1 Capstone project: Adverse Drug Reaction in elderly NRS 493 06/4/2022 Background The paper focuses on Adverse Drug Events (ADEs). The effects of ADEs on the current healthcare settings cannot be overlooked. According to CDC, ADEs causes 1.3 million emergency visits annually. Americans 65 years and above are at the highest risk of experiencing ADEs. (Sarkar et al., 2011) researched the effects of ADEs on ambulatory visits. Their study was done between 2005 and 2007. They found that 13.5 million ADE-related visits occurred between 2005 and 2007, with most cases related to outpatient settings while others to the emergency visits. ADEs also add an extra burden to the healthcare system, with the same research showing that approximately 17 to 19 billion dollars were used to deal with ADEs. Studies have presented additional evidence to show how ADEsinclude enhanced medication costs, unplanned operations, increased patient mortality, and morbidity and operations. The focus has been to control the effects that result from medical malpractice by eliminating the problem from healthcare. Several scholars have investigated the problem from different perspectives. Although the scholars have approached the problem from different perspectives, all the studies aim to develop evidence-based solutions to the problem. The current study is not different as it compared the effectiveness of electronic medication and educating and training the nurses as means of adverse effects Clinical Statement Problem The clinical problem is Adverse Drug Events (ADEs). ADEs increase financial in the healthcare system, lead to a high risk of infections, lowers healthcare quality, and cause unwanted deaths. Due to these impacts, there is a need for an evidence-based solution to mitigate ADEs occurrence in the healthcare settings. Purpose of the Change Proposal Several pieces of research show that ADEs add economic burden by resulting in lost incomes, disabilities, and increased healthcare expenditures (Sarkar et al., 2011). Therefore, one purpose of developing a change proposal is to reduce the economic burden incurred from ADEs. Through appropriate interventions, the health care system will tackle high treatment costs while the patients will be able to resume their economic activities on time. The second purpose of the proposed change is to reduce infections in the healthcare settings. ADEs increase the Length of Stay (LOS) in hospitals. Increased LOS increases the risk of infections that threaten patients and staff safety. In addition, mitigating ADEs will increase healthcare treatment delivery quality and make hospital facilities more attractive to patients. PICOT Question Is electronic medication compared to education and training effective in reducing ADEs among older adults aged above 65 years? Literature Search Strategy The literature aimed to identify reputable sources related to education, training, and electronic medication. All the studies ...

1. 1
Capstone project: Adverse Drug Reaction in elderly
NRS 493
06/4/2022
Background
The paper focuses on Adverse Drug Events (ADEs). The
effects of ADEs on the current healthcare settings cannot be
overlooked. According to CDC, ADEs causes 1.3 million
emergency visits annually. Americans 65 years and above are at
the highest risk of experiencing ADEs. (Sarkar et al., 2011)
researched the effects of ADEs on ambulatory visits. Their
study was done between 2005 and 2007. They found that 13.5
million ADE-related visits occurred between 2005 and
2007, with most cases related to outpatient settings while others
to the emergency visits. ADEs also add an extra burden to the
healthcare system, with the same research showing that

2. approximately 17 to 19 billion dollars were used to deal with
ADEs.
Studies have presented additional evidence to show how
ADEsinclude enhanced medication costs, unplanned operations,
increased patient mortality, and morbidity and operations. The
focus has been to control the effects that result from medical
malpractice by eliminating the problem from healthcare. Several
scholars have investigated the problem from different
perspectives. Although the scholars have approached the
problem from different perspectives, all the studies aim to
develop evidence-based solutions to the problem. The current
study is not different as it compared the effectiveness of
electronic medication and educating and training the nurses as
means of adverse effects
Clinical Statement Problem
The clinical problem is Adverse Drug Events (ADEs).
ADEs increase financial in the healthcare system, lead to a high
risk of infections, lowers healthcare quality, and cause
unwanted deaths. Due to these impacts, there is a need for an
evidence-based solution to mitigate ADEs occurrence in the
healthcare settings.
Purpose of the Change Proposal
Several pieces of research show that ADEs add economic
burden by resulting in lost incomes, disabilities, and increased
healthcare expenditures (Sarkar et al., 2011). Therefore, one
purpose of developing a change proposal is to reduce the
economic burden incurred from ADEs. Through appropriate
interventions, the health care system will tackle high treatment
costs while the patients will be able to resume their economic
activities on time.
The second purpose of the proposed change is to reduce
infections in the healthcare settings. ADEs increase the Length
of Stay (LOS) in hospitals. Increased LOS increases the risk of
infections that threaten patients and staff safety. In addition,
mitigating ADEs will increase healthcare treatment delivery
quality and make hospital facilities more attractive to patients.

3. PICOT Question
Is electronic medication compared to education and training
effective in reducing ADEs among older adults aged above 65
years?
Literature Search Strategy
The literature aimed to identify reputable sources related
to education, training, and electronic medication. All the studies
included in the literature were published between 2018 and
2022 and are not more than five years old). Using current
sources was to obtain more recent and reliable findings on
appropriate interventions to reduce ADEs.
The articles were searched on reputable academic
databases of Google Scholar and PubMed. To obtain more
accurate sources, keywords and Boolean operators (and, or)
were used. For instance, one search term using Boolean
operators was electronic medication and adverse drug events.
Efforts were made to identify articles related to either education
and training and electronic medication and their effectiveness in
reducing ADEs.
Evaluation of Literature
Eight studies were evaluated in the literature. Gregory et al.,
(2021) investigated the experiences of Registered Nurses who
administered medications to patients using the electronic
medication administration record using a qualitative descriptive
exploratory study and thematic analysis. They collected data
using focus groups and observation. The analysis results showed
that electronic medication reduced the time nurses spend with
their patients, and thus, more study is needed to determine the
effectiveness of the electronic medication. Li et al., (2019)
investigated the effectiveness of different interventions that can
apply to mitigate ADEs. The study was a systematic review of
different articles, and the findings showed that electronic
medication was the best intervention. In addition, a study by
Lau et al., (2018) analyzed patients’ perspectives on electronic
medication using a cross-sectional survey in an Australian
Metropolitan hospital setting. They analyzed data using

4. descriptive statistics and found that patients were more
optimistic about e-prescribing. Martin et al., 2018 researched
the effectiveness of the educational intervention on medical
safety and found a positive correlation.
Wang et al., (2019), Kinlay et al., (2021), Fuller et al., (2018),
and Bugnon et al., (2021) have also conducted additional
research on the efficacy of the electronic medication and
educational intervention in reducing ADEs in medical settings.
The study by Wang et al., (2019) was a meta-analysis
investigating the efficacy of electronic medical reconciliation in
reducing ADEs. The results showed that electronic medical
reconciliation reduces unintended medical discrepancies and
improves medical safety. The articles by Kinlay et al., (2021)
and Fuller et al., 2018) were also systematic reviews. Kinlay et
al., (2021) investigated the effects of electronic medical
management in enhancing medical safety. The results showed
that electronic medical management reduces medical errors and
improves workflow in healthcare settings.
Fuller et al., (2018) intended to map the extent, range, and
nature of research on the effectiveness, level of use, and
perceptions about electronic medication administration records
(eMARs) in long-term care facilities (LTCFs). The findings
revealed that evidence linking electronic Medication
Administration Records (eMAR) as effective in reducing errors
was weak, and thus, more robust research is needed. Bugnon et
al., (2021) conducted a longitudinal study to summarize lessons
learned from primary care professionals involved in a
pioneering pilot project in Switzerland for the system-wide
implementation of shared electronic medication plans. Using
group interviews and descriptive data analysis methods, the
authors found that study participants considered medication
plan management, digitalized or not, a core element of good
clinical practice
In summary, there is a broad literature on the efficacy of the
electronic medication and education training in reducing ADEs.
Most of the articles show that electronic medication or digiti zed

5. medical management effectively reduces medical errors in
healthcare settings. Nevertheless, more research is needed to
support these findings further.
Applicable Change
The current findings in the literature show that stakeholders can
handle the issue of ADEs in healthcare. Since most research
support using electronic medication to reduce medical errors,
the applicable change should be electronic medication,
including e-prescribing, to deal with ADEs.
Proposed Implementation Plan and Outcome Measures
The proposed plan introduces electronic medication in
healthcare facilities to reduce ADEs. The first implementation
plan will identify the desired outcomes after implementing the
plan. The first desired outcome is increased patient safety after
introducing electronic medication. Other expected outcomes
will be reduced ambulatory visits and infection risks. The
second step in implementing the proposal will be identifying
areas that will be affected by the change. Thirdly, the
implementation team will craft a working plan that defines time
frames for each task within the change and assign
responsibilities to different individuals. Afterward, the
management will allocate a budget that will be used in
implementing the change process. A process and outcome
analysis will be initiated during the implementation to ensure
the program aligns with initial goals.
The use of Evidence-Based Practice in Creating the Plan
Robust research on the implementation of a project was
conducted before the implementation plan was adopted. During
implementation, the stakeholders first identify required goals
before embarking on a work plan that will lead to the
achievement of the project. A risk assessment is also conducted
before a budget is allocated for the project.
Evaluating the Intervention
The intervention plan will be evaluated based on the desired
goals set at the start of the implementation process. For
instance, the plan is expected to increase patient safety by

6. improving quality care, reducing ambulatory visits, and
lowering healthcare costs. After implementation, the change
team will research whether these objectives were met. Besides
measuring the outcomes, the change team will evaluate the
impact to determine patients’ perspectives on the new
intervention. Data for evaluation will be collected from medical
records, observations, and interviews.
Potential Barriers
One of the potential barriers to implementing the initiative is
financial constraints. Some healthcare facilities may lack
enough funds to support electronic medication or e-prescribing.
Secondly, insufficient expertise to implement the initiative
could also hinder attaining intended goals. Lastly, electronic
medication is susceptible to cyber-attacks, and thus,
organizations will have to invest more in data security
measures, which could add to operational costs
References
Bugnon, B., Geissbuhler, A., Bischoff, T., Bonnabry, P., & von
Plessen, C. (2021). Improving primary care medication
processes by using shared electronic medication plans in
Switzerland: Lessons learned from a participatory action
research study. JMIR Formative Research, 5(1).
https://doi.org/10.2196/22319
Fuller, A. E. C., Guirguis, L. M., Sadowski, C. A., &
Makowsky, M. J. (2018). Electronic Medication Administration
records in long‐ term Care Facilities: A scoping review. Journal
of the American Geriatrics Society, 66(7), 1428–1436.
https://doi.org/10.1111/jgs.15384
Gregory, L. R., Lim, R., MacCullagh, L., Riley, T., Tuqiri, K.,
Heiler, J., & Peters, K. (2021). Intensive Care Nurses'
experiences with the new electronic medication administration
record. Nursing Open, 9(3), 1895–1901.
https://doi.org/10.1002/nop2.939
Kinlay, M., Ho, L. M., Zheng, W. Y., Burke, R., Juraskova, I.,
Moles, R., & Baysari, M. (2021). Electronic Medication

7. Management Systems: Analysis of enhancements to reduce
errors and improve workflow. Applied Clinical Informatics,
12(05), 1049–1060. https://doi.org/10.1055/s-0041-1739196
Lau, G., Ho, J., Lin, S., Yeoh, K., Wan, T., & Hodgkinson, M.
(2018). Patient and clinician perspectives of an integrated
electronic medication prescribing and dispensing system: A
qualitative study at a multisite Australian Hospital Network.
Health Information Management Journal, 48(1), 12–23.
https://doi.org/10.1177/1833358317720601
Li, R., Zaidi, S. T., Chen, T., & Castelino, R. (2019).
Effectiveness of interventions to improve adverse drug reaction
reporting by healthcare professionals over the last decade: A
systematic review. Pharmacoepidemiology and Drug Safety,
29(1), 1–8. https://doi.org/10.1002/pds.4906
Martin, P., Tamblyn, R., Benedetti, A., Ahmed, S., &
Tannenbaum, C. (2018). Effect of a pharmacist-led educational
intervention on inappropriate medication prescriptions in older
adults. JAMA, 320(18), 1889.
https://doi.org/10.1001/jama.2018.161 31
Wang, H., Meng, L., Song, J., Yang, J., Li, J., & Qiu, F. (2018).
Electronic medication reconciliation in hospitals: A systematic
review and meta-analysis. European Journal of Hospital
Pharmacy, 25(5), 245–250. https://doi.org/10.1136/ejhpharm-
2017-001441

8. Explore the latest trends in TeleMedicine and the latest Apps.
"Telemedicine, which enables video or phone appointments
between a patient and their health care practitioner, benefits
both health and convenience. More health care providers are
offering to “see” patients by computer and smartphone."
Just refer following link to get the background idea

9. https://www.hopkinsmedicine.org/health/treatment-tests-and-
therapies/benefits-of-telemedicine
Criteria
2- It will be researched and contain proper in-text, paraphrased
and quoted citations with references listed in APA format.
Includes minimum two Full APA references.
3- It will present your own opinion, be insightful and have
supporting evidence through research.
4- It will be between 250 - 500 words.
5- It will have no grammatical or spelling mistakes.
Last but not the least give third person review for this answer in
two to three sentences.