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Leadership Competencies in Nursing and Healthcare

Leadership Competencies in Nursing and Healthcare


Leadership Competencies in Nursing and Healthcare

Medical Error Reduction on Paper MAR’s


            Medical errors still remain a challenge in healthcare due to a challenge in the detection and lack of effective ways of managing the identified problems. They still remain a leading cause of mortality in the US. Through early recognition of the challenge, learning from experiences, and working towards the improvement of interventions, patient care can be easily improved. Creating and maintaining a culture of ensuring safety challenges, and implementing viable solutions is an amicable way of facing the menace in healthcare and nursing practice (Safarpour et al., 2017). However, there are many challenges facing health professionals, such as the threat of impending legal action that lead inefficiency in implementing prevention strategies. Healthcare workers (HCWs) must learn to view medical errors as challenges within their profession and be able to overcome them in order to facilitate quality improvement. Nurses play the greatest role in reduction through drug administration. A medical administration record (MAR) is a chart used by nurses providing a detailed expression of drugs administered during patient management in a certain health facility (Booth et al., 2017). They are commonly referred to as a drug chart, and they are legally binding hence forming a key aspect of nursing management. They can be either paper or electronic.

Over the years, most health facilities have worked towards establishing the eradication of paper MARs and implementation of the eMARs with the aim of medical error reduction. The aim of this study is to provide a detailed explanation of quality improvement by reducing medical errors using second nurse checks, nightly chart audits, and advocating for computerized physician order entry (CPOE) via evidence-based practice models.


Part one: Capstone Paper: Evidence-Based Practice (EBP) Plan

The FADE model is a cyclical process for quality improvement initiatives in the nursing practice that can be applied in most of the performance challenges. The model is an integration of the PDCA/ PDSA cycles of development. It utilizes a four-step approach in a repetitive manner evaluating how the plans become implemented and the impact of the interventions. It is aimed at identifying if the expected goals and outcomes have been achieved and how to improve on the challenges that may be experienced. There are four main steps in executing the FADE model; focus, analyze, develop, and execute (Watters, 2019). The first phase involves identifying a problem and creating a statement explanation. Analyze phase involves further study on the problem and data collection on the same. The developing stage is where the nurses and HCWs develop a solution for their problem identified and a plan for its implementation. The final phase involves implementing the interventions and monitoring the outcome obtained. Additionally, the execution phase allows for adjustments and improvements in the plan of action.

Following the FADE approach, the first step in the quality improvement plan will be determining the problem affecting the patient outcomes and leading to medical errors. There a vast number of challenges associated with using paper MARs; lack of scalable storage, limited security and inability to provide backups, time-consuming, inconsistent layouts, and lack of clarity of audit trails (Akhu-Zaheya et al., 2018). To address the problem involves providing alternatives measures to curb or improve on the use of paper records. Additionally, enhancement using computerized records will enhance the quality of care and lead to a reduction in the errors. Electronic records remain the best solution to improving health management, but sometimes it may be difficult to implement as it requires numerous resources and great hospital preparedness.

The second phase of the plan will be to analyze where the selected healthcare team will be tasked with conducting research and packaging the findings into products that can be put into action. The research phase enables the proper gathering of information regarding the existing problem and how to best provide solutions. Paper MARs lead to exhaustion, causing a lack of accuracy and hence susceptibility to errors during treatment (Feder, 2018). A number of cases need to be identified and should have profound facts on what the cause of the mistake was. The process should be guided by end-users for research findings in order to enable the evidence to find its way into practice. The information gathered should be relative to the current health problem and the real-world health care setting (Baumann et al., 2018). Based on the number of cases detected, the volume of data should correspond to the size of the health organizations. The frontline workers and most affected practitioners such as the nurses and clinicians must be included in the research to alienate the immediate problems and the most significant methods of managing them.

After conducting research, the team a solution and plan for implementation. The most appropriate method of managing the problem is converting from using paper MARs to eMARs. However, converting to EHRs involves a longer period, and it is quite expensive (Longhurst et al., 2019). Thus, the team tasked with managing the problem comes with three main alternatives; using second-order checks by a second nurse, nightly chart audits, and computerized physician order entry (CPOE). The planning phase will require partnering with other health organizations and professional leaders so as to ensure the best mode of action is arrived at (Honeycutt & Keller, 2018). Some of the leaders that will be involved are the heads of departments for both nurses and clinicians so that they may educate their fellow staff members. The plan will encompass proper information dissemination to all the targeted parties to ensure a smooth transitioning. The educators will use mass communication multifaceted strategies that will be most effective for nurses, clinicians, and physicians, such as the use of social media.

Execution will involve implementation of the plan of action. During this phase, the team will focus on getting all the individuals and organizations to adopt a culture of nightly chart audits and second-order checks by a second nurse which will have a great impact in the reduction of error margin. Moreover, various team members will be chosen to spearhead the implementation and conduct an evaluation. They will also have the role of championing for change and motivating other staff members to adopt the newly developed plan of action.

Part two: Capstone Paper Quality Improvement Plan, Resources and Conclusion

            Various resources will be required in implementing the quality improvement plan. Independent double checking (IDC) also known as using second order checks by a second nurse is a strategy of reducing medical errors such as wrong dosage and prescription through the use another nurse (Koyama et al., 2020). It is one of the most basic and effective ways of preventing medical administration errors. However, even with the efficacy, the method becomes quite challenging and cumbersome as it is almost difficult to perform it for all drugs. It is normally time-consuming and bearing in mind that nursing is a profession faced with staff shortages, it is not always done. Hence, to help manage the shortcoming, it was concluded that IDC should be done for the critically ill patients in the ICU and medical units, and those at the ER and patients waiting to go to the theatre.

Nightly chart audits were also another intervention to be implemented in curbing errors. Nursing is a profession founded on effective nursing. Chart audits enable compliance through identifying procedures and processes that do not meet the regulations and standards of care (Loftus & Wiesenfeld, 2017). Even though it is a time-consuming exercise, day nurses should perform an audit of all care provided during the night shift. Moreover, stationery material was increased to ensure that all charts were available (nursing cardex, fluid chart, prescription chart) for 24hour patient monitoring. All departmental heads ensured that their junior team members adhered to the culture of chart auditing.

A number of new computers and integrated medical software will be required to facilitate computerized physician order entry (CPOE). A CPOE system is designed to replace the hospital paper system. It allows clinicians and physicians to order medicine electronically and maintain an online medication administration record (Wiegel et al., 2020). Besides additional computers and software, funds will also be channeled towards training the professionals hence becoming the most expensive of all the implementations. However, the accrued benefits will be abundant as the mishap that normally occurs at the pharmacy will be eliminated. Additionally, accountability will be upheld, reducing the financial losses associated.

All the strategies for reducing errors will require education and even training. All nurses, clinicians, and physicians will undergo a fresher course on the importance of effective documentation and application of CPOE in drug and medical supply ordering. Two hours will be allocated for four days to allow alternating periods of study, and a lecture hall equipped with a LED projector will be required to facilitate effective education.


Reduction of medical errors is one of the basic quality improvement initiatives in nursing and healthcare. Through evidence-based practice application of the FADE model, a detailed quality improvement plan is developed that ensures effective implementation of various strategies such as the use of order checks by second nurses, nightly chart audits, and advocating for computerized physician order entry.



Akhu‐Zaheya, L., Al‐Maaitah, R., & Bany Hani, S. (2018). Quality of nursing documentation: Paper‐based health records versus electronic‐based health records. Journal of clinical nursing, 27(3-4), e578-e589.

Baumann, L. A., Baker, J., & Elshaug, A. G. (2018). The impact of electronic health record systems on clinical documentation times: A systematic review. Health Policy, 122(8), 827-836.

Booth, R. G., Sinclair, B., Brennan, L., & Strudwick, G. (2017). Developing and implementing a simulated electronic medication administration record for undergraduate nursing education: using sociotechnical systems theory to inform practice and curricula. CIN: Computers, Informatics, Nursing, 35(3), 131-139.

Feder, S. L. (2018). Data quality in electronic health records research: quality domains and assessment methods. Western journal of nursing research, 40(5), 753-766.

Honeycutt, L. C., & Keller, S. D. (2018). Effectiveness of the Lean process compared to other quality improvement initiatives on length of stay and wait times in healthcare organizations: a systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 16(1), 12-20.

Koyama, A. K., Maddox, C. S. S., Li, L., Bucknall, T., & Westbrook, J. I. (2020). Effectiveness of double checking to reduce medication administration errors: a systematic review. BMJ quality & safety, 29(7), 595-603.

Loftus, C. A., & Wiesenfeld, L. A. (2017). Geriatric delirium care: using chart audits to target improvement strategies. Canadian Geriatrics Journal, 20(4), 246.

Longhurst, C. A., Davis, T., Maneker, A., Eschenroeder Jr, H. C., Dunscombe, R., Reynolds, G., … & Adler-Milstein, J. (2019). Local investment in training drives electronic health record user satisfaction. Applied clinical informatics, 10(2), 331.

Safarpour, H., Tofighi, M., Malekyan, L., Bazyar, J., Varasteh, S., & Anvary, R. (2017). Patient safety attitudes, skills, knowledge and barriers related to reporting medical errors by nursing students. International Journal of Clinical Medicine, 8(01), 1.

Watters, R. (2019). Translation of evidence-based practice: quality improvement and patient safety. Nursing Clinics, 54(1), 1-20.

Wiegel, V., King, A., Mozaffar, H., Cresswell, K., Williams, R., & Sheik, A. (2020). A systematic analysis of the optimization of computerized physician order entry and clinical decision support systems: a qualitative study in English hospitals. Health informatics journal, 26(2), 1118-1132.



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Medication error reduction on paper MAR’s, using second order checks by a second nurse, nightly chart audits and advocating for CPOE (computerized physician order entry)

Part one: Capstone Paper: Evidence-Based Practice (EBP) Plan

Using the Quality Improvement model of FADE (Focus, Analyze, Develop, and execute). provide a detailed explanation of the evidence-based practice plan that you will use to address the practice problem. Be sure to include the sources you found in the analysis of the evidence to support your EBP plan. Use appropriate and persuasive language that communicates meaning with clarity and fluency to readers, and is virtually error-free

For this Assignment, write 4-5 paragraphs that address the following:

  • Evidence-Based Practice Performance Improvement Plan Explanation
    • Using the Quality Improvement model FADE, provide a detailed explanation of the quality improvement plan that you will use to address the practice problem.
    • Use the sources you found in the analysis of the evidence to support the plan.

Part two: Capstone Paper Quality Improvement Plan, Resources and Conclusion

  • In week 5 you will write the final section your Capstone Paper. The Assignment you will submit this week will combine the work you completed in Week 4 (Evidenced-Based Practice Plan) and will integrate the Resources and Conclusion details in approximately 3-5 paragraphs for your Capstone Paper. Be sure to include scholarly references identified in the literature review to support your EBP plan. Use appropriate and persuasive language that communicates meaning with clarity and fluency to readers, and is virtually error-free

Putting part one and part two together, write a 3–4-page paper that addresses the following:

Introduction. Briefly review your practice problem and include a purpose statement.

  • Evidence-Based Practice Plan Explanation  (Completed in Week 4)
    • Provide a detailed explanation of the evidence-based practice performance improvement plan that you will be use to address the practice problem.
    • Support your plan with scholarly references (the sources you found in the analysis of the evidence).
  • Resources (completed in Week 5)
    • Describe the resources needed to support the change in practice such as personnel time, supplies for staff education, cost of new equipment, or cost of software.
    • Explain why each resource is necessary.
  • Conclusion
    • Discuss all key points addressed in this assignment.

Capstone Paper, Part II


  • Quality Improvement Plan (Completed in Week 4)
    • Using the Quality Improvement Model as a framework provide a detailed explanation of the quality improvement plan that you will use to address the practice problem.
    • Use the scholarly references identified in the analysis of evidence to support the quality improvement plan.
  • Resources (Completed in Week 5)
    • Describe the resources needed to support the change in practice such as personnel time, supplies for staff education, cost of new equipment, or cost of software.
    • Explain why each resource is necessary.
  • Summary
    • Summarize the key points discussed in the paper.


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