A patient named Tyrion Lannister, is a 84-year-old man. He is living in aged care since past 5 years. He has been admitted to the emergency as he encountered with a fracture in his hip joint. The patient has dementia from last 7 years and is currently showing urinary retention. The patient is prescribed medication for pain management as well as for urinary retention. Nurse A gave the medications while she was leaving as her shift ended but did not documented and as there was no reminder system so, the other nurse when commenced her shift she also gave the same medication. Though, at that time no serious harm occurred to the patient but, it could have led to serious issue due to this medication error. It has been seen that the chances of medication errors increases in case of elderly people so, the hospital settings after this incidence introduced reminder system in order to avoid the medication errors.
The structured clinical question for this assessment is “How effective is a reminder system to reduce medication error in elderly patients with dementia in comparison to just nurse monitoring during hospitalization?”
Elderly patients with dementia
Reduction in medication error
The selected study that suits the best to the formulated PICOT question is the study presented by Dalton et al., (2018) entitled as “Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: a systematic review and meta-analysis”. This study is selected because firstly, the flow of the study is appropriate and understandable and secondly, it is somewhere quite relevant to the PICOT research question selected by the study as it is able to answer how the use of computerised interventions are able reduce the errors in prescribing the medicines and medication errors.
This critical appraisal is an appraisal of the above selected systematic review presented by Dalton et al., (2018). This will critically appraisethe published systematic reviewon the basis of a thorough evaluation of the studyin order to check the validity of the study this will entail the internal as well as external validity of the selected study and its generalizability to the other population and settings (Umesh, Karippacheril & Magazine, 2016). The article aims to gather all the currently available and relevant evidences that have been utilised the advanced computerised interventions to check their capability of identifying the potentially inappropriate prescribing of medicationsthat tends to improve the suitability of this intervention in the hospitalised older adults. This article would be evaluated by taking Joanna Briggs Institute (JBI) tool into consideration and as per the checklist given for the systematicreviews and researchsyntheses thevalidity; interpretation and discussion of the resultswill be appraised.
According to the JBI checklist rule 5 i.e., to check whether the criteria for appraising the studies were appropriate or not we could check the validity of the article. According to Hayashi, Abib & Hoppen, (2019) the internal validity of a study can be understood as the scope up to which the study establishes a reliable and trustworthy relationship between the methodology that is used to obtain the outcome. For the studies that are bases on randomised controlled trials internally valid is a must and it says the design and the conduct of the study must be in such a way that it eliminates the chances of bias, along with the internal validity the article must be external valid too and this happens when the articleis clinically useful and its results are relevant to a particular definable group of the patients in a particular clinical setting. It has also been said that the random selection and randomization methods improves the internal validity of a study.
As per the above evidences, the selected study could be considered asboth internally and externally valid. This is so, because there is no bias identified in the article and the methodology used in the article is randomised controlled trial that shows the internal validity of the study.And,as per the study the computerised interventions helps in reducing the potentially inappropriate prescribing for the older adults in hospital settings and this study is clinically useful as well as relevant to the particular group i.e., elderly people in the hospital setting so, this shows that the study is also externally valid.
The next aspect of the critical appraisal is interpretation of the results. According to Moller & Myles (2016),in a literature review the interpretation of the results should be like that it acknowledge the sources of bias along with considering the generalizability, heterogeneity, and contemporary clinical relevance. The extent up to which the results or the findings of a study are applicable, valid, and reliable to other settings also is known as generalizability (Leung, 2015).While, the heterogeneity is the variety of data included and, traditionally it was considered that the heterogeneity that is the variability in data should be diminished in order to ensure the reliability of the findings. However, now it is said that the engagement with heterogeneity can potentially be helpful in producing the useful findings (Lorenc et al., 2016). And, contemporary clinical relevance refers to the clinical relevance of a study with the settings.
So, according to the evidences it could be said that all the three factors i.e., generalizability, heterogeneity, and contemporary clinical relevanceare there in the study. Because, the interpretations of the findings of the selected study are applicable, valid, and reliable to other settings as using computerized interventions whenever would be implemented shows the generalizability. As this study is a literature review and a variety of data has been incorporated from other relevant articles this also shows the heterogeneity. And, in contemporary clinical relevance, the interpretation of the results was applicable in the healthcare systems and this shows the article is clinically relevant.
The third aspects to be appraised critically would the discussion of the results of the literature review. According to the Vieira, Lima & Mizubuti, (2019) it has been seen that the discussion is one of the most difficult section of a literature review. It has also been seen that the cognitive skills along with the session so that there should be togetherand must be used in contextualizing the findings of the study. In this particular section, the discussion must be prepared by gathering the organizing information and for that. The statement of the principal findings must clearly show the strengths as well as the weaknesses of the study; later it was seen that on the form should be conducted that strengths and weaknesses in relation to other studies, so discussing regarding them always helps. It has also been seen that the introduction and discussion must function as a pair. All the findings of the study were incorporated well in the discussion sections.
As per the above given justification of the evidence it could be seen that an extensive research findings have been used in the discussion of the results. Along with fulfilling the research question’s answer there have been recommendations for the alternative interventions.
The results of the study shows that the computerised interventions that used for prescribing the medication were helpful in reducing the potentially inappropriate prescribing in the hospitalized elderly people similarly, in the selected case scenario as we know that the patient is an elderly patient and has been admitted due the fracture, along with this patient has dementia and is showing urinary retention and for this themedications would be prescribed however, doing this manually, there is high risk of getting medication errors however, if computerised interventions is used in Tyrion’s case then, there would be a lesser chance of medication error.
A clinical bottom line
One best suited study was reviewed and appraised out of six. The type of study design was randomised controlled trial
Dalton, K., O'Brien, G., O'Mahony, D., & Byrne, S. (2018). Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: A systematic review and meta-analysis. Age and Ageing, 47(5), 670–678. https://doi.org/10.1093/ageing/afy086
El-Saifi, N., Moyle, W., Jones, C., &Tuffaha, H. (2018).Medication adherence in older patients with dementia: A systematic literature review. Journal of Pharmacy Practice, 31(3), 322–334. https://doi.org/10.1177/0897190017710524
Hayashi, P., Abib, G., &Hoppen, N. (2019).Validity in qualitative research: A processual approach. The Qualitative Report, 24(1), 98-112. Retrieved from https://nsuworks.nova.edu/tqr/vol24/iss1/8
Kessler, J. B., Troxel, A. B., Asch, D. A., Mehta, S. J., Marcus, N., Lim, R., Zhu, J., Shrank, W., Brennan, T., &Volpp, K. G. (2018). Partners and alerts in medication adherence: A randomized clinical trial. Journal of General Internal Medicine, 33(9), 1536–1542. https://doi.org/10.1007/s11606-018-4389-7
Leung L. (2015). Validity, reliability, and generalizability in qualitative research.Journal of Family Medicine and Primary Care, 4(3), 324–327. https://doi.org/10.4103/2249-4863.161306
Lim, R. H., &Sharmeen, T. (2018). Medicines management issues in dementia and coping strategies used by people living with dementia and family carers: A systematic review. International Journal of Geriatric Psychiatry, 33(12), 1562–1581. https://doi.org/10.1002/gps.4985
Lorenc, T., Felix, L., Petticrew, M., Melendez-Torres, G. J., Thomas, J., Thomas, S., O'Mara-Eves, A., & Richardson, M. (2016). Meta-analysis, complexity, and heterogeneity: A qualitative interview study of researchers' methodological values and practices. Systematic Reviews, 5(1), 192.https://doi.org/10.1186/s13643-016-0366-6
Moller, A. M. & Myles, P. S. (2016). What makes a good systematic review and meta-analysis?BJA: British Journal of Anaesthesia, 117(4), 428–430.
Verloo, H., Chiolero, A., Kiszio, B., Kampel, T., &Santschi, V. (2017). Nurse interventions to improve medication adherence among discharged older adults: A systematic review. Age and Ageing, 46(5), 747–754. https://doi.org/10.1093/ageing/afx076
Vieira, R. F., Lima, R. C., &Mizubuti, E. S. G. (2019).How to write the discussion section of a scientific article.ActaScientiarum Agronomy, 41.
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