Reducing Medication Errors in the Surgical Unit

Reducing Medication Errors in the Surgical Unit

Abstract
The problem that has been identified in the current facility, and that this Capstone project seeks to address, is rapid rise in drug reactions among hospitalized
patients in the surgical unit. These drug reactions occur as a result of medication errors. It has been discovered that nurses in the surgical unit administer drugs
incorrectly and increasingly make wrong infusions. In a span of four weeks, medication errors in the surgical unit have increased by 7 percent from 1 percent in
the last quarter. The problem of rising medication errors in the surgical unit is of great concern to nursing practice because it impacts negatively on patients’
outcomes. Information that has been obtained following a thorough investigation over the issue is that nurses in the surgical unit frequently make medication
errors because they have limited pharmacological knowledge. The most appropriate evidence-based practice change which can help to solve the problem of
medication errors is implementation of a staff training program. The effectiveness of a staff training program in increasing nurses’ pharmacological knowledge
and in reducing medication errors is a matter that is supported by a large volume of research evidence. Clear steps have been followed to facilitate successful
implementation of the evidence-based practice change in the surgical unit. Furthermore, members of trans-professional teams have been involved in the
implementation of the staff training program with the aim of reducing rates of medication errors. Additionally, appropriate measures have been taken to ensure
continued success of the project. Generally, this Capstone project has allowed for integration of two major MSN program outcomes.

Acknowledgements

Table of Contents
Abstract……………………………………………………………………………………..2
Acknowledgements…………………………………………………………………………3
List of Tables……………………………………………………………………………….6
Chapter 1: Introduction…………………………………………………………………….. 7
Problem Statement……………………………………………………………………… 7
Problem Background…………………………………………………………………….8
Description of the Practice Change, Quality Improvement, or Innovation……………..10
Rationale for the Practice Change, Quality Improvement, or Innovation……………….11
Chapter 2: Review of the Literature…………………………………………………………13
Credible Sources…………………………………………………………………………13
Best Practices Identification……………………………………………………………..13
Evidence Summary………………………………………………………………………15
Recommended Practice Change, Quality Improvement, or Innovation…………………..18
Chapter 3: Implementation…………………………………………………………………..20
Capstone Project Steps……………………………………………………………………20
Changes to original implementation plan………………………………………………22
Barriers associated with implementation………………………………………………22
Overcoming barriers……………………………………………………………………23
Transprofessional Relationships………………………………………………………….23
How relationships facilitated implementation………………………………………..24
Chapter 4: Post Capstone Project Considerations……………………………………………25
Capstone Successes……………………………………………………………………….25
Successful aspects…………………………………………………………………….25
Impact on future projects…………………………………………………………….25
Capstone Challenges…………………………………………………………………….26
Aspects that did not go well…………………………………………………………..26
Impact on future projects……………………………………………………………..26
Evidence and Current Practice…………………………………………………………..26

Post-Implementation……………………………………………………………………..27
Resources Required for Post-Implementation Support…………………………………..29
Chapter 5: Reflection…………………………………………………………………………30
Integration of MSN Program Outcomes………………………………………………….30
References……………………………………………………………………………………32
Appendix A: Credible Sources……………………………………………………………….38
Appendix B: Organization Approval Letter………………………………………………….46
Appendix C: Preceptor Agreement……………………………………………………………47
List of Tables

Table 1: Capstone Project Steps

Chapter 1: Introduction

The specific problem that this project will address is the rapid rise in drug reactions in the surgical unit as a result of medication errors. It has been
discovered that medication errors in the surgical unit are on the rise in the surgical unit over the past one month due to limited pharmacological knowledge
among nurses. The proposed practice change that can help to solve the problem is implementation of a staff training program in the surgical unit. The main
rationale for the practice change is that, it will increase nurses’ pharmacological knowledge, thereby reducing rates of medication errors in the unit. It is
believed that implementing a staff training program in the surgical unit will help nurses to administer correct drug doses and infusions, and this will ultimately
improve patient outcomes, reduce mortality rates, and minimize organizational financial losses.
Problem Statement
There has been a significant rise in rates of medication errors in the surgical unit of the current organization in the past two months, and this has
contributed to the rise in drug reaction cases in the unit. This problem is of great concern to nursing practice because nurses are charged with the responsibility
of administering drugs to patients, and they should therefore be held responsible for the high rates of medication errors in the unit. In a span of four weeks,
medication errors in the surgical unit have increased by 7 percent from 1 percent in the last quarter. The surgical unit of the current facility has a capacity of 45
beds. Surprisingly, various forms of medication errors have been recorded in more than 50 percent of patients admitted in the unit over the past two months.
Following close investigation, it is has been discovered that a large percentage of medication errors in the surgical unit involve administration of incorrect drug
dosages and wrong infusion of medicines.
The problem of medication errors in the current facility has negative impacts on patients as well as on the organization. With regards to patients,
medication errors always result into increased disease complications which impact negatively on patient outcomes. As the health of patients continues to
deteriorate, they are compelled to stay in the hospital longer than expected, and this makes them to pay huge medical bills at the time of discharge (Silva and
Krishnamurthy, 2016). With respect to the organization, medication errors make the facility to incur huge financial losses because it must budget for the wasted
drugs. Moreover, medication errors are directly associated with high patient mortality rates, and this tends to affect the organization’s reputation (Samp,
Touchette, Marinac, and Kuo, 2014). These negative impacts of medication errors call for the need to implement a practice change in the facility with an
immediate effect. In order to effectively solve the problem, the organization must select a practice change whose effectiveness is supported by research-based
evidence (Low, Fletcher, Goodenough, Jeon, Etherton-Beer, MacAndrew, and Beattie, 2015).
Problem Background
The problem of medication errors has not been identified in the facility for the first time, but it has lasted for more than two weeks. Many cases of
medication errors in the facility occur during drug administration. According to Silva and Krishnamurthy (2016), a large percentage of medication errors have
been reported to occur at the time when the healthcare provider is interacting directly with the patient in the course of care. The main points of interaction
between the healthcare provider and the patient, and in which medication errors can occur include prescription phase, dispensation phase, administration phase,
and at the time of follow-up after the patient has been discharged from the hospital (Silva and Krishnamurthy, 2016). Prescription and dispensation of drugs in
the facility are normally done by the physician and the pharmacist respectively. However, the nurse plays the role of administering drugs to patients as directed
by the physician. According to Elden & Ismail (2015), approximately 21 percent of medication errors occur during drug administration stage. This is because
nurses may either give incorrect drug dosages or wrong infusions due to their limited pharmacological knowledge (Cheragi, Manoocheri, Mohammadnejad,
and Ehsani, 2013). Nurses with inadequate pharmacological knowledge are highly likely to make medication errors because they cannot make the right
judgment in relation to drug dose calculations and possibilities of drug interactions (Cheragi et al., 2013).
As Simonsen, Daehlin, Johansson, and Farup, (2014), explain, “nurses experience insufficient medication knowledge; not only in drug dose
calculations, but also in drug management and pharmacology. The weak knowledge could be a result of deficiencies in the basic nursing education, or lack of

continuing maintenance training during working years (p. 580).” Based on this statement, it can be concluded that there is a close link between medication
errors made by nurses and nursing education as well as on-the-job training. In another study aimed at finding the causes of medication errors in hospitals,
Ehsani, Cheraghi, Nejati, Salari, Esmaeilpoor, and Nejad, (2013), have discovered that, “the most important causes of medication errors are shortage of nurses
(47.6%), and lack of sufficient pharmacological information (30.9%) (p. 11).” In order to reduce medication errors in healthcare settings, Cheragi et al. (2013)
recommend “increasing pharmacological knowledge of nurses as a strategy to reduce serious medication errors. Therefore, nurses are required to update their
knowledge about medicines, especially new drugs (p. 231).” Tshiamo, Kgositau, Ntsayagae, and Sabone, (2015) assert that, “educators can also provide
leadership in the improvement of conditions that pose a risk for medication errors in the clinical settings as well as in researching medication errors (p. 23).”
Description of the Practice Change, Quality Improvement, or Innovation
The best practice change that would solve the problem of medication errors in the current facility is that which will increase nurses’ pharmacological
knowledge. Increasing pharmacological knowledge of the nurses will be achieved by implementing a nurse training program, specifically for nurses in the
surgical unit. A nurse educator plays a very significant role in promoting nursing knowledge, and the best way through which this can be achieved is by
identifying the most appropriate staff development program for a particular situation and advocating for its integration into the organization (Salmond and
Echevarria, 2017). In the current situation, the nurse educator will develop a new staff training program that can help to enhance the pharmacological
knowledge of nurses in the surgical unit. The nurse educator will then work in collaboration with various stakeholders to ensure that the facility makes the staff
training program part of its standard operating procedure. The specific stakeholders who will be involved in the practice change include, “patients, nurses,
physicians, hospital administrators, and health care accrediting agencies (Task 1).”
Implementation of the practice change will take a total of six weeks. The specific action items that will be accomplished during change implementation
include; meeting the hospital’s management for two days, briefing stakeholders about the proposed change for three days, setting project’s goals for two days,
setting up the site for two days, acquisition of resources for three days, arrangement of project’s team for two days, training nursing staff for two weeks, and
studying fluctuations in medication errors for another two weeks. In order to generate positive project outcomes, the nurse educator will ensure careful and
efficient utilization of resources and personnel. For instance, the nurse educator will require support from the hospital’s management in order to carry out staff
relocation in the surgical unit to facilitate accomplishment of project’s activities. In addition, training materials such as computers and handouts will be
purchased in advance as they will enhance the speed at which the practice change will be implemented.
Rationale for the Practice Change, Quality Improvement, or Innovation
The main rationale for the practice change is to increase nurse pharmacological knowledge in order to help minimize and prevent medication errors in
the surgical unit. This will help to prevent drug reactions which occur as a result of administration of incorrect drug dosages and wrong infusion. As earlier
mentioned, medication errors are directly associated with negative patient outcomes, high financial losses for the organization, and increased patient mortality
rates. According to Cheragi et al., (2013, p. 229), “Medication errors can significantly affect patient safety and treatment costs and result in hazards for patients
and their families.” For this reason, there is a great need for practice change in the current facility because this will result into an improvement in patient
outcomes, reduced patient mortality rates, and minimized financial losses for the organization. Since medication errors in the surgical unit affect operations of
the entire organization, a practice change that focuses on increasing the pharmacological knowledge of nurses in the surgical unit should be supported fully by
the hospital’s management (Brown, Patel, Mclnnes, Mays, Young and Haines, 2016).
The specific component of the practice change is implementation of a staff training program for nurses in the surgical unit. The rationale for selecting
a staff development program for the practice change is that, nurses can easily be assisted to learn relevant information about drugs if they receive a
comprehensive training about pharmacology and pharmacokinetics (Saldivar, Taylor, and Sugarman et al., 2016). The specific components of the staff training
program will include topics related to; types of medication errors, sources of medication errors, impacts of medication errors on patients and the organization,
routes of drug administration, drug dose calculations, drug interaction, and how to avoid medication errors. Implementation of a staff training program has
been selected as the best practice for reducing medication errors in the surgical unit because its effectiveness in increasing nurses’ pharmacological knowledge
is widely supported by research-based evidence (Ehsani et al., 2013).

Chapter 2: Review of the Literature

Credible Sources
A total of 32 credible sources which are related to the project topic, and which have been published within the past five years, have been reviewed. These
articles have been located by searching a number of databases including CINAHL, EBSCO, Cochrane, Pro-Quest, PubMed, and WGU Library. The specific
search criteria which have been used during the literature search include; medication errors, impacts of medication errors, nurses’ pharmacological knowledge,

and advantages of nurses’ training program. All articles that match the search criteria have been appraised with the aim of evaluating their credibility and
applicability to the project. The appraisal has been conducted based on a number of criteria including; the database where the source has been located, whether
it is peer-reviewed or not, its applicability to the project, evidence grade assigned, general appraisal, and whether it will be used to support the project or not.
All this information has been summarized in Appendix A: Credible Sources.
Best Practices Identification
The problem of medication errors in the surgical unit can be solved by implementing a number of strategies. As Keers, Williams, Cooke, and Ashcroft
(2013) explain, medication errors are attributed to a combination of multiple factors, and organizations should remember to focus on change interventions that
target specific causes. For instance, if medication errors occur as a result of limited pharmacological knowledge among nurses, the most appropriate change to
be implemented in such a case must focus on increasing nurses’ knowledge about drug administration. According to Weant, Bailey, and Baker (2014),
healthcare practitioners, especially nurses, should be helped to understand medication use process if medication errors are to be reduced and eliminated.
One of the best practices for helping nurses to understand medication use process in order to reduce medication errors in hospital settings is offering
educational curriculum that teach nursing students about drugs (Ehsani, Cheraghi, Nejati, Salari, Esmaeilpoor, and Nejad, 2013). According to Kief, Brouwer,
Francke, and Delnoij (2013), one of the factors that improve the quality of nursing care received by patients is availability of clinically competent nurses.
Tshiamo et al., (2015) further assert that the problem of rising medication errors can be solved by assisting nursing students to learn important aspects of
pharmacology. This is because graduate nurses who possess adequate knowledge about pharmacology are at decreased risk of making medication errors
(Simonsen, Daehlin, Johansson, and Farup, 2014). In this regard, Ehsani et al., (2013) recommend that the best way through which nursing institutions can
produce pharmacologically competent nurses who are at reduced risk of making medication errors is by ensuring that their educational curriculum adequately
teaches students about pharmacology. In addition, in evidence-based practice guidelines documented by Small, Sidebotham, Fenwick, and Gamble (2016),
midwives must complete an educational program in pharmacology for them to be given an authority to prescribe drugs.
The other best practice that should be considered by healthcare organizations which are interested in enhancing nurses’ knowledge with the aim of
reducing medication errors is training nurses as they continue to perform their roles as employees after graduating from school. This best practice is supported
by a large volume of evidence-based literature. For instance, in a study conducted by Stumm, Kirchner, Guido, Benetti, Belasco, Sesso, and Barbosa (2017),
the researchers have revealed that nurse training is highly effective in reducing chances of drug overdose by nurses for patients with renal problems and who
are on hemodialysis. Additionally, Wegner, Silva, & Peres et al. (2017) support that frequent training of healthcare workers can help to increase their drug
knowledge thereby maximizing patient safety. Ideally, training interventions are highly effective in changing nurse practices and in improving patient
outcomes in healthcare settings (Low et al., (2015).
Evidence Summary
a. Medication errors
Although other healthcare professionals may also make medication errors, a large percentage of these errors are normally made by nurses. In a study
conducted by Elden and Ismail (2015), 20.9 percent of medication errors occur during drug administration stage, and mostly occur because of drug overdose by
nurses. Therefore, in order to prevent medication errors that occur during drug administration, healthcare organizations should implement educational and
training programs to help increase nurses’ knowledge concerning how they should effectively administer drugs (Elden and Ismail, 2015). In a study conducted
by Berdot, Gilizeau, Caruba, Prognon, Durieux, and Sabatier (2013), the researchers have found that drug administration errors are more common among
hospitalized patients than among out-patients. These included patients admitted in the surgical unit and in the intensive care unit.
According to Cheragi et al., (2013), lack of pharmacological knowledge is the main cause of medication errors in healthcare settings. Similarly, Keers
et al. (2013) have identified limited nurse knowledge as one of the multiple factors that cause medication errors in healthcare settings. In this regard, any
strategy that aims at increasing nurses’ knowledge about drugs can help to reduce occurrence of medication errors among hospitalized and non-hospitalized
patients. According to Weant, Bailey, and Baker (2014), healthcare practitioners should be helped to understand medication use process if medication errors
are to be reduced and eliminated.
Several authors have supported the need to implement a staff training program as one of the strategies that can help to minimize and prevent occurrence
of medication errors in hospitals. For example, Athnasakis (2012) points out that nursing training and education should be used to prevent medication errors in
healthcare settings because it helps to increase drug dosage calculation skills of nurses. Additionally, Stumm et al. (2013) explain that nurse training is highly
effective in reducing chances of drug overdose by nurses in hospitals. This idea is greatly supported by Cestari, Florencio, Moreira, Pessoa, Barbosa, Lima, and
Custodio (2016), who state that training interventions can be used to enhance nursing competencies and to generate health promotion for patients with chronic
illnesses. The significant role that nurse education and training plays in enhancing nurses’ pharmacological knowledge is the main reason why midwives in the
United Kingdom are required to complete an educational program in pharmacology for them to be given the authority to prescribe drugs (Small et al., 2016).
Since the effectiveness of nurse training programs in reducing medication errors is a matter that is supported by research-based evidence, Dhawan et al. (2017)

propose that healthcare organizations should develop a culture of nurse training in order to prevent medication errors.
b. Organizational Financial Losses
Medication errors impose a big economic burden to healthcare organizations because the cost of wasted drugs as a result of avoidable errors must be
incorporated into the budget. For instance, medication errors result into wastage of drugs which causes medicine deficiency. In case of drug shortage, the
affected healthcare organizations must plan to purchase additional drugs for treating patients (Silva and Krishnamurthy, 2016; & Saldivar et al., 2016). The
economic impact of medication errors becomes worse than expected when nurse educators cannot effectively utilize available resources to teach nurses about
pharmacology. Underutilization of organizational resources, coupled with wastage of drugs, compels healthcare organizations to plan effectively on how they
can get funds to keep operations running (Zare and Adib-Hajbaghery, 2016). Therefore, in order to maximize efficiency, healthcare organizations should
involve nurse educators in implementing initiatives which can help to reduce and completely prevent medication errors (Samp et al., 2014).
According to Saldivar et al., (2016), enhancing nurses’ knowledge of pharmacogenetics can help to prevent medication errors, thereby reducing
economic burden for healthcare organizations. As Simonsen et al., (2014) explain, nurses are at a decreased risk of making medication errors whenever they
possess high pharmacological knowledge. According to Weant, Bailery, and Baker (2014), medication errors can be eliminated if healthcare practitioners are
helped to understand medication use and drug administration processes. Medication errors in organizations can also be prevented by offering educational
courses to nursing students while they are still learning (Tshiamo et al., 2015). Generally, the best strategy for increasing nurses’ pharmacological knowledge
with the aim of maximizing efficiency is providing nurses with in-service education and workshops that teach about medication preparations, drug reaction, as
well as side-effects of drugs in order to prevent occurrence of medication errors (Gorgich et al., 2016; & Nanji et al., 2016).
c. Increased Morbidity and Mortality
Medication errors are a big threat to patient safety and they have been found to be a contributing factor to increased morbidity and mortality in
hospitals. According to Cheragi et al., (2013) and Keers et al., (2013), quite a number of deaths in contemporary healthcare organizations occur as a result of
medication errors. These authors further assert that the high rates of morbidity and mortality in hospitals can be minimized if only those interventions that are
geared towards eliminating medication errors were implemented. Since available literature support limited pharmacological knowledge among nurses as the
main cause of medication errors in healthcare settings (Cheragi et al., 2013), interventions that increase nurses’ knowledge of drug reactions and administration
can help to maximize patient safety and to reduce cases of deaths that occur as a result of medication errors (Gorgich et al., 2016). A good example of such an
intervention I s a staff training program that teaches nurses about pharmacology (Ehsani et al., 2013; Kief et al., 2013; Low et al., 2015; & Wegner et al.,
2017). The use of nurse straining programs to improve the quality of care and increase patient safety is therefore supported by research evidence. Cope,
Abozour, and Tally (2016) give a good example of how healthcare organizations utilize nurse training programs to prevent occurrence of deaths as a result of
medication errors. According to these authors, nursing institutions in the United Kingdom perfectly understand the role that adequate nurse training plays in
reducing deaths that occur due to medication errors in healthcare settings. For this reason, these institutions offer nursing education programs that enable them
to produce graduate nurses who possess relevant knowledge and skills in relation to medication prescription and administration. In this manner, nursing
institutions in the United Kingdom ensure that nurses achieve the right qualifications that will enable them to prescribe drugs in accordance with the national
guidelines in order to minimize patient morbidity and mortality rates (Small et al., 2016).
Recommended Practice Change, Quality Improvement, or Innovation
The rise in drug reaction cases in the surgical unit of the current facility is attributed to medication errors that are made by nurses who are charged
with the responsibility of delivering care to patients in the unit. The recommended practice change in the surgical unit of the current organization must be
supported by research-based evidence (Low et al., 2015). Based on the findings of the literature review and evidence summary, the recommended practice
change in the current facility would be to implement a staff training program that specifically focuses on teaching nurses in the unit about pharmacology and
pharmacokinetics. Such a training program will help to enhance pharmacological knowledge of nurses thereby helping to reduce and prevent occurrence of
medication errors in the facility (Ehsani et al., 2013; Cheragi et al., 2013; Kief et al., 2013; Tshiamo et al., 2015; Low et al., 2015; Stumm et al., 2017; Small et
al., 2016; Wegner et al., 2017; Liu et al., 2016; Cestari at al., 2016; Zare and Adib-Hajbaghery, 2016; Cope, Abuzour, and Tully, 2016; Athnasakis, 2012;
Dhawan et al., 2017; Gorgich et al., 2016; & Nanji et al., 2016). These authors agree to the idea that, by teaching nurses about pharmacology and
pharmacokinetics, they will be able to acquire knowledge about drug reactions, contraindications, drug dose calculations, drug prescription, and drug
administration which will help them to reduce medication errors. Since the nurse educator is charged with the responsibility of ensuring that nurses posses
relevant knowledge and skills to enable them to deliver care that can contribute positively to patient outcomes (Zare and Adib-Hajbaghery, 2016; & Gorgich et
al., 2016), the nurse educator of the current facility must work in collaboration with the organization’s administration, nurse managers, staff nurses, and
accrediting bodies to ensure that a staff training program that teaches nurses about pharmacology is successfully implemented in the facility (Brown et al.,
2016; Habib et al., 2016; & Liu et al., 2016). Following successful implementation of a staff training program in the surgical unit, it is anticipated that; rates of
medication errors will reduce significantly, financial losses that are currently being incurred by the healthcare organization will considerably be reduced, and

that morbidity and mortality rates that occur in the unit as a result of medication errors will greatly be minimized (Cheragi et al., 2013).

Chapter 3: Implementation

Capstone Project Steps
The entire Capstone project ran for a period of six weeks. A total of eight action steps were taken to complete the project. The eight steps in a
chronological order include; meeting the hospital’s management for two days, communicating with stakeholders for three days, establishment of project’s goals
for two days, setting-up the site for 2 days, resource acquisition for three days, arrangement of project’s team for two days, training staff nurses for two weeks,
and monitoring the impact of the staff training program for two weeks.
A number of activities were carried out in each and every step to influence change within the organization. In the first step, a meeting was held with the
hospital’s management with the aim of seeking for permission to execute the practice change in the surgical unit of the organization. This step was followed by
educating stakeholders about the significance of the project as well as its intended benefits. In the third step, specific project goals were established, and this
was followed by site set-up to allow familiarization with the project’s environment. Following site set-up, relevant training equipments were purchased and the
project’s team was successfully created.
In the seventh step, the actual project was executed by training staff nurses in the surgical unit. The specific topics which were covered during project
execution include; various types of medication errors, reasons why medication errors occur, effects of medication errors on health outcomes of patients and on
the organization in general, different methods of drug administration, issues related to drug dose calculations, topics concerned with drug interaction, as well as
how medication errors can be avoided. The final action step of the project implementation involved monitoring response to training. In this step, any changes in
rates of medication errors in the surgical unit were observed and recorded. The action steps that were taken to complete the project have been summarized in
table 1 below;
Table 1: Capstone Project Steps

Successful completion of the above action steps was achieved through comprehensive interaction with stakeholders and through effective utilization of
resources. For instance, the hospital’s management provided maximum support with issues concerning staff-allocation and personnel adjustments in the
surgical unit for successful completion of project’s tasks. Additionally, the hospital’s administrators, physicians, patients, and nurses were actively involved in
identification and purchase of training materials that were used during project implementation. Examples of training materials which were identified,
purchased, and utilized include; printing materials, tablets, a computer, and a projector. Wastage of these resources was minimized through careful distribution
and allocation as explained by Alhassan, Nketiah-Amponsah, Akazili, Spieker, Arhinful, and de Wit, (2015).
Changes to original implementation plan: No major changes were made to the original implementation plan. Although there was a delay in
acquisition of resources and in arrangement of project’s team, this did not cause any significant effect on the project’s timeline because the necessary resources
and personnel were organized within three days and two days respectively as planned. The fact that there was no major changes to the original plan means that
the project was implemented as initially planned.
Barriers associated with implementation: Two major barriers were encountered during implementation of evidence-based practice change. One of

the barriers is lack of support from some members of the hospital’s administration. A few members of the hospital’s administration opposed the idea of
implementing a staff training program in the surgical unit. This is the main factor that delayed the process of arranging project’s team during implementation.
The other barrier which was encountered in the process of project implementation is financial constraint, which created difficulty in acquisition of resources.
The secured funds were still not enough to facilitate acquisition of all the resources as originally planned despite the fact that the process of acquiring finances
to purchase resources was started early. Although it was anticipated that time constraints could prevent successful implementation of the evidence-based
practice change, this potential barrier was not encountered during project implementation. Lack of support from members of staff and limited finances are
common barriers to successful implementation of many projects and the project’s team should be prepared in advance in order to avoid their impact on
project’s execution (Fitzgerald, Geaney, Kelly, McHugh, and Perry, 2016).
Overcoming barriers: Appropriate actions were taken to overcome the encountered barriers in order to prevent their impact on the project. For
instance, resistance from members of the hospital’s administration was mitigated by educating them about the significance of the practice change as well as its
associated benefits. As Fitzgerald et al., (2016) explain, one of the best approaches for mitigating resistance from members of staff during implementation of a
change intervention is providing comprehensive education about the potential advantages of the proposed change. A similar approach was taken in the current
project and it greatly helped to enhance stakeholders’ support of the evidence-based practice change. Furthermore, resources that could be acquired with the
limited resources were purchased to avoid putting pressure on the budget. Hastings, Madrian, and Skimmyhorn (2013), greatly emphasize on the importance of
proper financial planning in mitigating financial constraints that may be encountered during project implementation.
Trans-professional Relationships
Successful implementation of the evidence-based practice change was facilitated by members of transprofessional team. The transprofessional team was
developed by merging professional boundaries whose contributions could generate positive impacts on the entire project. The team members and their
positions are as follows;
a. Patients: Those people who have been admitted in the surgical unit
b. Nurses: The nurse educator, nurse managers, and all staff nurses in the surgical unit
c. Physicians: All surgeons in the surgical unit
d. Administrators: Quality improvement officers and Clinical Nurse Officer
e. Family members: Those who are directly involved in the after care of the patients
f. Health care accrediting agencies
How relationships facilitated implementation: The trans-professional relationships identified above played significant roles in facilitating
implementation of the staff training program in the surgical unit. For example, patients and their families facilitated implementation of the practice change by
encouraging staff nurses to support its execution. They did so because they believed that the practice change will improve the quality of care and maximize
patient safety (Smith, Saunders, and Stuckhardt, 2013). Staff nurses, in collaboration with surgeons, nurse managers, and the nurse educator, facilitated the
project’s implementation by convincing the hospital’s administration to approve the practice change. Furthermore, this team informed the hospital’s
administration about the specific resources that must be purchased for the practice change to be implemented successfully. The administration influenced the
project’s implementation in one major way. It worked in collaboration with healthcare accrediting agencies to approve execution of the practice change in the
organization. Without this approval, the staff training program could not have been implemented in the facility (Brown et al., 2016).

Chapter 4: Post Capstone Project Considerations

Capstone Successes
Successful aspects: There are four major successful aspects of the capstone practice change. First, comprehensive stakeholder education has greatly
improved awareness around the importance of a staff training program within the organization. Second, there has been an improvement in communication
among stakeholders following their understanding of the significance of the practice change. Third, through personal influence, the organization’s leadership
and staff nurses have demonstrated commitment to practice change, and this has positively influenced implementation of a staff training program in the facility.
Fourth, application of financial planning knowledge has facilitated acquisition of relevant resources using limited finances.
Impact on future projects: A number of aspects have been learnt from the successes of the Capstone project that would inform future projects. The
Capstone project provides a foundation for future evidence-based practice changes. Specifically, it is anticipated that rates of medication errors in the surgical
unit will decrease following successful implementation of the Capstone project. The outcome of the project should be used to influence similar evidence-based
practice changes in future (Califf, Robb, and Sherman, 2016). Furthermore, the Capstone project has created a blueprint for other change agents within the
current facility. Specifically, based on project’s successes, other change agents within the organization will be able to educate project’s stakeholders in order to
increase their awareness of evidence-based practice change. Through comprehensive education, future change agents will be able to improve communication

among stakeholders and to influence the organization’s leadership to demonstrate commitment to the practice change. Moreover, learning from the successes of
the Capstone project, facilitators of future evidence-based practice changes will be able to utilize available finances to purchase relevant resources required for
successful completion of projects (Fitzgerald et al., 2016).
Capstone Challenges
Aspects that did not go well: Major Capstone steps have gone well and there are no identifiable aspects that did not go well. This is evidenced by the
fact that specific project tasks have been completed as planned and within schedule. The main reason for this achievement is proper project planning and close
collaboration with project’s stakeholders (Brown et al., 2016).
Impact on future projects: A detailed discussion of the impact of the Capstone’s challenges on future projects is not necessary in this case because
there are no aspects of the project that did not go well.
Evidence and Current Practice
The evidence that has been gathered to support the effectiveness of a staff training program in increasing nurses’ pharmacological knowledge for
reduction of medication errors has greatly enhanced the development and implementation of the Capstone project. Following a comprehensive literature search,
the best practice change that has been found to solve the problem of limited pharmacological knowledge among nurses is implementation of a staff training
program that educates nurses about pharmacokinetics and pharmacology Ehsani et al., 2013; Cheragi et al., 2013; Kief et al., 2013; Tshiamo et al., 2015; Low
et al., 2015; Stumm et al., 2017; Small et al., 2016; Wegner et al., 2017; Liu et al., 2016; Cestari at al., 2016; Zare and Adib-Hajbaghery, 2016; Cope, Abuzour,
and Tully, 2016; Athnasakis, 2012; Dhawan et al., 2017; Gorgich et al., 2016; & Nanji et al., 2016). It is for this reason that a staff training program has been
implemented in the surgical unit of the current facility. During implementation of the evidence-based practice change, the main idea that has helped to guide
the nurse educator is an agreement among several authors that nurses can easily acquire knowledge about drug administration, drug reactions, drug
prescription, drug contraindications, and drug dose calculations, and this can greatly help to minimize and even prevent occurrence of medication errors in the
surgical unit (Cheragi et al., 2013).
Although some authors support the use of an educational curriculum that teaches nurses about drugs before they can graduate from institutions of higher
learning (Ehsani et al., 2013; Kief, et al., 2013; Tshiamo et al., 2015; Simonsen et al., 2014; & Small et al., 2016), this idea has not be considered for the
current practice change. Future nursing research should be organized around this new knowledge in order to confirm the effectiveness of a drug-related
educational curriculum in reducing medication errors in the healthcare setting.
A large percentage of reviewed articles support the effectiveness of staff training in enhancing pharmacological knowledge of nurses. However, the
main gap in available literature is limited evidence to confirm the significance of staff training in reducing medication errors in healthcare settings. This
Capstone project has helped to bridge the gap between staff training and reduction in rates of medication errors which are frequently made by nurses.
Specifically, this project helps to enhance the reader’s understanding of the important role played by staff training programs in increasing nurses’
pharmacological knowledge and in reducing medication errors in hospitals.
Post-Implementation
The organization must develop a plan to ensure continued success of the project, otherwise, the problem of medication errors in the surgical unit will
not be solved (Elden and Ismail, 2015). There are three short-term maintenance plans that the organization will use to ensure the project’s continued success.
First, the organization will create small working groups as soon as possible to monitor nurses’ activities in the surgical unit and to establish the occurrence of
medication errors. Second, it will make staff adjustments with an immediate effect to ensure that there are adequate nurses in the surgical unit to assist one
another with drug prescription, administration, as well as with drug dose calculations. Third, the organization will develop standard operating procedures right
away to guide nurses on how they should administer drugs to patients in the surgical unit (Navabi, Ghaffari, Shamsalinia, and Faghani, 2016).
There are two long-term maintenance plans that the organization will use to ensure continued success of the project. The first long-term plan is
development of policies that will help to remind staff nurses in the surgical unit to always administer drugs appropriately as per the documentations of the
standard operating procedures. With well written policies, the nurses will be able to understand the organization’s commitment in reducing medication errors

and they will be careful whenever they are administering drugs to patients (Navabi et al., 2015). One of the policies that the organization will develop for long-
term maintenance of the project concerns maximum adherence to the standard operating procedures (SOPs). Although the SOPs will be developed as a short-
term maintenance plan, emphasis of their implementation will be done as a long-term maintenance plan. The other policy that will be developed is related to

error reporting. This policy will guide staff nurses in the surgical unit to always report any suspected cases of medication errors for timely management and to
prevent their impact on patients’ health (Elden and Ismail, 2015).
The second long-term maintenance plan that the facility will use to ensure project’s success is modification of the organizational structure. Initially, the
organizational structure of the surgical unit comprised of the nurse manager and staff nurses. Following implementation of the evidence-based practice change,
a nurse educator will be integrated into the organizational structure to help with decision-making in relation to how effective pharmacological management can

be enhanced, for long-term success of the entire facility. This team approach to problem solving will help to prevent occurrence of medication errors in the
hospital’s surgical unit in future (Mahone, Maphis, and Snow, 2016).
Resources Required for Post-Implementation Support
The organization will put relevant resources in place in order to sustain the project and to ensure that nurses in the surgical unit receive constant
training on pharmacology and pharmacokinetics. For instance, the facility will hire nurse educators from other organizations on a monthly basis to offer
continued education about drugs in accordance with the components of the staff training program which has just been implemented. Additionally, it will
allocate additional funds for purchasing training materials every time a training session is organized. Moreover, the organization will hire additional nurses to
help with care delivery and drug administration in the surgical unit (Salmond and Echevarria, 2017). The newly hired nurses will join the currently employed
ones during training in order to increase their drug knowledge and to prevent them from making medication errors which the facility is currently striving to
eliminate. Furthermore, the organization will hold ongoing meetings with the aim of discussing strategies that can be utilized to further sustain the project
(Brown et al., 2016).

Chapter 5: Reflection

Integration of MSN Program Outcomes
The Capstone project has allowed for integration of two major WGU MSN program outcomes which are relevant to nursing education. The two
program outcomes include; integration of clinical reasoning with organizational, patient-centered, culturally appropriate strategies to plan, deliver, and evaluate
evidence-based practice; and construction of interprofessional teams to communicate, coordinate, collaborate, and consult with other health professionals to
advance a culture of excellence.

Integration of clinical reasoning with organizational, patient-centered, culturally appropriate strategies to plan, deliver, and evaluate evidence-
based practice: The Capstone project has encouraged integration of clinical reasoning with various strategies to facilitate successful implementation and

evaluation of evidence-based practice. Specifically, during implementation of the project, clinical reasoning has been integrated with organizational, patient-
centered, and culturally appropriate strategies to organize, execute, and evaluate a staff training program that teaches nurses about pharmacology and

pharmacokinetics. For instance, the staff training program which has been implemented in the surgical unit has been selected because its effectiveness in

increasing pharmacological knowledge of nurses and in reducing medication errors in the healthcare setting is a matter that is widely supported by evidence-
based clinical research. Moreover, organizational, patient-centered, and culturally-appropriate approaches have been utilized to plan, implement, and to

monitor the success of the evidence-based practice change in the surgical unit.
Construct interprofessional teams to communicate, coordinate, collaborate, and consult with other health professionals to advance a culture of
excellence: The Capstone project has allowed for involvement of interprofessional teams who have played a significant role in enhancing communication,
coordination, collaboration, and consultation with other professionals in the healthcare field to advance a culture of excellence in the current facility. Examples
of interprofessional teams who have been involved in implementation of the Capstone project include nurse managers, nurse educators, staff nurses, healthcare
administrators, organization’s management, physicians, family members of hospitalized patients, and healthcare accrediting agencies. These professionals have
worked in collaboration with project managers and planners to ensure that the current facility develops a culture of staff training with respect to pharmacology
and pharmacokinetics.

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Running head: FIRST THREE/FOUR WORDS OF TITLE 1
Appendix A
Credible Sources

Author(s)

Database
(CINAHL,
EBSCO, Cochrane,
Pro-Quest, PubMed,
and WGU Library)

Peer-
Reviewed

(Yes/No)
Applicability
(Yes/No)

Evidence
Grade
(Strength/
Hierarchy)

Appraisal
(Brief summary of findings; how findings
inform your project?)

Inclusion
(Yes/No)

Keers, Williams,
Cooke, and Ashcroft
(2013). PubMed Yes Yes

1/Systematic
review of
quantitative and
qualitative
evidence

Medication administration errors are
attributed to a combination of multiple
factors including limited nurse knowledge.
For this reason, interventions for reducing
medication errors should target specific
causes.
My project focuses on a practice change that
would reduce medication errors. Yes

Ehsani, Cheraghi,
Nejati, Salari,
Esmaeilpoor, and
Nejad (2013). WGU Library Yes Yes

4/Descriptive
study

Healthcare organizations should introduce
retraining courses for nurses who are
working in the emergency department in
order to reduce cases of medication errors
and to maximize patient safety.
My project is about reducing medication
errors through implementation of a nurse
training program. Yes

Brown, Patel,
Mclnnes, Mays,
Young and Haines,
(2016). Pub Med Central Yes Yes

1/Systematic
review of
quantitative and
qualitative
literature

Clinical networks are highly effective in
improving patient outcomes and quality of
care in healthcare organizations.
My project focuses on improving health care
quality through prevention of medication
errors. This will require effective
collaboration among stakeholders. Yes

Elden and Ismail
(2015). Google Scholar Yes Yes

2/Experimental
design

20.9 percent of medication errors occur
during drug administration stage. Healthcare
organizations should implement educational
and training programs to help increase
nurses’ knowledge of drug administration.
My project focuses on reducing medication
errors through implementation of a nurse
training program. Yes
Lack of pharmacological knowledge is the
main cause of medication errors in
healthcare settings.

Cheragi,
Manoocheri,
Mohammadnejad,
and Ehsani (2013).

CINAHL Yes Yes

4/Cross-
sectional study

My project is about reducing medication
errors in the surgical unit by increasing
nurse pharmacological knowledge.

Yes

Habib, Blanche,
Souha, El-Jardali,
and Nuwayhid
(2016). Cochrane Library Yes Yes 2/Experimental

Healthcare organizations must implement
relevant training programs for nurses for
them to obtain relevant accreditation.
My project focuses on enhancing healthcare
quality through implementation of a training
program that can help to prevent medication
errors. Yes

Kief, Brouwer,
Francke, and Delnoij
(2013). WGU Library Yes Yes 6/Qualitative

One of the factors that improve the quality
of nursing care received by patients is
availability of clinically competent nurses,
which can be achieved through nurse
training.
My project involves increasing nurses’
pharmacological competency by using a
nurse development program. Yes

Payne (2013) ProQuest Yes No 4/Descriptive

Kurt Lewin’s change theory can be used to
overcome transformation-related challenges
that are frequently faced by healthcare
organizations.
My project focuses on reduction of
medication errors in the surgical unit. No

Simonsen, Daehlin,
Johansson, and
Farup, (2014). Pub Med Yes Yes 2/Experimental

Nurses who possess high pharmacological
knowledge are at decreased risk of making
medication errors.
The goal of my project is to increase nurse
pharmacological knowledge in order to
reduce medication errors in the surgical unit. Yes

Tshiamo, Kgositau,
Ntsayagae, and
Sabone (2015). CINAHL Yes Yes

1/Systematic
review of
literature

The problem of rising medication errors can
be solved by assisting nursing students to
learn important aspects of pharmacology.
My project focuses on reducing medication
errors in the surgical unit by helping staff
nurses to learn important ideas related to
pharmacology. Yes

Weant, Bailey, and
Baker (2014). Google Scholar Yes Yes 4/Descriptive

Healthcare practitioners should be helped to
understand medication use process if
medication errors are to be reduced and
eliminated.
My project is concerned with increasing
nurses’ knowledge of medication use
process in order to reduce and prevent
occurrence of medication errors in the
surgical unit. Yes

Saldivar, Taylor, and
Sugarman et. al.,
(2016). EBSOhost Yes Yes

2/Randomized-
Controlled trial

Enhancing nurses’ knowledge of
pharmacogenetics can help to prevent drug
reaction, thereby reducing economic burden
for healthcare organizations
My project focuses on increasing nurses’
knowledge of drug performance and drug
reactions with the aim of reducing and
preventing medication errors Yes

Salmond and
Echevarria (2017) WGU Library Yes Yes 4/Descriptive

Nurses should contribute in leading
meaningful reforms in their organizations by
becoming active members of
interprofessional teams that are concerned
with change implementation.
My project focuses on implementation of a
training program that will increase nurse
pharmacological knowledge and to reduce
medication errors. Yes

Porterfield,
Engelbert, and
Coustasse (2014) PubMed Yes No

1/Systematic
review of
literature

E-prescribing can be used to prevent
medication errors and to increase efficiency
by healthcare organizations.
My project aims at reducing medication
errors through the use of a nurse training
program. No
Hospitals should implement initiatives to
prevent medication errors in order to
maximize efficiency.

Samp, Touchette,
Marinac, and Kuo,
(2014). Cochrane Library Yes Yes 4/Case control

My project focuses on increasing nurses’
pharmacological knowledge with the aim of
preventing medication errors and to
maximize efficiency.

Yes

Silva and
Krishnamurthy
(2016). CINAHL Yes Yes 7/Case study

Medication errors impose huge economic
burden to healthcare organizations and
patients.
My project aims at reducing medication
errors in the surgical unit through the use of
a nurse training program. This will help to
reduce economic burden for organizations. Yes

Berdot, Gilizeau,
Caruba, Prognon,
Durieux, and
Sabatier (2013). MEDLINE Yes Yes

1/Systematic
review of
literature

Drug administration errors are more
common among hospitalized patients than
among out-patients.
My project is about implementing a practice
change that will help to reduce medication
errors in the surgical unit. Yes

Flynn, Evanish,
Fernald, Hutchinson,
and Lefaiver (2016). EBSOhost Yes No

4/Prospective
Observational
study

Strategies which are aimed at limiting nurse
interruptions during drug administration can
help to reduce medication errors.
The aim of my project is to increase nurses’
knowledge of drug administration in order to
reduce medication errors. No

Mahone, Maphis,
and Snow (2016) WGU Library Yes No 4/Descriptive

Nurses can use a team approach to client
education to increase patients’ knowledge of
drug use and to promote improvement in
health outcomes.
My project is about implementation of a
nurse training program with the aim of
reducing medication errors in the surgical
unit. No

Low, Fletcher, and
Goodenough, et al.,
(2015). Google Scholar Yes Yes

1/Systematic
review

Training interventions can greatly change
nurse practices and improve patient
outcomes in nursing home.
My project focuses on utilization of a
training intervention to increase nurses’
pharmacological knowledge with the aim of
improving patient outcome in the surgical
unit. Yes

Stumm, Kirchner,
and Guido et al.,
(2017). Cochrane Library Yes Yes

3/Quasi-
experimental

Nurse training is highly effective in reducing
chances of drug overdose among patients
with renal problems and who are on
hemodialysis.
My project focuses on implementation of a
nurse training program to enhance
pharmacological knowledge of nurses and to
prevent medication errors.

Yes

Small, Sidebotham,
Fenwick, and
Gamble, (2016) Pub Med Central Yes Yes

1/EBP
Guidelines

Midwives must complete an educational
program in pharmacology for them to be
given an authority to prescribe drugs.
My project is about utilizing an educational
program to increase nurses’ drug knowledge
and to prevent them from making
medication errors during prescription and
administration. Yes

Wegner, Silva, and
Peres et al., (2017) CINAHL Yes Yes

1/Systematic
review of
literature

Frequent training of healthcare workers can
help to increase their drug knowledge
thereby maximizing patient safety.
My project is about maximization of patient
safety through implementation of a training
program which is intended to increase
nurses’ medication knowledge. Yes

Liu, Peng, Zhang,
Hu, Li, and Weirong,
(2016) Pub Med Central Yes Yes

1/Systematic
review of
literature

Bended learning is highly effective in
increasing medication knowledge among
health professionals.
The focus of my project is implementation
of a training program to increase medication
knowledge among nurses and to prevent
medication errors on the surgical unit. Yes
Training interventions can be used to
enhance nursing competencies and to
generate health promotion for patients with
chronic illnesses.

Cestari, Florencio,
and Moreira et al.,
(2016). EBSCOhost Yes Yes

1/Systematic
literature review

My project convents utilization of a training
intervention to increase pharmacological
knowledge of nurses and to promote
improvement of health for patients in the
surgical unit.

Yes

Zare and Adib-
Hajbaghery (2016). Pub Med Central Yes Yes

4/Cross-
sectional study

Nursing students are less satisfied with their
own pharmacological knowledge and skills.
Clinical nurse educators should improve
their approaches to pharmacology teaching
in order to increase nurses’ medication
management competencies.
My project focuses on utilization of a staff
training program in order to increase nurses’
medication management competencies. Yes

Cope, Abuzour, and
Tully, (2016). EBSCOhost Yes Yes 4/Descriptive

Nursing education programs in the United

Kingdom have greatly enhanced non-
medical prescribing, which has positively

contributed to patient outcomes.
My project focuses on implementation of
staff training program in the surgical unit to
improve nurses’ prescription knowledge. Yes

Navabi, Ghaffari,
Shamsalinia, and
Faghani, (2016). Pub Med Yes No

4/Quality
improvement

Evaluation tools are highly effective in
assessing nurses’ knowledge and skills in the
clinical pharmacology unit.
My project is concerned with enhancement
of nurses’ pharmacological knowledge using
a staff training program. No

Athnasakis (2012). Google Scholar Yes Yes

1/Systematic
review of
literature

Nursing training and education should be
used to prevent medication errors in
healthcare setting because it helps to
increase drug dosage calculation skills of
nurses.
My project is about utilizing a nurse training
program with the aim of increasing
pharmacological knowledge of nurses in
order to prevent medication errors in the
surgical unit Yes

Gorgich, Barfroshan,
Ghoreishi, and
Yaghoobi, (2016). Pub Med Central Yes Yes

4/Cross-
sectional

descriptive
study

Nurse managers should provide nurses with
in-service education and workshops that
teach about medication preparations, drug
reaction, as well as side-effects of drugs in
order to prevent occurrence of medication
errors and to improve patient outcomes.
My project aims at providing nurses in the
surgical facility with in-service education to
enhance their knowledge about drugs and to
prevent medication errors. Yes

Dhawan, Tewari,
Sehgal, and Sinha,
(2017). Cochrane Library Yes Yes 4/Descriptive

Healthcare organizations should develop a
culture of nurse training in order to prevent
medication errors.
The focus of my project is prevention of
medication errors using a nurse training
program. Yes

Nanji, Patel, Shaikh,
Seger, and Bates,
(2016). ProQuest Yes Yes

4/Prospective
observational
study

Nurse teaching and education is one of the
strategies for solving the problem of rapid
rise in medication errors in today’s
healthcare organizations with the aim of
maximizing efficiency.
My project focuses on implementation of a
nurse training program in order to solve the
problem of high incidences of medication
errors in the surgical unit. Yes

Running head: FIRST THREE/FOUR WORDS OF TITLE 1
Appendix B
Organization Approval Letter
Appendix C
Preceptor Agreement Form

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