Project title: Improving Emergency Medication Administration safety in an inpatient psychiatric unit during psychiatric emergencies (code gray events).
Goal:
To improve medication safety and reduce emergency medication errors during Code Gray events through implementation of the MACC checklist on a unit.
SECTION II: METHODS
1.) Project Design
2.) Sample and Setting
3.) Instrumentation
4.) Data Collection
5.) Data Analysis Methods
6.) Data Management Methods
7.) Ethical Considerations
8.) Timeline, Budget, Resources, and Sustainability
9.) Summary
References
Alanazi, S. M., Alotaibi, H. F., Alanazi, I. M., Aldukhain, A. M., Albasri, R. F., Alharbi, S. A., Alanizi, H. G., Alharbi, Y. F., Almutairi, D. B., Alturki, N. A., Alhasson, A. H., Ghassap, S. A., Almutairi, K. A., Al Otaibi, M. R., & Alshahrani, A. D. (2021). Management of Acute Psychiatric Emergencies. International Journal of Health Sciences, 5(S1), 1191–1206. https://doi.org/10.53730/ijhs.v5ns1.15139
Alhur, A., Alhur, A. A., Al-Rowais, D., Asiri, S., Muslim, H., Alotaibi, D., Al-Rowais, B., Alotaibi, F., Al-Hussayein, S., Alamri, A., Faya, B., Rashoud, W., Alshahrani, R., Alsumait, N., & Alqhtani, H. (2024). Enhancing patient safety through effective interprofessional communication: A focus on medication error prevention. Cureus. https://doi.org/10.7759/cureus.57991
Alrabadi, N., Shawagfeh, S., Haddad, R., Mukattash, T., Abuhammad, S., Al-rabadi, D., Abu Farha, R., AlRabadi, S., & Al-Faouri, I. (2021). Medication errors: A focus on nursing practice. Journal of Pharmaceutical Health Services Research, 12(1), 78–86. https://doi.org/10.1093/jphsr/rmaa025
Berdot, S., Vilfaillot, A., Bezie, Y., Perrin, G., Berge, M., Corny, J., Thi, T. T., Depoisson, M., Guihaire, C., Valin, N., Decelle, C., Karras, A., Durieux, P., Lê, L. M., & Sabatier, B. (2021). Effectiveness of a ‘do not interrupt’ vest intervention to reduce medication errors during medication administration: A multicenter cluster randomized controlled trial. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00671-7
Chance, E. A., Florence, D., & Sardi Abdoul, I. (2024). The effectiveness of checklists and error reporting systems in enhancing patient safety and reducing medical errors in hospital settings: A narrative review. International Journal of Nursing Sciences, 11(3), 387–398. https://doi.org/10.1016/j.ijnss.2024.06.003
Harris, K., & Russ, S. (2021). Patient-completed safety checklists as an empowerment tool for patient involvement in patient safety: Concepts, considerations and recommendations. Future Healthcare Journal, 8(3). https://doi.org/10.7861/fhj.2021-0122
Kukielka, E., & Jones, R. (2022). Medication safety in the emergency department: A study of serious medication errors reported by 101 hospitals from 2011 to 2020. Patient Safety, 49–59. https://doi.org/10.33940/data/2022.3.5
Misasi, P., & Keebler, J. R. (2019a). Medication safety in emergency medical services: Approaching an evidence-based method of verification to reduce errors. Therapeutic Advances in Drug Safety, 10. https://doi.org/10.1177/2042098618821916
Misasi, P., & Keebler, J. R. (2019b). Medication safety in emergency medical services: Approaching an evidence-based method of verification to reduce errors. Therapeutic Advances in Drug Safety, 10. https://doi.org/10.1177/2042098618821916
Owens, K., Palmore, M., Penoyer, D., & Viers, P. (2020). The effect of implementing BAR-code medication administration in an emergency department on Medication Administration Errors and nursing satisfaction. Journal of Emergency Nursing, 46(6), 884–891. https://doi.org/10.1016/j.jen.2020.07.004
Lebas, R., Calvet, B., Schadler, L., Preux, P.-M., & Laroche, M.-L. (2024). Relationships between medications used in a mental health hospital and types of medication errors: A cross-sectional study over an 8-year period. Research in Social and Administrative Pharmacy, 20(7), 597–604. https://doi.org/10.1016/j.sapharm.2024.03.006
Misasi, P., & Keebler, J. R. (2019). Medication safety in emergency medical services: Approaching an evidence-based method of verification to reduce errors. Therapeutic Advances in Drug Safety, 10. https://doi.org/10.1177/2042098618821916
Prossor, D., Constantinescu, S., Stubbs, C., Stewart, N., & Johansson, F. (2024). Medical Emergency Equipment Medication (MEEM) training: A quality improvement project focusing on transforming the emergency response to inpatient psychiatric medical emergencies. BJPsych Open, 10(S1). https://doi.org/10.1192/bjo.2024.438
Medication-administration errors in an urban mental
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Section II METHODS RUBRIC
Introduction
Start by restating the project’s purpose and its importance.
Tie in the problem statement, theoretical framework, and purpose from Section I.
Mention the needs assessment/gap analysis and its influence on method selection.
Introduce the PICOT question in the approved format with no errors.
State the aim of the QI project.
Outline the design type, sampling, data collection, and analysis plan.
Address any validity threats and control measures.
Set up the roadmap for what the section will include.
Project Design
Identify the design type (e.g., descriptive, quasi-experimental, qualitative, quantitative).
Justify why this design is the best fit for your PICOT and outcomes.
Detail the EBP (Evidence-Based Practice) intervention:
What is it?
How does it address the PICOT?
How will it produce the desired outcomes?
Cite literature to support the intervention’s effectiveness.
Name and describe the implementation framework (e.g., PDSA)
Walk through how each phase of the framework was used.
Reintroduce your change theory (from Section I) and explain how it aligns with your implementation framework.
Sample and Setting
Define the intervention population:
Who is receiving the intervention?
Who is the target population?
Discuss sampling methods (random, purposive, convenience, etc.).
Identify the micro-meso-macro systems:
Micro: frontline (e.g., unit or team).
Meso: departments or organizations.
Macro: healthcare system-wide level.
Explain the 5 P’s of the microsystem (Patients, Professionals, Processes, Patterns, Purpose).
Detail inclusion and exclusion criteria.
Discuss stakeholders’ roles and organizational readiness for change.
Include recruitment strategies and cite your flyer in the Appendix if applicable.
Describe the setting without naming it:
Type of facility
Services, support, resources, and cost involved
Include written permission to use the setting (Appendix).
Instrumentation
State what instruments were used to measure:
Primary outcomes (from PICOT)
Influencing variables
Justify why each instrument is appropriate for your outcomes.
Provide psychometric properties:
Reliability (e.g., Cronbach’s alpha, test-retest)
Validity (construct, content, criterion)
Bias control measures
Include:
Statistical evidence of reliability/validity
Developer validation methods
Permission letter if using someone else’s tool (Appendix).
If using equipment, state its sensitivity/specificity.
For surveys/questionnaires:
Describe key items and how they measure outcomes.
Explain why these constructs and formats were chosen.
Avoid creating a new tool. If unavoidable:
Justify it with literature and explain how you’ll test validity/reliability.
Address how you’ll minimize bias.
Discuss benchmarking if you’re tracking outcomes over time.
Data Collection
Describe “Who, What, When, Where, and How” of data collection:
Who collects data?
What data?
When is it collected (pre/post)?
Where (paper/electronic system)?
How (manual entry, automated extraction)?
Clarify sampling units are non-human (e.g., records).
Provide detailed description of record retrieval process.
Clearly define data elements and why they were chosen.
Describe how site entry and permission were obtained.
Address consent (implied or waived), if required.
Itemize all Appendices:
IRB
Letters of approval
Data access permission
Recruitment materials
Describe how data is protected and de-identified.
Data Analysis Methods
Link analysis plan to your project purpose and objectives.
Describe each step from data collection to final analysis:
Cleaning
Coding
Entry
Statistical analysis
Clearly identify:
Independent and dependent variables
Type, level of measurement, coding method
Provide a codebook (include table in Appendix).
Address:
Handling of missing data
Statistical tests (e.g., t-test, chi-square, regression)
Whether test is parametric or nonparametric
Discuss assumptions for tests (e.g., normality).
Define significance level (commonly p < 0.05).
Outline timeline to consult a statistician.
Data Management Methods
Provide a step-by-step plan:
Collection
Entry
Storage
Transfer
Analysis
Destruction
Address:
Who handles the data?
When and where it’s stored?
What format is used?
Must be on a password-protected, secure institutional device.
Describe de-identification process.
State how long data will be:
Retained (typically 3 years)
Destroyed (method and timeline)
Ethical Considerations
Acknowledge minimal risk to participants:
“This project is deemed minimal risk. The probability and magnitude of harm or discomfort are no greater than ordinarily encountered in daily life or routine examinations.”
Emphasize that it’s a QI project, not a human subjects study.
Reiterate no physical or psychological harm is expected.
Ensure confidentiality and voluntary participation (if applicable).
Note IRB exemption, if obtained.
Timeline, Budget, Resources, and Sustainability
Use Level 2 subheadings for each subtopic.
Timeline:
Describe phases: assessment, design, implementation, evaluation, dissemination.
Budget
Clarify source of funds (site or PI)
Separate direct and indirect costs
Cost-benefit analysis:
Is the intervention financially justified?
Resources:
Personnel, training, space, tech, materials
Sustainability:
Describe how the project will be maintained post-implementation.
Include Tables/Figures in Appendix (e.g., see Table 1).
Summary
Restate the purpose of the Methods section.
Highlight key methods used:
Design
Sample
Instrumentation
Data collection/analysis
Ethical and logistical planning
Set up the transition to Section III: Results and Discussion.