Master of Science, The Ohio State University, 2007, Graduate School

Committee: Not Provided (Other) Subjects:

Doctor of Nursing Practice , Case Western Reserve University, 2024, School of Nursing

Among hospitals, the number of chief executive officers (CEO) who are nurses is small. For example, only two of the 400 major academic medical centers-health care systems are led by nurses (Bean et al., 2022). Even fewer hospital and health system CEOs are advanced practice registered nurses (APRNs). The CEO is the highest ranking executive leader in an organization, in this case, a hospital. APRNs have grown from less than 68,000 before 1990 to over 355,000 in 2023 (American Association of Nurse Practitioners, 2023). The APRN brings essential and possibly unique knowledge, skills, and attitudes to the CEO role, as they are well versed in providing bedside nursing care, similar to a CNO's expectations. They are also licensed independent providers and can relate to other advanced practice providers (APPs) and physicians, much like the expectations of a chief medical officer (CMO). This project is a theory-driven narrative exploring the evolution of two nurse-manager-led quality improvement (QI) projects in which one chief executive officer-APRN (CEO-APRN) provided the initial vision and oversight and how reflection on this narrative led to an organizing, hard-wired framework to reduce patient harm through multiple QI projects hospital-wide. This report is a program evaluation specific to one institution and is not ready for generalizability outside one hospital system.

Committee: Chris Winkelman (Advisor); Peter Pronovost (Committee Member); Terry Winemiller (Committee Member); Shelly Loop (Committee Member) Subjects: Nursing

PhD, University of Cincinnati, 2023, Nursing: Nursing - Doctoral Program

Background: Medication errors are the most common type of error affecting patient safety and the most preventable cause of adverse medical events globally. Medication errors occur most frequently (33.3%) during the administration phase. New graduate nurses are especially vulnerable to these errors due to reported insufficient educational preparedness and inexperience. There is limited literature examining the nurse's educational preparedness and perceptions of the importance of the medication competencies to its relationship with their confidence in medication administration. Studies show that the performance of success in a given task is based on a person's mindset and view of importance of the task. In addition, many nurses feel that the curriculum did not properly prepare them for practice and left them vulnerable to errors suggestive that current nursing curricula may be insufficiently preparing students to perform this task. Purpose: The purpose of this dissertation study was to determine the relationship between educational preparedness and perceived importance of the medication administration competencies for Ohio new graduate Registered Nurses' to their confidence in clinical medication administration. Design: A descriptive, correlational, cross-sectional design was employed. Methods: Ohio new graduate nurses were surveyed using a research team-created survey. The Likert-style questions asked the participants their opinion on their educational preparedness, perceived importance, and confidence in the nine medication competencies identified. Descriptive and inferential statistical analysis were used with T-tests, ANOVAs, Spearman's Rho correlations, and logistical regressions to identify relationships between the variables, as well as differences between the demographics. Results: A total of 201 Ohio new graduate nurses completed the study. A significant, positive relationship was found between both educational preparedness and (open full item for complete abstract)

Committee: Kimberly Johnson PH.D. C.E.N. (Committee Chair); Carolyn Smith Ph.D. (Committee Member); Benjamin Kelcey Ph.D. (Committee Member) Subjects: Nursing

Doctor of Nursing Practice, Mount St. Joseph University , 2020, Department of Nursing

Executive Summary Ninety percent of intravenous (IV) medication administrations are given through a smart infusion pump. Intravenous medication errors are one of the top two types of medication errors, which can result in severe harm to patients due to their immediate biological effect. Unfortunately, smart infusion pumps have not eliminated IV medication errors as expected. Despite the built-in safety features nurses can create workarounds and shortcuts that bypass these safety features that were created to assist the bedside nurse in preventing IV medication errors. To reduce the need to create workarounds and shortcuts, a new standard of care for infusion therapy known as interoperability was developed to allow bi-directional communication to occur between the smart infusion pump and the infusion order in the electronic health record (EHR). Workarounds and shortcuts are a common practice in the Emergency Center (EC) due to a fast-paced environment. EHR-smart infusion pump interoperability was implemented in a 12-bed EC to assist twenty-three nurses with IV medication administration. When the results of post-implementation data were compared with 3 months of pre-implementation data, the results of the project demonstrated a: 1) 46% decrease in ID band scanning workarounds; 2) 68% decrease in medication scanning workarounds; 3) 59% decrease in severe harm averted alarms; 4) 10% increase in guardrail library usage; and 5) and 6% increase in the overall hospital usage rate of interoperability. Recommendations for this project include the implementation of EHR-smart infusion pump interoperability at all of the other ECs and current out-of-scope patient care areas in this thirteen-hospital system to further improve safety measures when administering IV medications.

Committee: Susan Johnson Ph.D, RN (Advisor) Subjects: Information Technology; Nursing

Doctor of Nursing Practice , Case Western Reserve University, 2020, School of Nursing

Patient medication administration is one of the major responsibilities of the professional nurse. Pre-licensure nursing students and new nursing graduates often lack competency to safely administer medications. Nursing educators teach and evaluate safe medication administration by undergraduate bachelor of science nursing (BSN) students during sophomore year. These students are expected to demonstrate safe medication competence through senior year and post-licensure. The purpose of this study was to determine the medication safety competence of undergraduate junior and senior BSN students. A descriptive comparison design of undergraduate BSN students from two cohorts was used to collect data at an urban, public university in Northeast Ohio. The convenience sample included 188 BSN students who agreed to participate in the simulation study, comprised of 98 juniors and 90 seniors. Data was collected over two weeks via observation and focused on the six rights of medication administration using the Medication Administration Safety Assessment Tool (MASAT). Analyses included descriptive statistics and independent samples t-tests to compare the medication competency of juniors and seniors. Results revealed 29.6% of juniors and 14.4% of seniors demonstrated competence on all eight medication checklist items on the MASAT. The difference between the medication safety competence of juniors and seniors on total MASAT scores did not show statistical significance (p > .05). On individual MASAT scores, there was no statistical significance (p > .05) between juniors and seniors on checklist items one through seven corresponding to right patient, right drug, right dose, right route, and right time. Results showed statistical significance (p < .01) on checklist item eight, indicating juniors performed right documentation more frequently than seniors. Two additional analyses revealed (1) no statistical significance (p > .05) between juniors and seniors asking about medication (open full item for complete abstract)

Committee: Celeste Alfes DNP (Committee Chair); Elizabeth Zimmermann DNP (Committee Member); Amy Weaver PhD (Committee Member) Subjects: Nursing

Doctor of Nursing Practice , Case Western Reserve University, 2018, School of Nursing

Abstract Problem: Intermittent intravenous infusion (III), also referred to as a secondary infusion or intravenous piggyback, is a common but complex process with safety risks in medication errors, infection, and residual medication management. Almost all patients receive IV therapy in acute care hospitals. III is a method frequently used to deliver IV medications, usually with the assistance of a smart pump. Little evidence exists to guide nursing practice with III. Available literature reports issues with poor nursing practice, errors, and limited knowledge by the nurse. Aims: This quality improvement study addressed the following questions. 1. What are the frequencies and types of III medication errors? 2. What are the frequencies and types of infection risks observed in III administration? 3. What are the frequencies of residual volume and what types of administration techniques are used to manage residual volume? Methods: An observational technique, framed in Donabedian's Structure, Process, and Outcome Model, was used to collect data in a large level one trauma center in the Midwest. Medications, fluids, tubings, smart pumps, and eMAR documentation were assessed with an adapted observation checklist tool initially developed by a multidisciplinary group from Brigham and Women's Hospital in Boston, MA. Pertinent findings: A total of 102 patients with 117 III medication administrations were assessed. Medication errors of unauthorized fluids, incomplete drug library within the smart pump, wrong concentrations and rates, and incomplete patient name labeling were found. Of the observed infusions 110 (96%) had between one to six medication errors each. Of the 102 patients, 77% had one to four infection risks from inappropriate end cap coverings of the IV tubing and incorrect or absent date labeling of tubing and fluids. In regard to residual volume, 56% of the 104 completed infusions had medication remaining in the IV bag or tubin (open full item for complete abstract)

Committee: Irena Kenneley PhD, RN, CNE, CIC, FAPIC (Committee Chair); Mary Dolansky PhD, RN, FAAN (Committee Member); Deborah Lindell DNP, RN, CNE, ANEF (Committee Member) Subjects: Health Care; Health Care Management; Medicine; Nursing; Pharmacology

DNP, Otterbein University, 2016, Nursing

There is currently no emphasis being placed on the significance of reporting medication errors, including near misses, for the anesthesia department in a Midwestern hospital system. Efforts to ensure patient safety depend upon collecting data related to actual medication errors, including near misses, so that educational or process improvement opportunities can be identified and implemented. The focus of this quality improvement project was to educate anesthesia providers about the importance of properly reporting all medication errors and near misses. The pre and post survey helped to provide data to determine whether anesthesia providers believe they are more apt to report medication errors and near misses after attending an educational session. An online or face-to-face educational session was conducted for all anesthesia providers in the anesthesia department in a specific Midwestern hospital system. Results from the pre and post test showed statistically significant data (P – value < 0.05) that anesthesia providers believe reporting medication errors and near misses improves patient safety (P = 0.043), education about the process of reporting medication errors will increase compliance in self-reporting (P = 0.018), and that fear of punishment (78%), lack of knowledge on how to use the current reporting system (75%), and fear of litigation (73%) were the top 3 barriers that kept the anesthesia providers from reporting medication errors and near misses.

Committee: Kay Ball Phd, RN, CNOR, FAAN (Advisor); Jacqueline Haverkamp DNP, RN, CNP (Advisor); Monica Nayar PharmD (Committee Chair); Colette Wolf MSN, RN, CPPS (Committee Co-Chair) Subjects: Health Care; Nursing

Doctor of Philosophy, University of Toledo, 2010, Health Education

The purpose of this study was to explore the relationship between nurse characteristics and medication errors. The study examined nurses' perceptions of factors which contribute to medication errors; barriers to reporting and factors that increase the reporting of medication errors; whether medication errors should be reported to the patient, family or an outside agency; and, medication administration technology for reducing medication errors. A survey was mailed to a random sample of 800 registered nurses (RN) from across the United States who were members of the American Nurses Association. A response rate of 49% was achieved using a three-wave mailing. The primary causes of medication errors identified were interruptions during medication pass, short RN staffing, nurses caring for high acuity patients, nurses working more than 12 hours in one shift, and nurses' knowledge of medications dispensed. Approximately one-fourth of nurses reported they had made at least one error that had resulted in some type of harm to a patient in the past 12 months, while approximately 60% of nurses reported making one or more medication errors that did not cause harm to a patient. Rank ordering identified three major barriers to reporting medication errors: fear of consequences that may result if a medication error is reported, fear of blame if something happens to the patient due to a medication error, and fear of a reprimand if they reported a medication error had been made. Nurses perceived that medication administration technologies would decrease medication errors in their hospital. The majority of nurses overwhelmingly agreed that medication errors should be communicated to patients or families, as well as hospitals being responsible for communicating their error rates to the public. Results of this study have serious implications for individual staff nurses, nurse administrators, as well as hospital administration and hospital systems in terms of error reduction and patient s (open full item for complete abstract)

Committee: James H. Price PhD (Committee Chair); Joseph A. Dake PhD (Committee Member); Timothy R. Jordan PhD (Committee Member); Jane Ransom PhD (Committee Member) Subjects: Nursing

Doctor of Philosophy, The Ohio State University, 2008, Pharmacy

Nurses are responsible for the safety of their patients. Nursing factors such as long work hours and fatigue are concerns as they may affect patient safety. One area of patient safety to consider is medication use, specifically medication administration errors. Quantitative data in the form of observational studies are needed to assess the impact of nurses' work hours and fatigue on medication administration errors. This non-blinded, observation-based study took place at an academic medical center in Columbus, OH. The medication administration process was observed in volunteer nurses at three points in time over a single 12-hour shift: 0-2 hours (7am-9am), 6-8 hours (1pm-3pm), and 10-12 hours (5pm-7pm). In addition to the data collected through observation, each nurse completed three questionnaires: demographic and work-related, acute fatigue, and chronic fatigue. A pilot study was conducted in both the ED and medical intensive care unit (MICU) in order to decide which setting was more feasible for this study design. Eligible nurses for the study worked in either the MICU or ED (depending on pilot results), were registered nurses, and did not work straight night shifts. Using SPSS 16.0, linear regression, repeated measures ANOVA, and frequencies were used to analyze the medication administration and nursing data. A total of 548 medication administrations were observed among the 30 MICU nurses who volunteered for this study. Within order-based errors, dose errors were the most common (6%). Administration technique errors (10.7%) were the most common within the preparation/administration-based errors, followed by administration time errors (5.7%). Within errors of process variation, not checking the patient's armband (79.6%), not double checking the MAR (16.6%), and not washing hands (12.5%) were the most common. Error rates for administration time, not washing hands, not checking armbands, and pre-charting differed significantly across the three time periods of obser (open full item for complete abstract)

Committee: Craig Pedersen (Advisor); James McAuley (Committee Member); Pamela Salsberry (Committee Member) Subjects: Nursing; Pharmaceuticals

Doctor of Philosophy, University of Akron, 2009, Nursing

Medication errors represent a significant concern in healthcare. The process of preventing medication errors is complex and involves several disciplines. Nurses play a vital role in identifying and preventing these errors using clinical judgment and astute decision-making skills. The purpose of this research was to identify the patient factors, workplace factors and nurse characteristics that influenced the conflict involved in questioning a medication order, the judgments made in administering the medication and contacting the prescriber to question the order. The Conflict Theory of Decision-making was the model that guided this study; simply stated the level of conflict that a decision-maker experiences directly affects the final choice that is made and the action that is taken. The factorial survey method was used in this study. The strength of the method lies in the ability to examine the effect of each independent variable on the dependent variable. A convenience sample of medical/surgical and intensive care nurses employed in three acute care facilities in Northwest Ohio completed a three-part survey. Part One of the survey asked the nurse to describe the last time a medication order was questioned. Part Two contained vignettes that portray ‘real-life' decision-making situations that nurses responded to using a Likert Scale. Part Three asked for specific information about the nurses' personal and professional characteristics. Results of the analysis of the data from 115 nurses' responses found the single most important influence in the experience of conflict, decision to administer the medication and contacting the prescriber was the dose and the route of the medication. In addition, nurses with a baccalaureate or higher degree were found to have a significantly different level of conflict to question a medication order than nurses with Associate Degrees or diplomas. These findings give impetus for developing educational strategies to support management of c (open full item for complete abstract)

Committee: Ruth Ludwick PhD (Advisor) Subjects: Nursing