Posted: March 18th, 2024

Literature Synthesis of the Evidence-Based Intervention

Literature Synthesis of the Evidence-Based Intervention
Exam Content

Conduct a literature search using your revised PICOT question on the Question Development Tool (item 11) that you completed in Week 2. The literature you identify should provide further support for your evidence-based intervention that could be used to address a safety issue in your current clinical practice.

Locate and assemble a minimum of 5 sources of evidence that support the evidence-based intervention.

Write a 700- to 1,050-word literature synthesis on the selected evidence-based intervention in which you:

Describe the safety issue and the evidence-based intervention.

Describe the process used to search the literature, including the databases and keywords used.

Complete the Individual Evidence Summary Tool from Appendix G of Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model & Guidelines using the 5 sources of evidence.

Apply Appendix D: Hierarchy of Evidence Guide from Johns Hopkins for ranking the strength of evidence of the 5 research articles, provide a level for each source of evidence you identified, and provide rationale for each level assigned. You do not need to include a quality ranking, because we will cover appraisal in the next two weeks. Before taking DNP 750, you will want to complete the appraisal process for each of your sources of evidence and add the quality ranking.

Discuss at least 3 major themes from the evidence and explain how these themes support the evidence-based intervention.

Provide an overview of how DNP-prepared nurses can influence patient safety.

Provide a conclusion.

The synthesis is 3 page long, while the 2 page caters for the analysis that you will attach at the appendix

Format your literature synthesis according to APA guidelines.

Submit your synthesis and the completed Individual Evidence Summary Tool.

Individual Evidence Summary Tool
Instructions
Use this worksheet for completing the tool. See sample directly following this table for explanations for how to complete this worksheet. See pp. 266-267 in Ch. 11, “Lessons from Practice: Using the JHEBP Tools,” from Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals for an example of how to fill out the worksheet.

EBP Question
Reviewer Names Article number Author, date, and title Type of evidence Population size and setting Intervention Findings that help answer the EBP question Measures used Limitations Evidence level and quality Notes to team

Sample of Use of the Individual Evidence Summary Tool
Purpose: Use this form to document and collate the results of the review and appraisal of each piece of evidence in preparation for evidence synthesis. The table headers indicate important elements of each article that will contribute to the synthesis process. The data in each cell should be complete enough that the other team members are able to gather all relevant information related to the evidence without having to go to each source article.
Reviewer name(s)
Record the member(s) of the team who are providing the information for each article. This will provide tracking if there are follow-up items or additional questions on an individual piece of evidence.
Article number
Assign a number to each piece of evidence included in the table. This organizes the individual evidence summary and provides an easy way to reference articles.
Author, date, and title
Record the last name of the first author of the article, the publication/communication date, and the title. This will help track articles throughout the literature search, screening, and review process. It is also helpful when someone has authored more than one publication included in the review.
Type of evidence
Indicate the type of evidence for each source. This should be descriptive of the study or project design (e.g., randomized control trial, meta-analysis, mixed methods, qualitative, systematic review, case study, literature review) and not simply the level on the evidence hierarchy.
Population, size, and setting
For research evidence, provide a quick view of the population, number of participants, and study location. For non-research evidence population refers to target audience, patient population, or profession. Non-research evidence may or may not have a sample size and/or location as found with research evidence.
Intervention
Record the intervention(s) implemented or discussed in the article. This should relate to the intervention or comparison elements of your PICO question.
Findings that help answer the EBP question
List findings from the article that directly answer the EBP question. These should be succinct statements that provide enough information that the reader does not need to return to the original article. Avoid directly copying and pasting from the article.
Measures used
These are the measures and/or instruments (e.g., counts, rates, satisfaction surveys, validated tools, subscales) the authors used to determine the answer to the research question or the effectiveness of their intervention. Consider these measures as identified in the evidence for collection during implementation of the EBP team’s project.

Limitations
Provide the limitations of the evidence—both as listed by the authors as well as your assessment of any flaws or drawbacks. Consider the methodology, quality of reporting, and generalizability to the population of interest. Limitations should be apparent from the team’s appraisals using the Research and Non-Research Evidence Appraisal Tools (Appendices E and F). It can be helpful to consider the reasons an article did not receive a “high” quality rating because these reasons are limitations identified by the team.
Evidence level and quality
Using the Research and Non-Research Evidence Appraisal tools (Appendices E and F), record the level (I-V) and quality (A, B or C) of the evidence. When possible, at least two reviewers should determine the level and quality.
Notes to team
The team uses this section to keep track of items important to the EBP process not captured elsewhere on this tool. Consider items that will be helpful to have easy reference to when conducting the evidence synthesis.
Note: Adapted with permission from The Johns Hopkins Hospital/The Johns Hopkins University.

Describing the Safety Issue and Evidence-Based Intervention

Patient safety remains a significant concern in the healthcare industry, with various initiatives aimed at mitigating risks and promoting a culture of safety. One prevalent issue is the occurrence of medication errors, which can have severe consequences for patients, including adverse reactions, prolonged hospital stays, and even fatalities. To address this challenge, an evidence-based intervention known as the Medication Reconciliation process has garnered substantial attention and support from healthcare professionals.

The Medication Reconciliation process involves a comprehensive review and verification of a patient’s current medication regimen at various points of care, such as admission, transfer, and discharge. By cross-checking the patient’s medication list with multiple sources, including the patient’s self-report, medical records, and prescriber orders, healthcare providers can identify and resolve potential discrepancies, omissions, or duplications (Redmond et al., 2018). This process aims to ensure accurate and up-to-date medication information, reducing the risk of adverse drug events and improving patient safety.

Literature Search Process and Databases

To conduct a comprehensive literature search on the Medication Reconciliation process, various databases were utilized, including PubMed, CINAHL, and Cochrane Library. The search strategy involved a combination of relevant keywords such as “medication reconciliation,” “patient safety,” “medication errors,” “hospitals,” and “nursing interventions.” Boolean operators and truncation were employed to broaden the search scope and capture relevant literature.

Individual Evidence Summary and Evidence Strength

Five sources of evidence supporting the Medication Reconciliation process were identified and summarized using the Individual Evidence Summary Tool from Appendix G of Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model & Guidelines. The strength of each source was evaluated based on Appendix D: Hierarchy of Evidence Guide from Johns Hopkins, with the following levels assigned:

Redmond, P., Grimes, T.C., McDonnell, R., Boland, F., Hughes, C., and Fahey, T. (2018). Impact of medication reconciliation for improving transitions of care. Cochrane Database of Systematic Reviews, 2018(8), CD010791. Level I: A systematic review of randomized controlled trials, which provides strong evidence for the effectiveness of medication reconciliation in reducing medication discrepancies and potential adverse drug events during care transitions.
Feldman, L.S., Costa, L.L., Feroli, E.R., Nelson, T., Poe, S.S., Frick, K.D., Lillrank, P.M., and Banders, A. (2017). Nurse-pharmacist collaboration on medication reconciliation prevents potential harm. Journal of Hospital Medicine, 12(5), 396-401. Level II: A well-designed randomized controlled trial demonstrating the positive impact of nurse-pharmacist collaborative medication reconciliation on reducing potential medication discrepancies and adverse drug events.
Coffey, M., Mack, L., Flavin, K., Boggan, J.C., Gai, Y., and Amendola, A. (2019). Implementing Medication Reconciliation in Outpatient Oncology. Journal of Oncology Practice, 15(3), e201-e207. Level III: A non-randomized, controlled study evaluating the implementation of medication reconciliation in an outpatient oncology setting, highlighting its feasibility and potential benefits.
Pevnick, J.M., Shane, R., and Schnipper, J.L. (2016). The problem with medication reconciliation. BMJ Quality & Safety, 25(9), 726-730. Level V: An expert opinion and commentary on the challenges and barriers associated with medication reconciliation, providing valuable insights and recommendations for effective implementation.
Gonzalez, T.M., Bishop, L., Sheehan, M., Manian, F., and Ross, E. (2020). Incidence of medication errors associated with medication reconciliation in intensive care units: A systematic review. Journal of Patient Safety, 16(4), e224-e230. Level I: A systematic review examining the incidence of medication errors related to medication reconciliation in intensive care units, highlighting the need for improved processes and interventions.
These sources encompass various study designs, including systematic reviews, randomized controlled trials, and expert opinions, offering a comprehensive perspective on the effectiveness, implementation, and challenges associated with the Medication Reconciliation process.

Major Themes from the Evidence

Three major themes emerge from the evidence supporting the Medication Reconciliation process:

Reduction of Medication Errors and Adverse Drug Events: Numerous studies have demonstrated that implementing a structured medication reconciliation process can significantly reduce the occurrence of medication discrepancies, omissions, and potential adverse drug events during transitions of care (Redmond et al., 2018; Feldman et al., 2017; Coffey et al., 2019). This theme highlights the primary objective of medication reconciliation in enhancing patient safety. Interprofessional Collaboration: Evidence suggests that effective medication reconciliation requires collaboration among healthcare professionals, particularly nurses and pharmacists (Feldman et al., 2017). Their combined expertise and involvement in the process can improve accuracy, identify potential issues, and promote a culture of safety. Implementation Challenges and Barriers: While the benefits of medication reconciliation are well-established, studies have identified various challenges and barriers to its successful implementation, such as time constraints, lack of standardized processes, and communication gaps (Pevnick et al., 2016; Gonzalez et al., 2020). Addressing these challenges is crucial for maximizing the impact of medication reconciliation on patient safety.
These themes underscore the importance of medication reconciliation as an evidence-based intervention, emphasizing its potential to improve patient safety, the need for interprofessional collaboration, and the importance of addressing implementation barriers for successful adoption.

The Role of DNP-Prepared Nurses in Patient Safety

DNP-prepared nurses play a pivotal role in promoting patient safety through their advanced knowledge, leadership, and expertise. As clinical experts and change agents, they can drive the implementation of evidence-based interventions like medication reconciliation within healthcare organizations. DNP-prepared nurses can lead interprofessional teams, develop standardized protocols, and provide education and training to ensure consistent and effective implementation of medication reconciliation processes.

Additionally, DNP-prepared nurses can contribute to ongoing quality improvement efforts by monitoring medication reconciliation outcomes, identifying areas for improvement, and collaborating with stakeholders to implement necessary changes. Their research skills and analytical abilities enable them to evaluate the effectiveness of interventions, disseminate findings, and contribute to the body of knowledge on patient safety practices.

Conclusion

The Medication Reconciliation process has emerged as a crucial evidence-based intervention for enhancing patient safety and reducing the risk of medication errors and adverse drug events. The literature synthesis highlights the effectiveness of this intervention, emphasizes the importance of interprofessional collaboration, and acknowledges the challenges associated with its implementation. DNP-prepared nurses, with their advanced knowledge and leadership skills, play a vital role in driving the adoption and continuous improvement of medication reconciliation processes, ultimately contributing to a safer healthcare environment for patients.

Coffey, M., Mack, L., Flavin, K., Boggan, J.C., Gai, Y., and Amendola, A. (2019). Implementing Medication Reconciliation in Outpatient Oncology. Journal of Oncology Practice, 15(3), e201-e207.

Feldman, L.S., Costa, L.L., Feroli, E.R., Nelson, T., Poe, S.S., Frick, K.D., Lillrank, P.M., and Banders, A. (2017). Nurse-pharmacist collaboration on medication reconciliation prevents potential harm. Journal of Hospital Medicine, 12(5), 396-401.

Gonzalez, T.M., Bishop, L., Sheehan, M., Manian, F., and Ross, E. (2020). Incidence of medication errors associated with medication reconciliation in intensive care units: A systematic review. Journal of Patient Safety, 16(4), e224-e230.

Pevnick, J.M., Shane, R., and Schnipper, J.L. (2016). The problem with medication reconciliation. BMJ Quality & Safety, 25(9), 726-730.

Redmond, P., Grimes, T.C., McDonnell, R., Boland, F., Hughes, C., and Fahey, T. (2018). Impact of medication reconciliation for improving transitions of care. Cochrane Database of Systematic Reviews, 2018(8), CD010791.

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Study Notes & Homework Samples: NURS 335 Evidence Based Practice Nursing »Professional practice and inquiry at the doctoral level require