Posted at 12.11.2018
William identified medication error as any problem in prescribing, dispensing or administration of a medication, whether such errors lead to undesirable consequences or not. A medication problem may lead to severe effect to both the patient and a healthcare facility. Patient could suffer from side effects of the wrong medication, permanent accidents could occur or in the most severe case scenario, death of the patient. As a result of medication problem, patient might have an extended remain in a healthcare facility and a healthcare facility is liable to pay injuries and incur the price tag on clinic stay of the patient.
When medication errors occur, it can affect the patient's self confidence and trust on the medical team. There are numerous reported circumstance of medication error in the mass media and this could damage a healthcare facility reputation.
Studies have been done and the results have shown that the nursing department is the primary department involved whenever a medication error experienced occurred. Drug supervision is often associated as the bigger risk areas in medical practice. Along the way of prescribing to the dispensing and the administration of the drug, the pharmacist or nurse may intercept prescribing errors and the nurse may capture dispensing errors but nurses tend to be the final specific engaged before administering of the medicine to the individual.
Numerous other studies have been done to look for the cause of medication error. Guidelines and steps have since been released to reduce medication error. Nursing schools took steps to enhance the knowledge of a nursing pupil in pharmacology and private hospitals have addressed conditions that contributed to medication error. A local federal medical center in Singapore for example, has taken huge steps to boost and reduce medication mistake.
In that medical center for example, nurses are required to wear medication vest with a "do not disturb" advice written on the vest. This is to indicate to patient or relative and fellow healthcare professionals to not distract the nurse who's serving medication which will allow the nurse to target while administrating drug. Technological support like the computerised medical doctor order admittance (CPOE) system in addition has been introduced to assist the nurse through the process of supervision of the medicine. To improve the knowledge on pharmacology, regular dialogue and in-service discussions are kept.
Despite employing many changes, medication error is still on the rise. For this research, the researcher try to reduce medication problem by using a non experimental, descriptive and quantitative research and look at the nurse itself and identify other possible factors which may have added to medication mistake. An important area for research and target for this newspaper is to find out if there is any relationship between abnormal work shift routine among nurses and medication problem in the ward.
Definition of term used in shift work.
In Singapore Basic Hospital, morning change is from 0700hrs-1600hrs while day move is from 1300hrs-2000hrs. Evening move will be from 2100hrs to 0730hrs.
Irregular work change pattern: Repeated alternating and rotating of shift from morning to afternoon transfer or vice-versa.
Rotating transfer: Work structure consisting of times, afternoon and night time shifts. Move can be from morning to evening or evening to morning hours. Rotation can be fast for example, a staff can work evening shift today and be morning change on the next day which could go on for two days prior to the staff off days and nights.
In a world and environment where services are to be provided night and day, has lead to an increase popular for switch work. It's important for the organisation to plan a good staff schedule to meet up with the demands of the customers. This is especially so in healthcare industry. With information of shortage variety of nurses from about the world, a highly effective scheduling shift is vital for the success of a medical center. Medical center wards for example, need to be staffed a day, 7 days a week, often with limited quantity of nurses (Clark and Walker, 2011). Studies have been conducted and it exhibited that transfer work can have significant impact on the nurse. It is important to understand the side effects of shift focus on the nurse as patient's life is at risk if nurses are created to work unwanted work schedules. It impacts the nurse performance at work. Extended hours, fatigues and insufficient rest or respite time to recuperate between shifts are associated with an increased risk of mistakes. Fatigue is recognised among the contributing factor in patient safety incident such as medication error. Absenteeism is also a major problem among nurses in medical center. Nurses who worked transfer work have been found to have a more impressive range of absenteeism rate.
Significance of the study
There's a restricted number of analysis done to concretely associate that there is a link between irregular work shift structure and medication error. If this study is suggestive that there is an association between unusual work shift routine and medication problem, the researcher hopes that the Ministry of Health (MOH) can ensure that steps are considered by the employers to lessen the potential risks of transfer work of the nurses. Employers have to be aware of the actual safety impact, of any nurse working on shift and the need to manage transfer work to improve patient safety
A overview of literature on the topic was conducted. The literature review identified four key factors that could influence a nurse focusing on shift:
Fatigue, problems and accident
Many of medical and safety effects of transfer work are associated with a disruption of the body clock or the circadian tempo. Circadian rhythms are controlled by our hypothalamus in the mind. The circadian rhythms of move workers working nights or rotating shifts can be disrupted which can lead to sleep disruptions, fatigues and health results.
There are best shift habits which can help mitigate disruption to the circadian rhythms and therefore reduce the risks, such as investing in place forward spinning shift habits- quite simply, moving from early to overdue to night time shifts somewhat than invert.
Studies show that most adults require between seven to eight hours a sleep each day. Sleep is protective as it allows the body and mind to extract and relax. Numerous studies pertaining to change work have suggested that shift worker slept smaller than the required seven to eight hours and the grade of the rest is poorer. Sleeping deprivation can be accumulated which is one of the contributing factors to poor health, tiredness or burnout.
Fatigue, mistakes and accidents
Fatigue is defined as the drop in mental performance that results from long working hours, lack of sleep, poor quality rest or inadequately designed switch work leading to disruption of the internal body clock. Fatigues show so it cans slower a person's reaction, lowering one's vigilance, increased risk taking behaviours, impaired problem handling capacity and it make a difference a person's decision making capacity. In healthcare, staff exhaustion has been accepted as a contributory factor to patient security incidents including medication problems (NPSA, 2004).
Numerous studies show that change work can have a substantial impact on health of the change worker. It really is greatly accepted that inadequately managed transfer work can have a poor effect on mental health, cardiovascular system, gastrointestinal system and reproductive system. Numerous other studies have shown that with the influences of shift focus on health, business lead to a rise in absenteeism rate of the switch worker. This will likely cause staffs that are on day off, being called in to work to displace the personnel that travelled for unwell leave or staff to be shifted to focus on a different plan or nurses having to stretch and look after more patient. This may lead to medication mistake.
Polit and Beck (2010, pg 16) define research method as "techniques researchers use to structure a study and to collect and evaluate information highly relevant to the study question". A quantitative methodology using a descriptive design is suggested for this review.
The researcher thought we would conduct this analysis at Singapore Standard Medical center (SGH). This medical center is chosen because it is Singapore's flagship tertiary clinic with an estimated amount of 1521 bedrooms and 3627 nurses.
The researcher will sought consent and authorization from MOH, SGH Section of Research and the school ethical table to conduct the analysis. Once agreement is granted, the researcher will address MOH for financing. Upon approval, the researcher will employ the service of a team of nurses and an expert statistician to assist with the analysis. Nurses appointed will be trained to be data collectors and you will be given guidelines and protocol to stick to. The statistician will assist in the statistical evaluation. Software applications called Statistical Deal for Social Sciences (SSPS) will be used. Power analysis may also be utilized by the statistician to look for the appropriate test size necessary for this research.
A questionnaire will be used as the info collection method. Questionnaire was chosen because opportunity for biasness will be lesser as the questions will be provided in a constant manner (Burns up and Grove, 2011). It will also offer privileges to anonymity and confidentiality as labels are not required to be written on the questionnaire. However there are a few limitations with all the questionnaire because the options given are given by the researcher and is also brief. This might affect the validity and accuracy of the data as it can not reflect the true opinion of the subject. The researcher will collect the examples through the info collected by using questionnaire.
Structured interview may also be conducted because of this study on the basis of the books review that evaluated other possible ill-effects of shift work and exactly how it might have resulted in the medication error. This set up interview allows the subjects to raised express themselves and give a more correct account on matter. To reduce recall biasness for this research, interviews will be conducted within 3 days and nights of the medication mistake event. All interviews will be conducted in a meeting room provided by a healthcare facility. This is to ensure that the to privacy and to anonymity and confidentiality are honored.
Burns and Grove (2011, pg 49) define research design as "a blueprint for the carry out of a study that maximizes control over factors which could interfere with the study's desired results".
For this analysis, a non-experimental, descriptive, quantitative strategy was picked.
The researcher chose a non experimental review because the researcher is more thinking about exploring possible relationships between unusual work shift structure and medication problem than to test a possible way to the challenge (Polit and Beck, 2010)
Burns and Grove (2011, pg 35) express descriptive as a design used to help identify new meaning and problems with current practice with a view to boost practice outcomes in the near future. A descriptive research is chosen because limited amounts of research have been done and little is well known if there is any connection between unusual work shift pattern and medication problem in the ward. Outcome of this review can offer a basis for future research.
In order to undertake the above study, a quantitative way was chosen by the researcher. Uses up and Grove (2011, pg 34) explain quantitative research as "a formal, objective, thorough, systematic process where numerical data are being used to obtain information about the world". A quantitative approach is most effective for this subject matter because it allows the researcher to evaluate and analyze the data using information and rule out other possible factors that may donate to medication error. This method will also permit the researcher to study in detail, the partnership between the impartial and dependent adjustable and be more goal about the studies of the research.
A retrospective design was chosen. Polit and Beck (2010, pg 235) illustrate retrospective research as "a sensation observed in today's is linked to phenomena occurring before". This design is better suited for this matter because the info will be gathered after the medication error had occurred. The researcher will focus on the presently happening end result, and then attempts to ascertain when there is any association with the irregular work shit pattern of the nurse. The researcher experienced no control over the impartial adjustable, which is the abnormal work shift design of the subject as the presumed causative factor experienced already occurred.
Permission will be obtained to perform the study from MOH, the hospital honest committee, the medical mother board and medical directors. Upon endorsement, the researcher will obtained authorization to get access to the chance Management System (RMS). This will likely allow the researcher to gather the data required to recruit the content.
At a healthcare facility, any clinical event for example, medication problem, must be reported in the RMS by the nurse involved and his/her ward supervisors. While using support of the nursing directors, the researcher will seek cooperation from ward supervisors from across the hospital to take part in this study. The aim, topic and details of the analysis will be e-mailed to the ward supervisors and information on the analysis were to be distributed to the ward staff during roll-call prior to the start of every shift.
The researcher will usage of the RMS everyday to monitor for just about any reported situations of medication mistake. If the medication error experienced occurred in the ward, the researcher will e-mail the ward supervisor involved and can obtain consent to execute the study. Upon getting the consent, the trained data collector will be delivered to the ward with a couple of questionnaire that is stored in a laptop provided by the researcher. The data collector will than asked the nurse who possessed dedicated the medication problem to complete the questionnaire in a tranquil comfortable environment. The data collector will than photocopy 2 weeks of the nurse duty roster before the medication error event.
With the assistance of a statistician, the researcher will than examine the questionnaire and the working timetable of the nurse involved and determines if the subject meets the criteria to be included in the sample for the analysis.
Population and Sample
Kerlinger and Lee (2000), illustrate people as all elements (individuals, items or chemicals) that meet specific group of requirements for an inclusion in a study. The population for this review will be nurses who got committed a medication mistake in the ward and have reported the occurrence on the RMS.
Burns and Grove (2011, pg 51) identifies a sample as "a subset of the populace that is decided on for a specific analysis, and the people of a sample are the subject matter or members". In such a study, the examples are nurses who acquired committed a medication error and fulfilled the sampling standards during the period of data collection. The writers add that sampling requires selecting a group of people, incidents, behaviours or component with which to execute a report (Burns and Grove, 2011).
According to Uses up and Grove (2011, pg 291), sampling standards are "characteristics needed for eligibility or account in the mark population". Because of this study, the topic had to meet up with the following criteria to be contained in the sample.
SGH nursing personnel.
Have conducted a medication problem and reported the occurrence in the RMS.
Have worked abnormal work shift style for 2 consecutive weeks.
Can be of either gender or any race.
Have at least 1 year of working experience in the same ward/self-control.
Willing to take part in the research.
Subjects who did not meet the requirements will be excluded from the analysis.
For this analysis, the researcher determined to make use of purposive sampling. Burns up and Grove (2011) summarize purposive sampling as a "judgemental" or "selective sampling". This technique is appropriate because of this study because proportionality is not a major concern and it will permit the researcher to purposively select the targeted sample quickly and review in-depth based on the topic.
Issues that might affect sample recruitment and test size
Issues that may affect the sample recruitment and sample size could be the unreported circumstances of medication problem.
Subjects who satisfied the sampling conditions might be coerced to participate in the research because of the affect from the ward supervisors. They might also dread that if indeed they did not take part in the study, they may be punished and it might affect their job performances.
Subjects who fulfilled the sampling criteria might be not prepared to take part in the study due to time constraint.
Burns and Grove (2011, pg 361) define data collection as a "procedure for acquiring the themes and collecting the data for the analysis". Burns up and Grove (2011, pg 362) contributes that during the duration of data collection, "researcher should concentrate on obtaining themes, training data hobbyists, collecting data in a steady way, maintaining research control buttons as indicated in the analysis design, guarding the integrity (or validity) of the analysis and solving problems that threaten to disrupt the analysis".
A team of nurses will be appointed to be data collector. They'll be trained and procedures and protocols will be given for them to adhere to.
Questionnaires design by the researcher will be used as the data collection method. Burns and Grove (2011, pg 353), explain questionnaire as "a printed self-report from designed to elicit information through written or verbal responses of the topic. The information obtained from the questionnaire is comparable to that obtained by an interview, however the questions tend to have less depth".
Questionnaires tend to have a low response rate. In an attempt to overcome this problem, the researcher will create the questionnaire using Microsoft Term and the questionnaire will be stored in the laptop provided by the researcher. Data collectors will go to the ward in person with the laptop and the necessary essential needed and topics must complete the questionnaire using the laptop provided. Themes must complete the questionnaire online to be able to minimise human mistake when the statistician is collating the info. To avoid the employers from being able to access to the info given by the topic, the info collector are instructed by the researcher to bring the topic to quiet room, ideally the tutorial room in the ward, and stay with the subject whilst the subject is doing the question. A "do not disturb" sign will be located on the entranceway. Upon conclusion of the questionnaire, the info collector will save the info in a separate folder with passwords in support of the statistician and the researcher will have access to it.
Before the questionnaire is consider suitable to be used and distributed across the hospital, a panel of experts, comprising of a doctor, a mature nurse clinician, a older pharmacist and a agent from the ethics committee, will review the questions in the questionnaire. The -panel of experts will assess the content validity of the questions and the researcher will seek for constructive feedback and will address issues advised by the -panel of experts. This is done to ensure that questions asked are obvious and is simple for at the mercy of understand.
According to Uses up and Grove (2011, pg 332), "reliability is concerned with the regularity of the measurement method". Exactly the same set of the online questionnaires will then be tested out on two wards to get the steadiness in the particular replies. The trained data collector will ensure that the questionnaires will be achieved in a calm comfortable environment to prevent interruption.
Structure of the question
The questionnaire will consist of largely close-ended question and a few open ended questions and is split into 3 portions.
In section A, a Yes or No option will be provided and subjects are required to tick the clear bins provided. Questions will be asked to find out if the subject meet the sample criteria.
In section B, a True or Fake option will be provided and themes are required to tick the unfilled boxes provided. Questions will be asked to evaluate subject knowledge on medical center polices and protocols released to reduce medication mistake.
In section C, the researcher will use a Likert-type range to assemble data. Six different response options which range from disagree to firmly disagree will be provided by the researcher. Questions will be asked on subject's behaviour and views on the impact of unusual work shift style and exactly how it impacts the nurse performance at the job. In section D,
Close-ended questions are questions created by the researcher with available option to choose from. It can be used because this is a descriptive analysis and it will enable the researcher, with the help of a statistician, to assemble data and understand in-depth regarding a wide spectrum of information and situation known by the topic (Burns and Grove, 2011).
Open-ended questions are questions which require written reactions from the subject. Open-ended questions are also used for this study because it will allow the researcher to assemble information about values, attitudes ideas, knowledge, or intention of the subject matter in regards to to the irregular work shift pattern (Melts away and Grove, 2011).
Subjects will than go through a structured interview program on a separate particular date with the researcher to encourage the topic to elaborate further about how irregular working schedule can affect the performance of an nurse in the ward. According to Melts away and Grove (2011, pg 350), "an interview entails verbal communication between the researcher and the topic during which information is provided to the researcher". A structured interview is necessary for this study since it will permit the researcher to explore in-depth and elicit more info from the test size (Melts away and Grove, 2011). To reduce recall biasness for this analysis, interviews will be conducted within 3 days of the medication error incident
According to Uses up and Groves (2011, pg 52), "data analysis reduces, organizes, and provides meaning to the info". Following the data was accumulated from the subject obligation roster, questionnaire and the interview, the statistician will coordinate and analyzed the info using descriptive statistic. Analysis of quantitative data is carried out using numbers. The reply to each one of the question in Section A and B of the questionnaire will be coded using statistics. The answer each question at Section C will be coded using volumes on an ordinal scale of 1 1 to 6. The statistician will help in collating the info using Statistical Package for Sociable Sciences (SSPS). The rate of recurrence of a specific response to a question will be calculated as a share and the data will be illustrated using graph and bar charts.
This review is important because there are incredibly limited numbers of studies associating unusual work shit design and medication problem. Although insurance policies and steps are put in destination to reduce the range of medication error in the hospital, the amount of medication error continues to be increasing.
Using the findings of this analysis and with the approval of MOH, the hospital can explore of option ways to lessen medication error. Cost benefits should not be the primary matter but the safe practices of the staff and patients must be considered.
The findings of the study may be used to improve the nurse's performance at the ward level, thus resulting in an improved quality look after the patients. The studies of this study might also reduce the absenteeism rate of the nurse.
At the hospital, Trend attention system is utilized by medical supervisors for scheduling of staff roster and the allocation of staff at ward level. Using development care system, the ward supervisor can schedule staff to turn shifts in every 2-3 days or atlanta divorce attorneys 3 to 4 week. The nurse supervisor should avoid weekly or fortnightly working switch pattern unless requested by the personnel. Where possible, take up a morning hours to afternoon shift working schedule instead of having the personnel to work evening followed by morning hours shift. This is to ensure that staffs have sufficient rest.
Human Source (HR) department may possibly also think of alternate ways assist wards that is understaffed without having to call in staff to work on their slated off times.
The total period of this study will be over 24 months. In the first three months of the analysis, the researcher will write a written authorization to a healthcare facility and seek cooperation to conduct the analysis. Through the fourth month, the researcher will searched for approval from the hospital, medical ministry and the college or university institutional review panel (IRB) which will be reviewed on point 6 under honest concerns. The researcher will than seek the services of team of nurses and train these to be data collector. A statistician will also be hired because of this research. Recruitment of research individuals & data collection will start on the 9th month of the study and will continue for an interval of just one 1 1 year. The statistician will than help out with statistical examination. Writing of results will take put on the 22nd month to the 23rd month and the researcher will post the consequence of the analysis to MOH on the 24th month. During this time period, there will be research team meetings and additional development/loan consolidation of job and upgrading of books review on every last Saturday of each month.
Months of Projects
Searching for clinic for involvement of study.
Seeking permission and co-operation from the hospital.
Seek agreement from institutional review mother board (IRB) and Ministry of Health (MOH)
Hiring staff: Team of nurses and training them to be data collector/ Statistician
Collating and writing up results
submitting leads to MOH for review
Research team meetings and further development/consolidation of task team
Ethical consideration is an important element in research studies. It begins at the identification of the research topic and is also applied throughout the span of this review. If this research were to be conducted, the protection under the law to self-determination, privateness, anonymity and confidentiality and enlightened consent will be totally observed.
To render this study ethical, the researcher must obtain agreement and sought acceptance to carry out this analysis from the university Institutional Review Board (IRB) & the hospital's ethical committee. Burns up and Grove (2011, pg 130) illustrate IRB as "a committee that reviews research to ensure that the investigator is doing the study ethically".
Burns and Grove (2011, pg 122) establish educated consent as the "prospective subject's agreement to participate in a report as subject after the transmitting of essential ideas and content from the investigator to the prospective subject". The researcher will prepared the things about the seeks and reason for this review and the techniques use to accumulate the data. Melts away and Grove (2011, pg 125), adds that "research workers using questionnaires to gather relatively safe data do not need to obtain a signed consent form from the topics. The subject's conclusion of the questionnaire may serve as consent". At the top of questionnaire, the researcher includes a assertion such as, "your completion of the questionnaire shows your consent to take part in this study. "
The rights to self-determination will also be maintained. Regarding to Burns and Grove (2011, pg 110), "the to self-determination is based on the ethical basic principle of admiration for individuals, and it indicates that humans can handle handling their own destiny". The researcher will treat topics as an autonomous real estate agents by informing them about the analysis and allowing them to voluntarily choose to participate or to withdraw from the with no penalty (Uses up and Grove, 2011). Because of the vulnerability of the topic, due to the medication error done, the researcher will reassure the subjects and can ensure that content are not coerced into participating in the study.
The researcher will protect the subject's to level of privacy, by informing and acquiring the subject agreement to get involved and voluntarily talk about private information with the researcher. Private information includes information received during the interview session such as the subject's attitudes, beliefs, behaviours, ideas and record (Melts away and Grove, 2011). The researcher will reassure the subject that any information received will never be shared minus the subject's knowledge or authorization.
According to Uses up and Grove (2011, pg 117), "based on the right to privateness, the research subject has the to anonymity and the right to assume that the info gathered will be kept confidential". The authors add that "complete anonymity is out there when the subject's personal information cannot be associated, even by the researcher, with his or her specific responses". Because of this study, anonymity will be purely observed by devoid of the subject's to write their name on the questionnaire rather than including the name of the topic on research survey.
The ethical consideration of confidentiality will totally be maintained by the researcher. Melts away and Grove (2011, pg 117) define confidentiality as "the researcher's management of personal information shared by a subject or participant". The researcher will avoid sharing information minus the permission of the topic. Information received and the data accumulated will be stored in the researcher computer. Data stored in the computer will be covered by software with top secret password to be able to protect subject's confidentiality.
While conducting the study, the topic might withdraw from the analysis due to various reasons. This may affect the entire data of the study.
The nurse might not collaborate with the researcher and the team while training the nurses in data collection. Being medical researchers, they are well trained and competent. By training them, the researcher and the team are questioning their skills.