Part 3A: Critical Appraisal of Research
Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.
Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.
Part 3B: Critical Appraisal of Research
Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.
Evaluation Table
| Full APA formatted citation of selected article. | Article #1 | Article #2 | Article #3 | Article #4 |
| Kim, Y. S., Kim, H. S., Kim, H. A., Chun, J., Kwak, M. J., Kim, M. S., Hwang, J. I., & Kim, H. (2020). Can patient and family education prevent medical errors? A descriptive study. BMC Health Services Research, 20(1), 269. https://doi.org/10.1186/s12913-020-05083-y | Jaam, M., Naseralallah, L.M., Hussain, T.A., & Pawluk, S. A. (2021). Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: A systematic review and meta-analysis. PLoS ONE, 16(6): e0253588. https://doi.org/10.1371/journal.pone.0253588
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Zakria, A., & Mohamed, S. (2017). Safety intervention educational program to reduce medication administration errors and interruptions. IOSR Journal of Nursing and Health Science, 6(2), 15-25. doi: 10.9790/1959-0602031525.
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Riordan, D. O., Walsh, K. A.,Galvin, R., Sinnott, C., Kearney, P. M., & Byrne, S. (2016). The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: A systematic review. SAGE Open Medicine, 4, pmid:27354917.
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| Evidence Level *
(I, II, or III)
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This article is a Level V because it was a quality improvement descriptive study. | This article is a Level I because it was a systematic review with meta-analysis of RCTs. | This article is a Level II because it was a quasi-experimental study. | This article is a Level I because it was a systematic review of RCTs. |
| Conceptual Framework
Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**see notes below
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No conceptual framework named in the study. | No conceptual framework named in the study. | No conceptual framework named in the study. | No conceptual framework named in the study. |
| Design/Method
Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). |
The study was a descriptive study that included patients who received care at the three hospitals, their family members, and patient safety officers who participated in the patient safety and quality program. Exclusion criteria were participants who refused to give informed consent and patient safety officers who did not participate in the patient safety and quality program at the hospitals (Kim et al., 2020). | The study was a systematic review with meta-analysis of RCTs. The study included 12 articles published from inception to June 2020 (Jaam et al., 2021).
Only studies that reported changes in medication error rates after the implementation of pharmacist-led educational interventions were included in the review.
Articles published after June 2020 were excluded from the review (Jaam et al., 2021). |
The study was a quasi-experimental pre and post design.
A safety intervention educational program was implemented to nurses working in the medical and surgical units of the hospital.
Nurses who worked in both units were excluded from the study (Zakria & Mohamed, 2017). |
The study was systematic review with meta-analysis of RCTs. The study included 5 articles published from inception to December 2015 (Riordan et al., 2016).
Only those articles that reported changes in prescribing error rates among older adults after the implementation of pharmacist-led educational interventions were included in the review.
Articles published after December 2015 were excluded from the review. |
| Sample/Setting
The number and characteristics of patients, attrition rate, etc. |
The settings for the study were two tertiary medical facilities in Seoul one general hospital in Gyeonggi-do, Korea. The study included a total of 242 participants: 113 patient safety officers, 58 patients, and 71 families (Kim et al., 2020). | The databases searched included Cochrane Library, EBSCO, EMBASE, Medline and Google Scholar.
Original search generated 9354 articles.
12 publications involving 115058 participants were reviewed. |
The setting for the study was Mansoura University Hospital in Egypt.
The study involved 48 nurses (Zakria & Mohamed, 2017).
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“The databases searched included PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, MEDLINE (through Ovid), Trip, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, ISI Web of Science, ScienceDirect, ClinicalTrials.gov, metaRegister of Controlled Trials, ProQuest Dissertations & Theses Database (Theses in Great Britain, Ireland and North America) (Riordan et al., 2016).”
2193 articles were obtained after removal of duplicates.
5 studies that met the inclusion criteria were reviewed (Riordan et al. 2016).
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| Major Variables Studied
List and define dependent and independent variables |
Dependent variable: Rates of medical errors.
Independent variable: Safety and quality education |
Dependent variable: Medication error rates
Independent variable: Pharmacist-led educational interventions. |
Dependent variables: medication errors and interruptions during medication administration.
Independent variable: Safety intervention educational program. |
Dependent variable: Medication error rates
Independent variable: Pharmacist-led educational interventions. |
| Measurement
Identify primary statistics used to answer clinical questions (You need to list the actual tests done). |
Cronbach’s α was obtained to evaluate the reliability of the questionnaire. Mean and standard deviations were calculated for the age of participants and career duration of Patient Safety Officers. A chi-square test was done to determine the difference between the general characteristics of patients and their families, differences in educational experiences among patient safety officers, and differences in medical error prevention between groups. Analysis of variance (ANOVA) was conducted to establish the elements that were contributing to the prevention of medical errors between the three groups and the variations in the degree of medical error prevention among the three groups (Kim et al., 2020). | Quality assessment of the articles was done using the Crowe Critical Appraisal Tool (CCAT).
Summary odds ratios were computed using a random-effected model for medication error rates (Jaam et al., 2021). |
The study sample was described using descriptive statistics including percentages and standard deviations (Zakria & Mohamed, 2017).
A chi-square test was performed to determine the link between medication error rates before and after the implementation of the educational program (Zakria & Mohamed, 2017).
The frequencies of medication administration interruptions were also calculated (Zakria & Mohamed, 2017).
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Th studies were assessed for risk of bias using the Cochrane Collaboration’s tool.
Major themes presented in the articles were identified. |
| Data Analysis Statistical or
Qualitative findings
(You need to enter the actual numbers determined by the statistical tests or qualitative data). |
Data analysis was performed using the IBM SPSS software version 24. The statistical level was set at p < .05. “The most important factors in preventing patient safety events were statistically significant differences among patients, family members, and Patient Safety Officers (p = 0.001). Patients and families had the highest ‘Patient and family participation’ (31.0% of patients; 39.4% of families) and Patient Safety Officers had the highest ‘Patient safety culture’ (47.8%) (Kim et al., 2020, p. 269).” | The study generated statistically significant results at 95% confidence level. Educational programs led by a pharmacist were associated with significant reductions in the overall rate of medication errors occurrence (OR, 0.38; 95% CI, 0.22 to 0.65) (Jaam et al., 2021). | Data analysis was conducted using the SPSS software version 19. The statistical level was set at p < .05. Statistical findings indicated that there was an increase in nurses’ knowledge regarding medication prescription and administration immediately after the implementation of the safety intervention educational program. 95.83% of the nurses could control interruptions and errors during medication administration after the intervention (Zakria & Mohamed, 2017). There was a reduction in medication error rates and interruption frequencies after the intervention. | Thematic analysis generated two important themes from the reviewed articles.
1. Education on medication review improved prescribing and reduces medication errors. 2. The use of computerized alerts improved prescription appropriateness among pharmacists (Riordan et al., 2016). |
| Findings and Recommendations
General findings and recommendations of the research |
The authors found that educational content used could prevent medical errors in medical facilities.
They recommended that evidence from the study should be used to develop standardized educational content for preventing medical errors in healthcare settings. |
The researchers found that pharmacist-led educational interventions targeting healthcare providers are effective at minimizing rates of medication errors (Jaam et al., 2021).
They recommended that healthcare organizations should implement educational interventions led by pharmacists to prevent medication errors (Jaam et al. 2021). |
Findings indicated that improving nurses’ knowledge by implementing safety intervention educational program promoted patient safety by minimizing rates of medication errors and reducing interruption frequencies (Zakria & Mohamed, 2017).
The authors recommended that healthcare organizations should conduct a continuous safety intervention education targeting nurses in order to reduce medication errors and interruption frequencies. This will help to protect patient safety (Zakria & Mohamed, 2017). |
The researchers found that pharmacist-led educational interventions improve prescribing appropriateness and reduces rates of medication errors (Riordan et al., 2016).
They recommended that healthcare organizations should make pharmacists part of healthcare multidisciplinary teams to optimize prescribing and reduce medication errors (Riordan et al., 2016). |
| Appraisal and Study Quality
Describe the general worth of this research to practice.
What are the strengths and limitations of study?
What are the risks associated with implementation of the suggested practices or processes detailed in the research?
What is the feasibility of use in your practice? |
The article is applicable to clinical practice as it guides the use of educational interventions to prevent medical errors in hospitals.
Strength: The researchers included in the study key people who always interact with patients during the care process both at home and in the hospital.
Limitation: The study was mainly based in Korean settings, a factor that might minimize the generalizability of study findings.
The use of similar educational content in other settings might not produce same results due to variations in environmental and participant characteristics.
The use of the educational contents is practically and economically feasible in my practice setting.
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The article is applicable to clinical practice as it guides the use of pharmacist-led educational interventions to prevent medication errors in hospitals.
Strength: The findings were obtained by reviewing randomized controlled trials which contain high quality evidence.
Limitation: A sample size of 12 articles is relatively small and may increase bias in the types of studies reviewed.
The application of these findings in other settings might not produce same results due to variations in environmental and participant characteristics.
The implementation of pharmacist-led educational interventions is practically and economically feasible in my practice setting.
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The article is of great worth to practice because it provides evidence that healthcare organizations can use to protect patient safety. The evidence directs healthcare settings to implement safety intervention educational programs to increase nurses’ knowledge, reduce medication error rates, and minimize frequencies of interruptions during medication prescription and administration (Zakria & Mohamed, 2017).
Strength: The investigators divided the study into two phases to include pre- and post-interventions. This allowed them to easily compare the status of medication errors before and after the educational program was implemented.
Limitation: The researchers used a relatively small sample size of only 48 nurses which might limit precision and power.
A potential risk is that a large hospital might require a lot of funds to be able to implement a safety intervention educational program for nurses.
The implementation of a safety intervention educational program to reduce medication errors and interruption frequencies is practically and economically feasible in my practice setting. |
The article is applicable to clinical practice as it guides the use of pharmacist-led educational interventions to improve prescribing appropriateness and prevent medication errors in hospitals.
Strength: The findings were obtained by reviewing randomized controlled trials which contain high quality evidence.
Limitation: A sample size of 5 articles is relatively small and may increase bias in the types of studies reviewed.
The application of these findings in other settings might not produce same results due to variations in environmental and participant characteristics.
The implementation of pharmacist-led educational interventions is practically and economically feasible in my practice setting.
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Key findings
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Educational content developed to teach patients, families, and patient safety officers about patient safety and healthcare quality prevents medical errors in hospitals (Kim et al., 2020). | Pharmacist-led educational interventions reduced rates of medication errors in healthcare settings. | A safety intervention educational program increases nurses’ knowledge of medication administration. The increase in knowledge is evidenced by a decrease in rates of medication errors and interruption frequencies. | Pharmacist-led educational interventions optimized prescribing and reduced rates of medication errors in healthcare settings. |
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Outcomes
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-Reduction rates of medical errors.
-Improved patient safety |
-Reduction in medication error rates.
-Improved medication utilization
-Improved patient safety |
-Increase in nurses’ medication administration knowledge
-Reduction in rates of medication errors
-Reduction in interruption frequencies during medication prescription and administration. |
-Optimized prescribing and reduction in rates of medication errors.
-Improved medication utilization
-Improved patient safety |
| General Notes/Comments | The article is relevant to the proposed change. | This article is relevant to the proposed change. | The article is relevant to the proposed change. | This article is relevant to the proposed change. |
- Level I
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis
- Level II
Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
- Level III
Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis
- Level IV
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
- Level V
Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence
Part B: Critical Appraisal of Research
Healthcare organizations should embrace evidence-based practice by implementing clinical practice interventions that are supported by research. The best way to locate evidence to support a proposed practice change is to conduct a crucial evaluation of evidence (Melnyk & Fineout-Overholt, 2019). The practice problem that requires a change is the recent rise in incidences of medical errors in the facility. Detailed investigation revealed that the problem is attributed to limited staff knowledge regarding medication administration. The proposed change is the implementation of a staff education program to help reduces rates of medication errors. The research question that the study aims to address is that “In patients in an acute care setting (P), how do on-the-job staff educational programs (I) compared with lack of staff education (C) affect rates of medical errors (O) within a period of four weeks (T)?” The reviewed evidence supports the association between on-the-job staff educational programs and reduced rates of medical errors in acute healthcare settings.
Based on the appraisal, the best practice that emerges from the reviewed research is that staff education about patient safety reduces rates of medical errors in healthcare settings. For instance, a study by Kim et al. (2020) found that educational content developed to teach patients, families, and patient safety officers about patient safety and healthcare quality prevents medical errors in hospitals. In another study, Jaam et al. (2021) discovered that pharmacist-led educational interventions reduced rates of medication errors in healthcare settings. These findings are supported by Riordan et al. (2016). Another study conducted by Zakria and Mohamed (2017) revealed that a safety intervention educational program increases nurses’ knowledge of medication administration. The increase in knowledge is evidenced by a decrease in rates of medication errors and interruption frequencies. Since the proposed change is supported by published evidence, the practice setting should proceed with its implementation in order to reduce rates of medical errors.
References
Jaam, M., Naseralallah, L.M., Hussain, T.A., & Pawluk, S. A. (2021). Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: A systematic review and meta-analysis. PLoS ONE, 16(6): e0253588. https://doi.org/10.1371/journal.pone.0253588
Kim, Y. S., Kim, H. S., Kim, H. A., Chun, J., Kwak, M. J., Kim, M. S., Hwang, J. I., & Kim, H. (2020). Can patient and family education prevent medical errors? A descriptive study. BMC Health Services Research, 20(1), 269. https://doi.org/10.1186/s12913-020-05083-y
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: a guide to best practice. Fourth edition. Philadelphia: Wolters Kluwer.
Riordan, D. O., Walsh, K. A.,Galvin, R., Sinnott, C., Kearney, P. M., & Byrne, S. (2016). The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: A systematic review. SAGE Open Medicine, 4, pmid:27354917.
The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing dvidence-based practice: appendix C: evidence level and quality guide. https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf
Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020). Medication administration errors and contributing factors among nurses: A cross sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC Nursing, 19, 4. https://doi.org/10.1186/s12912-020-0397-0