DPI Project Proposal Chapter 2 – Literature Review

DPI Project Proposal Chapter 2 – Literature Review

DPI Project Proposal Chapter 2 – Literature Review

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Impacts of Medication errors on 3-4-year-old Leukemia Patients

Submitted by

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Direct Practice Improvement Project Proposal

Doctor of Nursing Practice

Grand Canyon University

Phoenix, Arizona

[Insert Current Date]

GRAND CANYON UNIVERSITY

Impacts of Medication errors on 3-4-year-old Leukemia Patients

by

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Proposed

[Insert Current Date]

DPI PROJECT COMMITTEE:

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Full Legal Name, EdD, DBA, or PhD, Committee Member

Table of Contents

Chapter  1:

Introduction to the Project 6

Background of the Project 7

Problem Statement 9

Purpose of the Project 11

Clinical Question(s) 12

Advancing Scientific Knowledge 13

Significance of the Project 15

Rationale for Methodology 17

Nature of the Project Design 18

Definition of Terms 20

Assumptions, Limitations, Delimitations 21

Summary and Organization of the Remainder of the Project 23

References 25

Chapter 1: Introduction to the Project

According to research conducted by James et al. (2006), more than 98 000 deaths were occurring in the hospital, a more significant number than those caused by breast cancer and motor vehicle accidents put together. Most of these deaths that occur in hospitals are because of Medical Errors (Taylor et al., 2006). These medication errors usually happen because of ordering mistakes, monitoring errors, dispensing errors, or administrations errors. They are potential for Adverse Drug Events.

Patients with Acute Lymphoblastic Leukemia are a group of potential victims of Adverse Drug Events that could potentially harm (Walsh et al., 2013). In this project, I will focus on Pediatric Oncology; that is, the effects medication errors could have on patients of Leukemia who are between three and four years old. Pediatric oncology presents a very high-risk area and has potential adverse effects in the case that medication errors present themselves.

Annually, there are about 250,000 cases of children with cancer, with 200,000 being from developing countries. The survival rate of these patients is average at 25%, but the number rises to about 80% in states with underdeveloped health systems. Since there is improved management of these cases because of increased advancement in technology and medical interventions, these cases arise because of medical errors.

Children at the age of 3-4 years are at a high risk of potential Adverse Drug Events because the toxicity of drugs to their weight ratio is high. Also, because chemotherapy drugs are highly toxic, any medication errors could lead to fatal consequences (Goldspiel et al., 2015). Therefore, we must find a way of reducing medication errors in these children, both at the clinics and at home.

Background of the Project

According to the doctor’s prescriptions, pediatric patients with Acute Lymphoblastic Leukemia are subjected to oral dosages of chemotherapy. Typically, they receive their medication both in the hospital and out of the hospital. Chemotherapy drugs are highly toxic, and in the case that they are wrongly administered, there could be potential fatalities. Also, because of the toxicity to the weight ratio of the children who receive chemotherapy drugs, the risk of adverse drug events increases substantially.

Medical errors in administering chemotherapy medication could occur both in the hospital and at home for outpatient children (Walsh et al., 2009). In the hospital, there may be medication errors resulting from failure to reach a proper decision as to which medication or what dosage regimen to give to the patient. There could also be instances of prescribing faults like inappropriate prescription, under prescription, or over-prescription. Other errors that could occur both in the hospital setup and at homes include dispensing the formulation. This happens as a result of giving the wrong drug or the wrong formulation.

The causes of medical errors include poor communication between doctors about the dosage of the drug. Children aged three to four years have lower weight, which means that their dosage is hugely varied (Vázquez‐Cornejo, et al., 2019). Currently, there are no standard dosages for chemotherapy drugs administered to such patients. There could be a medical error resulting from a wrong consensus reached between doctors. There could also be poor communication between the doctors and the parents. Children at this age depend mostly on their parents to administer the drugs to them at home for the case of outpatient patients. In the fact that there is poor communication between doctors and parents, there could be administration errors. Other possible causes of medication errors include wrong drug labels and drug abbreviations that are similar.

Problem Statement

There is a low survival of children who have acute lymphoblastic Leukemia despite the improvement in medicine and technology. This is partly because of the persistent medical errors that occur to these children. Most of the mistakes arise both at the hospital setup and the home setup. Using a quantitative study, this project will determine the impacts of medication errors to 3-4-year-old patients with Leukemia, the probability of medication errors, the type of medication errors, and their severity. This information will help determine solutions that will be important to reduce the instances of adverse drug events resulting from medication errors.

Purpose of the Project

This project aims to study the impacts that Medication Errors have on patients with Acute Lymphoblastic leukemia that are aged between the age of three and four years. Using a quantitative design of the study, this research intends to identify the types of medication errors that are prevalent among this target population both in the hospital and out of the hospital, the causes of these errors and the severity of the impacts these medication errors have on the patients within this age bracket.

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Clinical Question(s)

This research is a quantitative study, aimed at finding out the impact of medication errors on children aged three and four years old with ALL. The study will involve clinicians, parents, and guardians of children with ALL and the children with ALL in addition to the researchers. To entirely conduct this research, it will be guided by the following research questions

1. How often to Medical Errors occur to children aged between 3-4 years with ALL?

2. What is the degree of adverse medical events that occur in children with ALL between 3 and 4 years in the case of Medical Errors?

Advancing Scientific Knowledge

A large number of children die and continue to die annually because of persistent cases of medication errors in the healthcare sector. Children have a higher risk of becoming victims of adverse drug events because of medical errors, particularly the pediatric oncology sector (Walsh et al., 2016).

Therefore, it is essential to understand the impacts of medical errors on children aged 3-4 years to understand the causes of these medical errors and their frequency. This will help in the formulation of solutions to deal with this problem. This study aims to determine the impacts of medication errors on children with acute lymphoblastic Leukemia to come up with solutions to these problems.

Significance of the Project

There has been a persistent rise in the number of medically related deaths among the population despite advancements in medicine and medical technology. Research indicates that this is mostly due to the impact of adverse drug effects that are brought about by medical errors. This study aims to understand one such area of medical errors among patients aged between 3-4-year-old with leukemia.

This study will be important in identifying the possible causes of medical errors in pediatric oncology sector. Given the large number of patients who continue to receive treatment both at home and in the hospital, the risk of medical errors increases substantially. It creates the need to come up with feasible solutions to reduce medical errors that may result in loss of lives or permanent damage to the patients.

The results of this study will identify the prevalence of medical errors among the named population, also identifying the main causes of these medical errors. This will provide a foundation for development of practices that will ensure that medical errors among children aged between 3 and 4 years with Acute Lymphoblastic Leukemia is reduced greatly. This study will therefore be important in improving healthcare outcomes in pediatric oncology as a whole.

Rationale for Methodology

To successfully conduct this study, there will be a need for the use of a quantitative design of research. The quantitative research methodology will be essential to quantify the prevalence of medication errors in the children. This frequency will be calculated by using descriptive statistics of the sample.

Thereafter, inferential statistics will be used to make conclusions about a whole population from the sample tested. The degree to which the impacts brought about by these medication errors are lethal will also be calculated by this study and thereafter inferred to the population using statistical calculations.

Nature of the Project Design

This study will take the form of a quantitative design. This study aims to study the impacts of medication errors to pediatric patients with ALL. The4 impacts will be measured on a basis of prevalence and severity. The quantitative phase of this research study, therefore, will be aimed at quantifying the variables of the research. One of the research questions we need to answer is how prevalent are these medical errors. We also need to create a scale through which the severity of the medical errors is measured. A quantitative research h design will be used to accomplish these tasks. The clinicians will note the medical errors among the selected sample in the population and using inferential statistics like ANOVA analysis. We will be in a position to infer these results on the whole population.

A sample of patients aged between 3 and 4 years will be selected from a population of children with a history of Acute Lymphoblastic Leukemia. Their parents will also be part of the research study. Accompanying this sample will be two clinicians who will take notes to determine the causes of medical errors. Medical history records of the patients participating in the study will be accessed, and a history of adverse drug events will be noted. There will be no control group in this research study.

Definition of Terms

Medical Errors. A mistake in the treatment process of a patient that results in, or has the potential of resulting in adverse drug events.

Adverse Drug Event. These are negative impacts resulting from the wrongful administration of a drug to a patient. Some of the effects include vomiting, stomach aches, headaches, and even death.

Acute Lymphoblastic Leukemia. This is a type of blood cancer that affects the white blood cells of their victims and is ordinarily genetic.

Assumptions, Limitations, Delimitations

This study assumes that the medication errors identified by the clinicians throughout the observation will continue to do so even after the observation period. Also, the researchers assume that the characteristics of the sample are shared in the population. It is expected that there are no other contraindicating infections among the patients who participate in the disease. The limitations of the study include:

1. There is no way to ascertain the appropriate principles of correct medication administration.

2. There will be limited funding to completely carry out this research study.

The delimitation of this study is:

1. The experiments happen naturally without any intervention of any artificial simulations. This gives the exact picture of the situation at hand.

Summary and Organization of the Remainder of the Project

Chapter 1 introduces the project of the research study. It then goes ahead to provide a background of the project and the statement of the problem. The subsequent section provides an overview of the purpose of this project and its clinical questions. The significance of the project, together with the advance in scientific knowledge, are expounded after that. The rationale for the methodology is described, and the nature of the project is explained briefly. There is a definition of terms used in this project, and the chapter concludes with assumptions, limitations, and delimitations of the study.

Chapter 2 will introduce a survey of current proof on the centrality of the training improvement venture writing audit and the current evidence accessible to direct extend the arrangement. Chapter 3 will portray the strategy, structure, and techniques for this examination. Chapter 4 subtleties how the information was broken down and gave both a composed and realistic rundown of the outcomes. Chapter 5 is an understanding and conversation of the results, as they identify with the current group of proof identified with the training improvement venture theme.

References

Goldspiel, B., Hoffman, J. M., Griffith, N. L., Goodin, S., DeChristoforo, R., Montello, C. M., … & Patel, J. T. (2015). ASHP guidelines on preventing medication errors with chemotherapy and biotherapy. American Journal of Health-System Pharmacy, 72(8), e6-e35. Retrieved from /orders/academic.oup.com/ajhp/article- abstract/72/8/e6/5111768

Taylor, J. A., Winter, L., Geyer, L. J., & Hawkins, D. S. (2006). Oral outpatient chemotherapy medication errors in children with acute lymphoblastic Leukemia. Cancer, 107(6), 1400- 1406. Retrieved from /orders/acsjournals.onlinelibrary.wiley.com/doi/abs/10.1002/cncr.22131

Vázquez‐Cornejo, E., Morales‐Ríos, O., Juárez‐Villegas, L. E., Islas Ortega, E. J., Vázquez‐Estupiñán, F., &Garduño‐Espinosa, J. (2019). Medication errors in a cohort of pediatric patients with acute lymphoblastic leukemia on remission induction therapy in a tertiary care hospital in Mexico. Cancer medicine, 8(13), 5979-5987. Retrieved from /orders/onlinelibrary.wiley.com/doi/abs/10.1002/cam4.2438

Walsh, K. E., Dodd, K. S., Seetharaman, K., Roblin, D. W., Herrinton, L. J., Von Worley, A., … &Gurwitz, J. H. (2009). Medication errors among adults and children with cancer in the outpatient setting. Journal of Clinical Oncology, 27(6), 891-896. Retrieved from /orders/www.academia.edu/download/39833209/891.pdf

Walsh, K. E., Roblin, D. W., Weingart, S. N., Houlahan, K. E., Degar, B., Billett, A… & Mazor, K. M. (2013). Medication errors in the home: a multisite study of children with cancer. Pediatrics, 131(5), e1405-e1414. Retrieved from /orders/pediatrics.aappublications.org/content/131/5/e1405.short

Walsh, K., Ryan, J., Daraiseh, N., & Pai, A. (2016). Errors and nonadherence in pediatric oral chemotherapy use. Oncology, 91(4), 231-236. Retrieved from /orders/www.karger.com/Article/Abstract/447700

Chapter 2 of the DPI Project Proposal is entitled “Literature Review” and expands upon work you completed in DNP-820 in the Develop a Literature Review assignment. Synthesis of the literature in the Literature Review (Chapter 2) defines the key aspects of the learner’s scholarly project, such as the problem statement, population and location, clinical questions, hypotheses or phenomena (if relevant to the project), methodology and design, purpose statement, data collection, and data analysis approaches. The literature selected must illustrate strong support for the learner’s practice change proposal. General Requirements: Use the following information to ensure successful completion of the assignment:

• Locate the “DPI Proposal Template” in the PI Workspace of the DC Network.

• Locate the Develop a Literature Review assignment you completed in DNP-820.

• Locate the “Research Article Chart” resource in the Topic Materials.

• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.

• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

• You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center. Directions: Use the “DPI Proposal Template” and the Develop a Literature Review assignment from DNP-820 to develop a draft of a literature review (Chapter 2) for your DPI Project Proposal. The literature review (Chapter 2) is required to be a minimum of 30 pages. You have already completed some of this review in previous courses. No less than 85% of the articles must have been published in the past 5 years. Articles selected must further provide strong, relatable support for the proposal. Use the following guidelines to create your draft Literature Review (Chapter 2):

1.Using the PICOT question format, identify at least three empirical or scholarly articles (25 articles total) related to the theme in the PICOT question.

2. Use the “Research Article Chart” resource located in the Topic Materials as a guide to: (a) analyze and synthesize the literature into your paper, (b) state the article title, (c) identify the author, (d) state the research question(s), (e) identify the research sample, (f) explain the research methodology, (g) identify the limitations in the study, (h) provide the research findings of the study, and (i) identify the opportunities for practice implementation. For scholarly, nonempirical articles, state the article title and author, and provide a brief contextual summary of the article.

3. Identify at least three subthemes that relate to each theme (six subthemes total).

4. Identify at least three empirical or scholarly articles related to each subtheme (18 articles total). At least one article must demonstrate a quantitative methodology. Write statements that synthesize the three studies for each subtheme based on the information you stated above. You will write six synthesis statements.

Research Article Chart