NURS FPX 8030 Assessment 1 Building the Case for Healthcare Improvement

Name

Capella university

NURS-FPX 8030 Evidence-Based Practice Process for the Nursing Doctoral Learner

Prof. Name

Date

Building the Case for Healthcare Improvement

(Slide 1) Hello, everyone. My name is  _______, and today, I will discuss medication errors, a critical patient safety issue, focusing on Martin Luther King Jr. Outpatient Center. 

Presentation Agenda

(Slide 2) The presentation will cover the following aspects 

• Medication Errors as Patient Safety Problem at Martin Luther King (MLK) Outpatient Center
• External Sources Supporting the Need for Change
• Why this is a Priority for Stakeholders
• Proposal of Quality Improvement Project 
• Expected Outcomes and Impact

Medication Errors as Patient Safety Problem

(Slide 3) Medicine administration mistakes within healthcare facilities function as dangerous safety hazards that result in negative drug responses, extended treatment times, elevated medical expenses, and occasionally fatalities. Data shows 44k to 98k deaths annually due to this, with an increased cost of 38-50 billion dollars given the care cost, disability concerns, and productivity loss (Tariq et al., 2024).

Patient safety issues at Martin Luther King Jr. Outpatient Center frequently cause repeated dosage errors, making it a priority to address them. Medication errors develop at different stages of drug prescribing and dispensing and drug administration processes, which create possible risks for patient health. Several errors occur during medication management due to information transfer problems, incorrect drug dose administration similarities between drug names commonly known as Look-alike and sound-alike (LASA) medications, and inadequate verification procedures (Tariq et al., 2024). Some examples of medication errors include:

Type of Medication Error	Description
Prescription Errors	A doctor prescribes the wrong medication or incorrect dosage.
Dispensing Errors	A pharmacist gives the wrong drug or mislabels the prescription.
Administration Errors	A nurse or caregiver gives the wrong dosage at the wrong time or by the wrong route (e.g., IV instead of oral).
Omission Errors	A necessary medication is not given at all.
Monitoring Errors	A patient is not properly observed for side effects or interactions.

 

The solution needs evidence-based programs to minimize errors and strengthen safety measures and healthcare results. The following sections will examine supporting evidence and new solutions for this problem.

Internal Evidence Supporting the Need for Change

(Slide 4) The medical facility at Martin Luther King Jr. Outpatient Center demonstrates substantial medication safety risks in its internal data. About 150 medication errors occurred between 2022 and 2024 at MLK Jr. Outpatient Center, where mistakes in administration and incorrect dosage amounts resulted in patient injuries. A yearly audit of patient cases conducted in 2023 showed a 15% failure rate of high-risk medication use during the monitored period of one year. Safety protocols and standard medication verification demonstrate significant issues underlining why healthcare organizations should maintain better clinical safety practices.

External Sources Supporting the Need for Change

(Slide 5) Evidence has demonstrated high medication errors, so doctors need better safety procedures as soon as possible. The researchers discovered prescribing mistakes as the most common medication error since they occurred in 54.4% of all reported cases (Atmaja et al., 2024). Wrong-label preparation errors (23.4%) and wrong-dose preparation errors (11.5%) constitute added risks to medication safety systems. Medical errors create patient health complications, leading to longer hospital stays, where some patients stay more than 11 days because of medication issues (Atmaja et al., 2024). The identified data shows that correct medicine prescribing methods, precise medication labels, and rigorous adherence to drug safety requirements strongly improve patient outcomes by reducing safety risks. 

Analyzing 3,372 medication error incidents reported from Norwegian hospitals further proved why medication safety must improve urgently (Mulac et al., 2020). The results demonstrate that administration is the most susceptible phase in medication delivery since errors happen in 68% of cases. Most reported incidents included wrong dose, strength, or frequency errors identified at 38%, whereas omission errors reached 23%, and bad drug errors caused 15% of cases (Mulac et al., 2020). These statistics document the medication administration process as high-risk because prescribing and administration errors occur frequently, requiring immediate action to implement stronger verification systems, better training programs, and stricter medication safety protocols to stop similar mistakes from happening again.

Why this is a Priority for Stakeholders

(Slide 6) Patient safety remains threatened by medication errors, which produce significant negative implications for patients, healthcare providers, and the community. These medication errors trigger adverse drug reactions and extend hospital stays together with increased healthcare expenses and prove fatal, which makes them the highest priority for attention. For instance, it is a reason for approximately 3.5 million visits to a doctor, 41% of hospital admissions, and 22% of readmissions (Rasool et al., 2020). The safety of patients deteriorates when they face medication errors, which may lead to destructive results or therapeutic deficits.

The occurrence of medication errors leads healthcare providers to an increased risk for malpractice claims while simultaneously diminishing trust in their profession and causing professional consequences. Excess medication errors will deteriorate public trust in healthcare facilities and cause health outcome inequalities throughout the community (Rodziewicz et al., 2024). The 15% high-risk medication error rate discovered during the MLK Jr. Outpatient Center’s Quality Improvement Audit (2023) emphasizes that the hospital needs immediate action to protect patient safety and enhance medication safety procedures.

Proposal of Quality Improvement Project

(Slide 7) The desired state at MLK Jr. Outpatient Center needs medication errors to decrease dramatically through safety protocols with standardized practices, skill-based training, and electronic medication verification systems. The quality improvement project will work towards deploying barcode medication administration (BCMA) while developing electronic prescribing systems (e-prescribing) along with routine competency assessments for staff regarding medication safety procedures (Rodziewicz et al., 2024; Williams et al., 2021).

This initiative would create significant outcomes such as higher patient safety, reduced adverse drug events, shorter hospital stays, and more efficient medication administration procedures. As told earlier, Atmaja et al. (2024) investigated prescribing errors that resulted in more than 50% of medication errors, thus showing the importance of developing advanced prescription verification systems. BCMA and nursing education are critical because about 70% of medication errors occur in the administration (Mulac et al., 2020). The institution can improve healthcare quality while advancing staff competency and delivering better patient results.

Expected Outcomes and Impact

(Slide 8) Summarizing the expected outcomes and impact of the proposed interventions: 

• Combining BCMA and e-prescribing systems will reduce medication errors by preventing prescribing and administration errors. 
• The system improves health results and shorter hospital durations by lowering adverse drug incidents (Williams et al., 2021). 
• Future workforce training sessions will improve medication safety protocol compliance, enhancing medication administration competency. 
• The optimized medication process will increase operating efficiency while decreasing wait times and enhancing system workflow (Ciapponi et al., 2021). 
• These improvements improve the hospital’s regulatory compliance, thus strengthening its accreditation status.

Conclusion

(Slide 9) In conclusion, medication errors pose a significant patient safety risk at MLK Jr. Outpatient Center, necessitating urgent action. Implementing BCMA and e-prescribing systems will enhance medication safety, reduce errors, and improve patient outcomes. Ongoing staff training and adherence to safety protocols will further strengthen competency and workflow efficiency. By prioritizing these improvements, the hospital can achieve better regulatory compliance, enhance public trust, and ensure safer healthcare delivery. Thank you for your time and commitment to improving patient safety.

References

Atmaja, D. S., Saksono, R. Y., Yulistiani, N., Suharjono, N., & Zairina, E. (2024). Evaluation of medication errors in one of the largest public hospital: A retrospective Study. Clinical Epidemiology and Global Health, 28, 101640–101640. https://doi.org/10.1016/j.cegh.2024.101640 

Ciapponi, A., Nievas, S. E. F., Seijo, M., Rodríguez, M. B., Vietto, V., Perdomo, H. A. G., Virgilio, S., Fajreldines, A. V., Tost, J., Rose, C. J., & Elorrio, E. G. (2021). Reducing medication errors for adults in hospital settings. Cochrane Database of Systematic Reviews, 2021(11). https://doi.org/10.1002/14651858.cd009985.pub2 

Mulac, A., Taxis, K., Hagesaether, E., & Granas, A. G. (2020). Severe and fatal medication errors in hospitals: Findings from the Norwegian incident reporting system. European Journal of Hospital Pharmacy, 28(1). https://doi.org/10.1136/ejhpharm-2020-002298 

NURS FPX 8030 Assessment 1 Building the Case for Healthcare Improvement

Rasool, M. F., Rehman, A. ur, Imran, I., Abbas, S., Shah, S., Abbas, G., Khan, I., Shakeel, S., Hassali, M. A. A., & Hayat, K. (2020). Risk factors associated with medication errors among patients suffering from chronic disorders. Frontiers in Public Health, 8(1). https://doi.org/10.3389/fpubh.2020.531038 

Rodziewicz, T. L., Houseman, B., Vaqar, S., & Hipskind, J. E. (2024). Medical error reduction and prevention. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK499956/ 

Tariq, R., Scherbak, Y., Vashisht, R., & Sinha, A. (2024, February 12). Medication dispensing errors and prevention. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK519065/ 

NURS FPX 8030 Assessment 1 Building the Case for Healthcare Improvement

Williams, J., Malden, S., Heeney, C., Bouamrane, M., Holder, M., Perera, U., Bates, D. W., & Sheikh, A. (2021). Optimizing hospital electronic prescribing systems. Journal of Patient Safety, Publish Ahead of Print(2). https://doi.org/10.1097/pts.0000000000000867