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8/3/2019 Action Research Kuno (3)

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CHAPTER I

Introduction

Nursing management is a curriculum that focuses on the development of nursing

leadership and management skills essential to the professional nurse. It includes ethico-moral

aspects of health care and nursing practice, the nurses responsibilities for personal and

professional growth. One strategy to use in enhancing leadership and management skills is

through action research. This action research is designed to provide students concepts necessary

to critically read and evaluate and experience problem-solving approach in meeting problems in

nursing care. It deals with the research process and its application to the nursing care

management of clients in varied settings. It includes concepts of research theories in nursing

tools for research.

While recent trends move nursing and health care out of the hospital and into the

community, some areas of nursing remain predominately in the hospital setting. One of these


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and midwives they are still liable to practice with good ethics. Furthermore, it's a huge impact to

the society on what they do, how much they know and why is their profession important.

The delivery nurse is a registered nurse and holds the nursing license required by his

state. The nurse usually holds a Bachelor of Science in Nursing and undergoes training to acquire

obstetric skills in the delivery and nursery rooms. Delivery room nurses have the joy of being a

part of bringing one new life after another into the world through the miracle of childbirth. A

delivery room nurse works with adults and newborns and in high-pressure situations, such as

high-risk pregnancies. Delivery nurses help relieve stresses new mothers-to-be might experience.

Unlike other area or department in the hospital, the delivery room nurses and midwives

give humane and excellent patient care that is entirely different. From welcoming the expecting

mothers, establishing rapport, comforting them during labor, explaining to them the proper

breathing, positioning and so on and so forth until delivery progresses and when the baby is out.

Convenience and respect as an individual manages the bonding between the nurses, midwives

and their patients. Through laughter's and tears the healthcare team and patients undertake. It is a


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through a healthy delivery. During labor, this nurse monitors the fetus and mother, counting

contractions as they come. The delivery room nurse performs the first vaginal examination for

the mother. During labor, the nurse might help the mother breathe her way through complicated

contractions. The nurse administers IVs to the mother and preps her for a cesarean section if

necessary. The nurse also takes care of the baby right after delivery. She takes the Apgar score of

the newborn and records birth weight, applies identification bands to newborns and supplies the

mother and baby with medications post-delivery. The delivery room nurse might also help the

mother if she shows signs of postpartum depression.

Labor and delivery registered nurses use professional judgment, critical thinking, and fast

decision making skills. They care for women who are laboring, having complications of

pregnancy or having recently delivered. They work closely with patients, families, and other

health care professionals.

Labor and delivery registered nurses provide care to women and their newborns during

the antepartum, intrapartum, postpartum, and neonatal stages of this important life event. They


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Labor and delivery registered nurses assume many different roles, including: antepartum

nurse who provides care to patients who have complications of pregnancy requiring

hospitalization; labor and delivery nurse who provides care to patients in labor who have

uncomplicated or complicated deliveries; circulating nurse who manages patient care in the

operating room during a cesarean delivery; scrub nurse who works directly with the surgeons

during a cesarean delivery by passing instruments, etc, to the physicians; postpartum nurse who

provides care to patients who have recently delivered and nursery nurse who provides care to

newborns. Labor and delivery registered nurses also may work as clinical coordinators

responsible for patient assignments and coordinating patient care.

Labor and delivery nursing requires empathy, critical thinking, decision-making, and

communication skills. Most labor and delivery registered nurses have some general medical-

surgical nursing background. They must be able to communicate well with patients, families, and

other health care providers. They must be skilled in prioritizing patient needs and cope well with

a fast-paced, sometimes stressful environment.


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have a medical professional she can trust. A labor and delivery nurse helps to make the mothers

pregnancy and delivery as safe and stress-free as possible

In general, the delivery room nurse is skilled in obstetrics and has broad knowledge of

labor, delivery and postpartum and nursery care. She is also skilled in principles and practices of

sterile technique and controlling infection. Delivery room nurses have technical skills in caring

for new mothers and newborns. She is also a leader with excellent communication skills.

Once said, hospital is a place where financial issue remains to be debated and unresolved

due to high hospital bills. It is so amazing where another phase of life begin to breathe, the

moment we see another life on earth, the place where a new child is born: the delivery room.

Perhaps, to some or mostly indeed, but for what nurses and midwives do believe in every bad

thought there is always a place where ideal care promises great competency. Delivery room, an

area where nurses and midwives always perceive and integrate proper assessment, heartily

diagnosis, good planning, right implementation and steadfast evaluation.

Gat Andres Bonifacio Memorial Medical Center (GABMMC) is a government hospital


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area is the pelvic room with two bed capacity, wherein the expectant mothers are being assess for

admission. Included in the pelvic room is a cabinet where sterile gowns and bed linens are

placed. Passing the pelvic room is a small lobby wherein soiled linens and trash are placed and

being collected by crews and where the instruments are being washed. This lobby also leads to

the other side of the operating room. In the pelvic room is another door leading to the labor room

wherein the admitted mothers take labor. It has four beds. When the baby is already crowning,

the mother is then carried to the delivery area. It is composed of four beds. In proximity to the

head of the beds is the medication area. Beside the medication area is a cabinet for IV fluids and

IV sets. In proximity to the foot of the beds is where the sterile instruments are placed and being

prepared in case of actual delivery. At the corner of the room is the hand washing area. In

proximity to the handwashing area is a sliding window connected to NICU wherein newborn

babies are being handed over the nurses in NICU for cord care.

Medical errors are always disturbing, but perhaps the most heartbreaking are those that

occur in the delivery room. Approximately 1.3 million people are injured annually in the United
http://www.nccmerp.org/


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quality use of the medicines and together with the patient counseling from the core professional

activities of a pharmacist. These activities allow the safe and efficient provision to the general

public of what would normally be dangerous or restricted drugs. The squeal to serious is

dispensing errors may be far-reaching, including patient morbidity and mortality, increased

health expenditure due to hospitalization and treatment, and loss of credibility and professional

standing for the pharmacist along with the risk of litigation and financial loss. Dispensing errors

generally refers to errors in the dispensing process like wrong drug, incorrectly labeled directions

or drug dispensed to wrong patients. Main risk factors associated with the dispensing errors were

found to be prescription overload, lighting levels, noise, interruptions and distractions and stress.

Also the major parts of the dispensing errors were related to wrong drug. While the majority of

physicians and nurses practice quality medicine and do their jobs admirably, they are also

human. Because of the environment, delivery rooms can become disorganized and stressful, and

an overworked staff is often required to deal with emergencies and multitask in less than

optimum conditions.


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CHAPTER II

Methodology

Conceptual Framework

SWOT Analysis and Prioritization

of controllable problems

Formulation of Plan of Action


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This action research aimed to find out an effective action plan with regards to the

medication error in GABMMCDelivery room.

The box on the left represents the SWOT analysis done in the hospital area and the

prioritization of the problems identified. It is connected to the box on the right side which

represents the action plan to be formulated when the problem had already been identified and

prioritized. This action plan was then implemented and evaluated at the said hospital area which

is represented by the box below.

These boxes are connected by a one-way arrow that shows the step by step process of the

entire action research.

Research Procedure:

The researcher spent 2 days to observe how GABMMC delivery room render services

to their patient. Direct observation in the entire area and direct communication to the staffs were

used in gathering the data needed.


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objectives. It is then a useful technique for understanding the Strengths and Weaknesses, and for

identifying both the Opportunities open to the hospital area and the Threats they face.

The SWOT analysis provides information that is helpful in matching the firm's resources

and capabilities to the competitive environment in which it operates. As such, it is instrumental

in strategy formulation and selection.

Strengths Weaknesses

Opportunities Threats

FIGURE 2: Sample SWOT Analysis

(Internal Analysis)

(External Analysis)


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Key staff Access to natural resources Operational efficiency Operational capacity Financial resources

The SWOT analysis summarizes the internal factors as a list of strengths and weaknesses.

External Analysis

An opportunity is the chance to introduce service that can generate superior returns.

Opportunities can arise when changes occur in the external environment. Many of these changes

can be perceived as threats and may necessitate a change in development of services in order for

the institution to remain competitive. Changes in the external environment in hospital setting

may be related to:

Patients


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2. Internal Weaknesses: what critical parts of institution must be strengthen or hide fromcompetitors

3. External Opportunities: the benefits that are likely to accrue from pursuing the visionand external opportunities

4. External Threats: the pitfalls and the dangers, the variations and exceptions possible.After the problems had been identified through Swot analysis, they are then prioritized.

Priority setting can be defined as making a choice based on a ranking process, although

occasionally the term is used as a synonym for rationing or resource allocation. Priority setting is

a process where decisions are made about the allocation of healthcare resources following the

completion of a needs assessment. Prioritizing takes place in all parts of the health care system

where demands and needs exceed resources. Priorities establish the order in which problems will

be approached.

Priority setting is a challenge because it involves making tough decisions about how
http://www.1000ventures.com/business_guide/opportunities_pursuing.htmlhttp://www.1000ventures.com/business_guide/opportunities_pursuing.html


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solvable problems first. The researcher began by having some criteria to classify problems

according to prioritization.

Criteria for prioritizing problems in order to focus on developing interventions

1) Urgency of the problem to solve2) Possibility of solving problem quickly/in short time3) Availability of resources to solve the problem4) Ability of staff members5) Availability of support by other stakeholdersThe problems are then ranked according to which problem should be attended first.

Template for Prioritizing Problems

A scale of 0, 1, and 2 is used to rank the problems. The higher the total score, the

problems meets more of the criteria for being a priority among the other problems.


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Scale for Criteria:

Urgency to Solve: 0= not urgent; 1= to some extent; 2= Very urgent

Possibility of solving problem quickly/in short time: 0= long time to solve; 1= can be solvedfairly quickly; 2= can be solved quickly;

Availability of resources to solve problem: 0 = do not have the resources; 2= have the resourcesavailable.

Ability of staff/QC to solve problem: 0 = problem cannot be solved easily by us; 2 = problem

can be solved easily by us.

Support from other stakeholders: 0= no support available from stakeholders; 2= supportavailable from stakeholders.

Formulating an Action Plan

The key to strategic priority action planning is to identify incident problems, classify each

problem strategically, and then prioritize classified problems tactically. After the problem had

been prioritized, action plan was then formulated by using SMART criteria. Action plan is a

series of activities that must be performed for a plan to succeed. The problem identified together

with the plan of action formulated was then addressed to the hospital area.

Activities Objectives Person Time Resources Evaluation


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Objectives that are SMART are likely to be achieved. These targets assist development of

individual work plans, and also provide a guidance system for supervisor-staff performance

review discussions. The acronym SMART has a number of slightly different variations, which

can be used to provide a more comprehensive definition for goal setting:

S - specific, significant, stretching

M - measurable, meaningful, motivational

Aachievable, agreed upon, attainable, acceptable, action-oriented

R - realistic, relevant, reasonable, rewarding, results-oriented

T - timely, time-based, tangible, trackable

SMART can be used to help ensure that effective objectives or goals are set.

Specific


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WHAT is to be done? This are best written using strong, action verbs such as conduct,

develop, build, plan, execute, etc. This helps objective to be action-orientated and focuses

on whats most important.

WHY is this important to do? WHO is going to do what? Who else need to be involved? WHEN should this to be completed? HOW to do this?

Diagnostic Questions

What exactly to do, with or for whom? What strategies will be used? Is the objective well understood? Is the objective described with action verbs? Is it clear who is involved? Is it clear where this will happen?


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How will it be known that the change has occurred? Can these measurements be obtained?

Achievable

When giving objectives, the person may not be able to achieve it for various reasons,

including a lack of skill, not having enough resources (computers, tools, etc.), not having access

to key people and not having management support. Achievable objectives ensure that everything

is in place and that if the person does not reach the goals they cannot reasonably point the finger

elsewhere.


Can it be done in the proposed timeframe? Are the limitations and constraints understood? Can it be done with the resources available? Has anyone else done this successfully?


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Is it possible to achieve this objective?

Timely

Descriptions of objectives should also include timescales of what is required by when.

This may also include details of delivery, stating (if relevant) where objectives are to be

completed.

Giving a time scale adds appropriate sense of urgency and ensures that the objectives do

not dribble out over an unreasonably long timescale.


When will this objective be accomplished? Is there a stated deadline?

Implementation and Evaluation


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strategies, and objectives, determine whether or not progress is being made toward the goal and

priority. Evaluation results validate or invalidate the effectiveness of the activities within the

plan.

Problem statement __________________________________________________

Action Steps Estimated

Time Frame

Actual Time

Frame

Responses Modifications

to the Plan

Continuing

Action

Needed

FIGURE 5: Evaluation Tool


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CHAPTER III

Results and Discussion

This chapter represented the findings and analysis of the data gathered. For easier

comprehensions of the details, texts and tables were likewise presented at every discussion.

This table represented the result of the SWOT Analysis done through direct observation

and direct communication with the staffs.

TABLE 1: SWOT Analysis

Strengths Weaknesses

1. There is a hand washing area

2.

There is a medication kit with labels

1. The towel is place at the medication areainstead of the hand washing area because

it is also used as protection in opening

ampules.

2. It is still not organized. Due to stressfulenvironment, medication labels are

sometimes not observed.


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It is clear in the table that the strengths given have its own weakness, opportunities and

threats. The first strength of the delivery room was having a hand washing area. The hand

washing area also has instruction for proper hand washing. Hand washing is the number one way

to prevent infection. While sanitizing hand lotions have become increasingly popular, studies

show that a good hand washing with soap and water is still more effective for visibly soiled

hands. But the weakness correlated to this is the absence of towel to dry hands. In the area, the

supposed hand towel for drying hands after hand washing is being used as a protection in

opening ampules. Using this hand towel to dry hands after handwashing clearly violates the

principle of aseptic technique. Hands are needed to be dry because most of bacteria thrive in wet

area. A single-use towel should be used to maintain sterility and observation of principles of

aseptic technique.

Another strength showed was having a medication kit in the medication area. The

medication kit has labels where the medication given to the mother is placed and get for

preparation of meds. The use of this medication kit is merely to avoid medication error. One type

f di i i h di i Di i ll f i h
http://surgery.about.com/od/questionsanswers/qt/SurgeryInfect.htmhttp://surgery.about.com/od/questionsanswers/qt/SurgeryInfect.htm


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The figure below illustrated by Kevin Gibbs a Clinical Pharmacy Manager of Bristol

Royal Infirmary showed a summary of the causes of medication error, the person and system

approach and their reaction to medication error.


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Another strength presented on the table was having a plastic bag for empty vials. As

verbalized by one of the staffs, the empty vials are being used for another purpose. It is a strength

having these empty vials separated from other sharp wastes but it is also hazardous if the plastic

bag has no support. If the vials are not organized inside the plastic bag, it can fall and break and

may cause unexpected accident. The medicines should be collected into a leak-proof storage

container. It is important to ensure that solid and liquid medicines are kept separate. This type of

waste includes all empty multidose bottles, vaccine vials and contaminated tablet pots. These are

best collected into a pharmaceutical waste bin separate from whole medicines. A detailed list is

not required as these are classified as non-hazardous waste. It should be ensured that all syringes

placed in the bin have been fully discharged of content. Snap-top vials should not be placed in

these bins. Snap-top glass should be placed in the sharps bin.

The last strength identified was having a separate cabinet for the gowns and linens. This

also adds to the organization of equipments inside the delivery room. Through direct

observation, it was noticed that linens and gowns have the same folds and color, thus often

i h i h Thi i i bl i ll i h i h h


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TABLE 2: Prioritization Criteria

Prioritization criteria

Problem

description

Urgency

to solve

Possibility

of solving

problem

quickly/inshort time

Availability

of

resources

Ability of

staff and

QC to

solveproblem

with own

resources

Support

from other

stakeholders

Total

Priority

Score

Problem 1 1 2 2 2 0 7

Problem 2 2 0 2 2 2 8

Problem 3 0 2 0 0 0 2

Problem 4 0 2 2 2 0 6

Scale for Criteria:

Urgency to Solve: 0= not urgent; 1= to some extent; 2= Very urgent.

Possibility of solving problem quickly/in short time: 0= long time to solve; 1= can be solved

fairly quickly; 2= can be solved quickly.

A il bili f l bl 0 d h h 2 h h


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Table 2 showed how the problem was prioritized. A scale from 0 2 was used in rating

prioritization criteria. In the Urgency to solve the problem, problems were rated with 0 being the

not urgent to solve, 1 as being urgent to some extent and 2 being very urgent. The possibility of

solving problem in short time was rated with scales of 0 being the long time to solve, 1 being the

problem which can be solved fairly quickly and 2 as the problem which can be solve very

quickly. Availability of resources to solve problem was rated with scales of 0 for not having

resources and 2 for having resources available. In the ability of staff to solve the problem, it is

rated in the scale with 0 being the problem that cannot be solved easily and 2 being the problem

that can be solved easily. For the support from the stakeholders it is rated in scale with 0 for

having no support from the stakeholders and 2 for having support from stakeholders.

All the rates of each problem were summed up as the total priority score. The problem

with the highest priority score is the priority problem of this action research. Based on the result,

Problem no. 2, which is the problem regarding the medication error, got the highest priority score

despite the fact that it requires a long time to solve.


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CHAPTER IV

Recommendation

Medication errors strike at the heart of being a nurse the responsibility to do well and

avoid harm. Medication errors have serious direct and indirect results, and are usually the

consequence of breakdowns in a system of care. Direct results include patient harm as well as

increased healthcare costs. Indirect results include harm to nurses in terms of professional and

personal status, confidence, and practice.

Based on research of Ann Mayo (2004), Labor and delivery nurses rank 2nd in the Top 10

Nurse Practice Setting that commits medication error with 9.7% of the sample population.

Consider that a hospital nurse in the delivery room grabs the wrong vial or ampule of medication

to administer to the patient - a potentially life threatening mistake -- because the packaging

closely resembles that of the correct medication stocked one shelf over. Nurses are accountable

for the drugs they administer and therefore require knowledge of the action, side-effects and

correct dosage of any drug they administer


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In relation to this common nursing problem, the researcher was able to come up with a

recommendation which was presented to GABMMCDelivery room.

1. Proper organization of the medications in the area. Proper use of medication kits withlabels would help reduce erroneous medication administration to patients. Right drug

must be placed on the right medication container to avoid swapping of medication during

medication administration.

2. Read medication labels and how to properly administer medication. This is to prevent agreat error in administering the drug for the patient. Know the right dose and right route

of the right drug to be administered.

3. Observing the 5 Basic Rights in Medication Administration. A poster must be posted onthe wall of the medication area to help remind the nurses on the rights in medication

administration. Strictly observing these 5 basic rights will help reduce medication error in

the hospital area.

4. Monitor vital signs that should be taken into consideration for some drugs that would bed i i d h i M h i d d i i d i f i i bi h


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V. APPENDICES


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29

ACTION PLAN

Strategy Activities Objectives PersonResponsible

Time Frame Resources Evaluation

1. Organizeproperly the

medication

area.

a. Continuous useof medication

kits with labels

b.Organize itemsaccording to

size, within

their groups.

c. Place right drugon right

medication

container

To be able to

achieve a

systematized

medication area:

a.to avoidconfusion of

each drugb.to easily

pinpoint drugs

needed

c.to avoidswapping of

medication

Staff Nurses 8 hours (every

shift) Medication kit

with labels

The medication

area maintained to

organize.

2. Strictlyobserve the 5

Basic Rights of

Medication

Administration

a.Readmedication

label before

administering

drug.

b.Review on howto administer

the medication

To be able to

minimize

medication error

by:

a. giving the rightmedication to

the mother

Staff Nurses 8 hours (everyshift) Poster of the 5Basic Rights in

Medication

Administration

The 5 rights inmedication

administration was

observed.


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30

that is to be

given to the

mother.

c. Know the rightdose and right

route of the

drug to be

administered.

d.Place a posterindicating the 5

basic rights of

medicationadministration

on the wall of

the medication

area

b.being able togive the

medication in

the proper and

right way.

c. rememberingthe 5 basic

rights before

administering

drug to the

mother

15 minutes


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31

EVALUATION

Problem statement: Prone to Medication Error

Action Steps Estimated Time

Frame

Actual Time

Frame

Responses Modifications to

the Plan

Continuing Action

Needed

Organizing

Medication area:

Continuous useof medication

kits with labels

Organize itemsaccording to size,

within theirgroups.

Place right drugon right

medication

container

Observing the 5

Basic Rights:

Read medicationlabel before

administering

drug.

Within the shift

Within the shift

Within the shift

Within the shift

The staff nurses

were able to do all

the action steps

The staff nurses was

able to do all the

action steps

None

None

All action steps

should be done

religiously

All action steps

should be done

religiously


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Review on howto administer the

medication that

is to be given to

the mother.

Know the rightdose and right

route of the drug

to be

administered.

Place a posterindicating the 5

basic rights of

medication

administration on

the wall of the

medication area

15 minutes 5 minutes The staff nurse was

able to place aposter of the 5

Rights in

Medication

Administration on

the medication area

wall within the

estimated time

None Poster should be

kept posted on thewall and be

replaced if it is

already worn out

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