Medication errors in health care reduce the quality of care and increase risks associated with patient safety and security. Kang et al. (2017) highlighted in their study that organizations face at least five near misses every month. The interdisciplinary plan aims to solve prescription, dispensing, and medication errors in the ICU unit of health care. 

Objective

Implement an error reporting and computerized physician order entry (CPOE) with direct communication and root-cause analysis to reduce prescription, dispensing, and medication errors and increase interdisciplinary communication between nurses, physicians, nurse analysts, and pharmacists. 

NURS FPX4010 Assessment 3 Interdisciplinary Plan Proposal

Questions and Predictions

The Socratic questioning approach was adopted to analyze the objective and answer five of the most critical questions. 

1. What actions should the nurse leader take to prepare the health care professionals to implement the plan?
   1. Nurse leaders should train the health care professional by collaborating with IT professionals, motivate nurses to adopt the change, provide literature related to the plan, and increase technological competencies. 
2. How much burden will the action plan put on nurses and managers?
   1. During the training stage, a burden on nurses and manager increase by four hours every week for one month. During the practice, the plan will increase the burden on nurses as they have to administer medication, report the error, and communicate with physicians and pharmacists. 
3. What are the different costs the plan includes from training health professionals to implementing the plan and is the cost feasible?
   1. The plan includes software procurement costs, software testing costs, training costs, and IT network infrastructure costs. The costs are one-time as once the system is implemented, the benefits are long-time. 
4. How to evaluate and measure computer science and system handling competencies among health care professionals?
   1. Confirmatory factor analysis (CFA) questionnaire classified into three main domains of informatics skills, computer skills, and informatics knowledge with scale rating help in measuring the competencies. 
5. What measuring criteria should be used to evaluate the effectiveness of the plan in reducing errors?
   1. The first criterion is to compare the errors in the pre-and post-intervention period to find whether the interdisciplinary plan is effective. The second criterion is to conduct a survey to understand the perspectives of the team. The third criterion is to compare the results with other similar health care settings and error reporting systems to check the effectiveness of the two systems. 

NURS FPX4010 Assessment 3 Interdisciplinary Plan Proposal

Change Theories and Leadership Strategies

As the plan has the objective to reduce medication errors by implementing a new error reporting system, issues such as resistance to change and conflicts in health care professionals during interdisciplinary collaboration can pose barriers (Rishoej et al., 2017). The first change theory is Lewin’s theory of change, which has three stages namely unfreezing, moving, and refreezing. However, the theory does not include outcome evaluation and an approach to promote interdisciplinary collaboration stages. As a result, Lippitt’s theory of change was selected, which includes five primary stages including seven phases. The action plan starts from the process of assessing the issue in the problem identification stage, which includes three different phases of diagnosing the issue, assessing the capacity, motivation, and need for the change, evaluating change process, and motivation among the interdisciplinary team for the change process (White & Brown, 2019). The problem of medication error and its associated errors were analyzed in this stage based on its need and adverse effects of errors on patient safety (Rishoej et al., 2017). This stage helped in analyzing the perspectives of the interdisciplinary team to motivate them to adopt the change. 

The second stage of the theory is the planning stage, which includes selecting the progressive change objective phase. This phase was used to create an objective to implement an error reporting and computerized physician order entry (CPOE) with direct communication and root-cause analysis to reduce prescription, dispensing, and medication errors and increase interdisciplinary communication between nurses, physicians, nurse analysts, and pharmacists (Rishoej et al., 2017). The second phase is to assign roles to the interdisciplinary team and promote communication between them by using assertive communication techniques. The final phase in this stage is to prepare the team to implement the proposed intervention (White & Brown, 2019). The phase was used to train the nurses and provide resources to them to prepare the team to implement the change. The fourth stage is to implement the plan at a small scale by using the transformational leadership style as this style promotes interdisciplinary communication, demonstrating knowledge-sharing, shared responsibilities, and shared decision-making (White et al., 2021). The final stage is to evaluate the change by comparing errors at pre-and post-intervention to update the action plan if needed (White & Brown, 2019).

NURS FPX4010 Assessment 3 Interdisciplinary Plan Proposal

Team Collaboration Strategy

The roles are as follows

• Nurses will administer the medication, compares the dispensed medication with the patient’s EHR, report the errors to pharmacists, communicate with the physician, and readminister the medication after resolving errors (Rishoej et al., 2017). 
• The pharmacist will print the medication information with the patient’s record and dispense the medication, communicate with the nurse to inform about the change in packaging of medication and resolve any errors reported by nurses (Schiff et al., 2015). 
• The nurse manager will manage the resources and monitor the effectiveness of the intervention, budget management, and solve conflicts (Rishoej et al., 2017). 
• The nurse leader will administer the nurses, advocate them in shared decision-making, manage to schedule the work, manage work-load, and analyze error analytics. 
• Physicians will directly enter the medication details in EHRs and error reporting systems with dosage and purpose of medication (Schiff et al., 2015). 

The collaboration strategy includes role-based care, shared decision-making, and issue analysis using the root-cause analysis to reduce medication errors (Mahdizadeh et al., 2015). For example, role-based care help in identifying the unit where medication error caused, and as the role of the nurse is different from the role of pharmacist or nurse manager, this strategy is effective (Lashko, 2021). The root-cause analysis increases communication and shared decision-making and it also helps in preventing blame culture. 

Required Organizational Resources

The organization will require all the nurses who administer the medication, physicians who prescribe the medication, and pharmacists. Further, the nurse leader and manager for every unit will collaborate with informatics nurses to statistical outcomes of the intervention (Farzandipour et al., 2021). Further, IT technicians and software usage trainers will implement the error reporting system, train the health care professionals, and troubleshoot the system whenever there is an error. Also, the organization will require a network infrastructure with EHRs, cloud-based servers, communication protocols, computers, and security software (Schiff et al., 2015). The organization has all of the above resources except the error reporting and CPOE system. One-time investment software development costs around $100,000. The overall cost during training includes the cost of IT professionals to train health care professionals ($20,000), data analytics costs ($10,000), and management costs ($50,000). 

NURS FPX4010 Assessment 3 Interdisciplinary Plan Proposal

References

Farzandipour, M., Mohamadian, H., Akbari, H., Safari, S., & Sharif, R. (2021). Designing a national model for assessment of nursing informatics competency. BMC Medical Informatics And Decision Making, 21(1). https://doi.org/10.1186/s12911-021-01405-0

Lashko, N. (2021). A coordinated collaboration approach to enhancing integrated health care within primary health care at North Richmond community health. International Journal Of Integrated Care, 20(3), 175. https://doi.org/10.5334/ijic.s4175

Mahdizadeh, M., Heydari, A., & Karimi Moonaghi, H. (2015). Clinical interdisciplinary collaboration models and frameworks from similarities to differences: a systematic review. Global Journal Of Health Science, 7(6). https://doi.org/10.5539/gjhs.v7n6p170

Rishoej, R., Almarsdóttir, A., Christesen, H., Hallas, J., & Kjeldsen, L. (2017). Medication errors in pediatric inpatients: a study based on a national mandatory reporting system. European Journal Of Pediatrics, 176(12), 1697-1705. https://doi.org/10.1007/s00431-017-3023-8

Schiff, G., Amato, M., Eguale, T., Boehne, J., Wright, A., & Koppel, R. et al. (2015). Computerized physician order entry-related medication errors: analysis of reported errors and vulnerability testing of current systems. BMJ Quality & Safety, 24(4), 264-271. https://doi.org/10.1136/bmjqs-2014-003555

White, K., Dudley-Brown, S., & Terhaar, M. (2021). Translation of evidence into nursing and healthcare. Springer Publishing Company.

Wright, M., & Mainous III, A. (2018). Can continuity of care in primary care be sustained in the modern health system?. Australian Journal Of General Practice, 47(10), 667-669. https://doi.org/10.31128/ajgp-06-18-4618

NURS FPX4010 Assessment 3 Interdisciplinary Plan Proposal