Increasing the Reporting of Medication Errors Through Leadership at Stanton Territorial Hospital

Regions: North Slave Region

Tags: health

Principal Investigator: Lennie, Fraser M (1)
Licence Number: 16104
Organization: Royal Roads University
Licensed Year(s): 2017
Issued: Jun 02, 2017
Project Team: Jazmine Drost (Reivew and pilot research questions, peer- Royal Roads University), Brianne Timpson (Organizational Sponsor, Stanton Territorial Hosptial)

Objective(s): To implement evidence-based leadership practices to create an environment that supports the increased reporting of medication errors by nurses.

Project Description: I hope this research will ultimately result in:
1. The implementation of evidence-based leadership practices to create an environment that supports the increased reporting of medication errors by nurses.
2. An increased reporting of medication errors by nurses at the Hospital.
3. Conformity with Accreditation Canada Qmentum standards.
4. A practice environment that promotes safe medication administration.

The research in this project will be conducted using action research engagement methodology. The Principal Investigator (PI) will follow the Action Research Engagement (ARE) Model as a framework to guide this research process, generate empirical knowledge and engage participants from the Hospital. The PI will use this method to guide the research process, generate empirical knowledge and engage participants from the Stanton Territorial Hospital. The participants will include nurses on in-patient units; front-line leaders at the Hospital, who are defined as the clinical coordinators and managers whose responsibilities include in-patient units, and the clinical coordinator staff development and education, and members of the medication safety working group.

Overarching question “How can clinical coordinators and managers lead an increase in medication error reporting by nurses at Stanton Territorial Hospital?”

Sub-questions:
1. What are the barriers to nurses consistently reporting medication errors at the Hospital?
2. What leadership skills could help clinical coordinators and manager’s increase reporting of medication errors by nurses at the Hospital?
3. What supports could clinical coordinators and managers provide to front line nurses to increase medication error reporting at the Hospital?

The research questions will be answered through a literature review, and the use of multiple research methods, namely a survey and focus groups. Following the literature review, a survey will canvas up to 132 participants who are identified as registered nurses or front-line leaders on in-patient units and members of the medication safety working group. Potential participants will receive by email from an administrative assistant at the Hospital, an invitation to participate in the survey. Included with the invitation will be a letter to participants explaining the research, background information and the information required to make an informed decision to consent to participating. The survey will be composed mostly of questions with a selection of set responses to choose from, or for participants to rank answers in priority. Two questions will be asked that will allow participants to write their own answer to the question rather than choosing from listed responses. A Canadian-based online survey tool, hostedincanadasurveys.ca will be used to collect the data. Once the survey period is closed, the survey company will forward the aggregate confidential data and the PI will proceed with analyzing the data. The results of the survey will be used for two purposes, first to help answer the research questions, and second, to help develop themes that will inform the questions asked in the focus groups.

Focus groups will be the second methodology used to collect data and will occur after the survey has been conducted and analyzed. Semi-structured questions will be used in the focus groups as it allows for certain topics to be covered but is flexible enough to allow for exploration of participants’ responses.

For the first focus group, there will be a minimum of four and a maximum of 12 participants. The invitation will go to all front-line nurses on in-patient units. The spots will be filled on a first-come, first-filled basis, with six spots reserved for non-front line leader floor nurses who are members of the medication safety working group. This is being done so they can participate in a focus group without the presence of their supervisors, who are also members of the medication safety working group.

For the second focus group, front line leaders and all other members of the medication safety working group who are not floor nurses, who expressed a willingness to participate in the research, will be invited to participate.

Sample selection: In selecting this sample, all registered nurses on in-patient units were selected. None will be excluded. The total number of participants was identified through a review of the organizational charts of in-patient units at Stanton Territorial Hospital. All front-line leaders with responsibility for in-patient units are being invited to participate. The clinical coordinator for staff education and development was included as she is partly responsible for education around medication administration. The coordinator for occupational health and safety was included as the literature has shown working conditions may be a contributing factor to medication errors. The members of the medication safety working group were selected as they meet to discuss medication safety. The medication safety working group includes those people already included in the sample, as well as a pharmacist and the occupational health and safety nurse.

Participants will be informed of their right to withdraw in a letter that provides them information about the research. All participants will be informed again in writing, in the email invitation to participate in the survey. An Administrative Assistant at the hospital who is a member of the inquiry team will email the invitation to participate in the survey, to avoid any undue influence or conflict of interest which could occur if the PI sent out the invitations. Participants will be informed of their right to withdrawal in the email invitation to participate in a focus group. There is also a research consent form that will be given to participants of the focus group that will state they have read the information letter for the study. Participants will also be advised verbally of their right to withdraw at the beginning of the focus groups.

Participants may withdraw at any time before they have submitted a completed survey. A participant may choose to leave the focus group at any time until the focus group is completed. If a participant chooses to leave a focus group, the note taker will be directed not to attribute any comments to that participant and where possible remove any information specifically provided by that participant.

Once a participant has completed and submitted the survey, their data may no longer be withdrawn from the study as their responses will become part of an anonymous data set.

Dissemination of the research results will consist of providing a final project report to the Stanton Territorial Hospital project sponsor, to Royal Roads University and to the Aurora Research Institute. The PI will share “Chapter Five: Inquiry Project Recommendations and Implications” from the final report with the clinical coordinators, managers, and members of the medication safety working group at Stanton Territorial Hospital.

The PI will use the results from the research to prepare draft recommendations, in consultation with the organizational sponsor. Following that, the PI will hold a planning meeting with the organizational sponsor, clinical coordinators, managers, and members of the medication safety working group to review the recommendations and plan next steps. The planning meeting will include giving a power point presentation summarizing the research, recommendations and the action research process. As noted above, the people attending this meeting are those who will receive a copy of Chapter Five of the final report.


The fieldwork for this study will be conducted from June 1, 2017 to September 12, 2017.