| Objectives1.To retrieve and evaluate the quality of clinical practice guidelines on prevention and management of medication administration errors and provide recommendations for the improvement of clinical medication safety.2.To use Delphi method to decide the included scientific and clinically feasible recommendations in preventing and managing medication administration errors and thus to guide the change of clinical practice.3.To apply the guidelines-based strategies in prevention and management of medication administration errors,and to explore measures to improve nurses'compliance with the recommendations and its clinical effectiveness in patients'medication safety.Methods1.ACE Star model was used as a theorectical framework in this study.The included guidelines recruited from international guideline websites,to websites of academic societies or institutions,and electronic databases were evaluated and analyzed by AGREE?or JBI critical appraisal checklist for text and opinion papers,to provide recommendations for reducing medication administration errors.2.A questionnaire was developed,and Delphi method was used to evaluate the importance and feasibility of the evidence to form strategies on the prevention and management of medication administration errors in a hospital ward.3.Guided by the Practical Application of Clinical Evidence System of JBI,using experimental research method,the research team selected a sugical ward in a tertiary teaching hospital in Shandong Province as the study setting of the pilot test.Evidence-based nursing practice was implemented in pilot ward from August to December 2019.The baseline level was gathered,and the clinical impacts of the guideline-based intervention were evaluated at the level of nursing staff,patient and hospital system,respectively.Results1.In total,there were ten guidilines included.Four of them were evidence-based and the other six were expert consensus.One evidence-based guideline was rated according to AGREE II as A,three were rated as B.All 6 expert consensus guidelines were rated as included.Totally 44 items of recommendation were summarized from 10 guidelines.2.Two rounds of Delphi were performed with effective recovery rate of 100%and 90.91%prospectively.Two rounds of Delphi results showed that the expert authority(0.86 and 0.87),average importance value?3.50.Feasibility value was 3.18-5.00 in round one and?3.50 in round two.Average coefficients of variation of importance were 0.09 and 0.10 prospectively,and average coefficients of variation of feasibility were 0.21 and 0.10 in round one and round two.Kendall's concordance coefficient was increased in round two(0.308,0.328)than in round one(0.286,0.237),with significant difference in coordination coefficient(P?0.01).After two rounds of Delphi,11 items were deleted,1 item was added,and 6 were revised,with 34 recommended strategies for prevention and management of medication administration errors eventually.3.Before the implementation of evidence-based prevention and management strategies of medication administration errors,a baseline survey in pilot ward showed:the implementation rate of review indicators was low,and the implementation rate of 8 review indicators was less than 50%.The main obstacles to clinical practice are nurse factors(lacking of medication-related knowledge,lacking of evidence-based knowledge),patient factor(lacking of awareness of involvement in medication safety),system factor(lacking of medication knowledge training system).There were no statistical significance difference(P?0.05)in nurses composition and general information of patients before and after the application.After the application of evidence,nurse compliance was improved significantly(the execution rate of standards>50%),as well as the level of patient safety culture and the practice,attitudes,and knowledge towards evidence-based practice of nurses and nurse medication environmental perception(P?0.05).The level of inpatients involvement in patient medication safety were higher than the basal level(P?0.05).Besides,a series of system-level improvements have also been made to ensure patient safety.Conclusion1.Medication safety is an important part of patient safety,reducing and preventing medication administration errors is key to patient safety.Recommendations on prevention and management of medication administration errors based on best clinical practice guidelines can offer evidence for regulated medication and improve safety of medication.2.Delphi method modified and improved recommendations based on evidence of prevention and management of medication administration errors,improving the scientificity,reliability,and practicality of the evidence.3.Evidence-based practice projects can facilitate the transformation of evidence into clinical practice and improve it at the levels of nurses,patient and the system. |
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