximizes control over factors that could interfere with the validity of the findings” (p.185). In this triangulation method data

The study participants were clearly mentioned in the abstract under the heading of study participants that eligible in hospital patients 18 or over, physicians prescribing drugs and nurses dispensing and administering drugs. The writer has not clearly mentioned about the inclusion and exclusion criteria of the study participants under the heading of methods which makes the reader confuse Polit & Beck (2003) stated that “sampling is the process of selecting a portion of the population to represent the entire population…a sample, then, is a subset of population elements” (p.291). The sample size is small 14 men and 13 women in medical ward and 16 men and 21 women in surgical ward. .The sampling method was not mentioned clearly by the researcher but it seems that is convenient non probability sampling because it is evident by the selection of sample from the teaching/ non teaching hospital of the Denmark and it could be purposive sampling because the researcher might know that he would get the certain number of admitted patients.

Cross sectional studies (add reference )

The authors used American Society of Health System Pharmacists (ASHP) criteria for classifying medication errors with slight modification in order to avoid overlap of error types and frequencies when separating the dispensing and administration. They did not mention any purpose, content, strengths, and weakness of the instrument including the validity and rational for choosing instrument. The reliability and validity of the instrument is not discussed by the researcher.

The data collection procedure of the study is thoroughly mentioned in the article. Step by step procedure was defined for the collection of data For e.g. they have mentioned that how do they approach to the participants, how much time required for the data collection procedure, listing of all dispensed and administrated drugs to compare it with prescription in the documentation profile, observation of drugs given to participants as their regular dose, unannounced control visit was made seven weeks after the observation and chart reviews were done for all patients. But on the other side author has mentioned the approval from the local ethics committee. The study is replicable but after the modification and improving a weak points According to Polit & Beck (2003), “Replications are attempts to validate the findings from one study in an independent inquiry” (p.41). Limitations of the study and assumption of the study is not clearly mentioned in the article. Burns & Grove (1999) shared that “Data analysis is conducted to reduce, organize, and give meaning to the data” (p.43). The choice of the statical data was appropriate as the researcher used SPSS 11.0 and NCSS 2000.authors have analyzed Frequencies in percentages and the descriptive data as mean or median. Fisher’s exact test was used to compare frequencies between the medical and surgical wards. Data were compared using the t-test while non-parametric data were compared using the Mann–Whitney non-parametric test. Friedman’s two-way ANOVA was used in order to compare physicians’ and pharmacists’ assessment of the clinical consequences. Statistical significance was defined at a level of 0.05 and data were described with a confidence interval of 95%. . Researcher has used the continues variable and also take out the mean, median and standard deviation in frequency table .there are four tables in the article all are clear and relevant .It would be more easy for researcher if he has explain finding in the form of graphs like bar or pie to define the relationship of findings and variable .

According to Burns & Grove (1999) “Generalization is the extension of the implication of the research findings from the sample to a larger population” (p.39) Generalizability of the study is warranted because of detailed result interpretation and also this is applicable to all stages of medication process. Under the heading of discussion author has mentioned the comparison of previous studies with their study which is easy for the reader to understand it . There is a separate heading for the conclusion it is mentioned clearly in the second last paragraph of the discussion and it is based on the data and it also summarize..

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