Jessica O’Shea

• Registered Nursing professional in Emergency Medicine with extensive knowledge in acute patient care, rapid assessment, and critical interventions. Skilled in team collaboration, maintaining high standards, and adapting to changing needs seamlessly. Known for strong clinical judgment, effective communication, and focus on achieving optimal patient outcomes in fast-paced environments.
• Healthcare professional with extensive experience in high-stress emergency settings. Proven ability to deliver exceptional patient care while maintaining composure during medical crises. Highly reliable team member with adaptability to changing situations and commitment to collaborative success.

Improving Medication Safety through Barcode Medication Administration (BCMA) Implementation in the Emergency Department

Jessica O'Shea

Executive Summary

Midwestern University

DRNPG1507: Preventative Care Initiatives and Interprofessional Collaboration

Dr. Kelly Vandenberg

June 9th, 2025

Problem/Opportunity

Among adult patients in the emergency department (ED) of a hospital in the southwestern United States, does the implementation of Barcode Medication Administration (BCMA), compared to current medication administration practices, decrease medication administration errors over an eight-week timeframe?

Every missed scan in the emergency department is a missed opportunity to prevent harm. Medication administration errors remain a persistent and preventable threat to patient safety, particularly in the high-pressure environment of the ED. This is a critical concern in emergency departments (EDs), where high patient acuity and rapid decision-making increase the risk of mistakes. Although Barcode Medication Administration (BCMA) technology has proven effective in reducing these errors, its underutilization and inconsistent use in ED settings present a significant patient safety challenge.

Proposed Solution

This quality improvement (QI) project proposes the implementation of a structured BCMA intervention in the ED, including nurse education, visual job aids, and leadership rounding. The intervention aims to enhance barcode scanning and reduce medication errors. Pre- and post-intervention data will be collected and analyzed from the electronic health record (EHR) to measure outcomes such as medication error rates and the timeliness of antibiotic administration.

Population and Sample

The population for this project includes adult patients (ages 18 and older) receiving medications in the ED. The convenience sample will consist of approximately 100–150 patients who received medications during both the pre-intervention and post-intervention periods. Demographic characteristics such as age, gender, race/ethnicity, and presenting diagnosis will be described to contextualize the data.

Intervention

The intervention involves implementing a structured BCMA improvement initiative that includes brief nursing education sessions, placement of visual job aids at medication workstations, and leadership rounding to reinforce barcode scanning. The goal is to promote safe and consistent medication scanning practices among ED nurses.

Comparison

The comparison group consists of the same ED setting prior to the intervention, using historical data to assess baseline medication error rates and scanning before BCMA reinforcement was introduced.

Value Proposition

BCMA is associated with substantial reductions in adverse drug events—up to 50% in some healthcare settings (van der Veen et al., 2022). Increasing barcode scanning directly contributes to safer medication practices, minimizes risk to patients, and supports institutional goals for high-reliability care. This initiative aligns national patient safety priorities and is expected to generate measurable improvements in both safety and efficiency.

Key Recommendations

• Deliver concise, targeted education to ED nurses on BCMA workflows and error prevention.
• Post visual reminders and scanning job aids at medication preparation stations.
• Conduct daily rounding by nurse leaders to support and answer staff questions.
• Use EHR data to track and provide feedback on scanning rates and medication error trends.

Outcome

Primary outcomes include a reduction in medication administration errors and an increase in BCMA scan rates. A secondary outcome is improved timeliness of antibiotic administration, measured as time from order to administration.

Timeframe

The project will be conducted over an eight-week period for data collection and analysis.

Conclusion

Implementing BCMA with structured staff support in the ED offers a meaningful solution to a persistent safety problem. This initiative is timely, feasible, and backed by strong evidence. Immediate adoption of these recommendations can improve clinical outcomes, safeguard patients, and strengthen the safety culture in emergency care.

References

van der Veen, W., van den Bemt, P. M. L. A., & Wouters, H. (2022). Barcode technology and medication administration errors: A systematic review. BMJ Quality & Safety, 31(2), 115–124. https://doi.org/10.1136/bmjqs-2020-012416

IRB Application Process

Week 8: Assignment #4

Jessica O’Shea

Midwestern University

DRNPG 1503: Information Systems and The Transformation of Global Health Assessment

Dr. Kelly Vandenberg

February 12th, 2025

Ethical Considerations for IRB Application

Among adult patients in the emergency department located in the southwest of the U.S., the implementation of the Barcode Medication Administration (BCMA), decreased medication errors over an eight-week timeframe, compared to current practice.

The institutional review board (IRN is designed to ensure that human and ethical conduction of research (Bradshaw & Vitale, 2021). This DNP is not a research project; however, this DNP project is designed in a way that protects participants from harm (Bradshaw & Vitale, 2021).

Two key ethical principles when implementing BCMA are Non-maleficence (Do no harm) and Justice (Equitable access to safe care). The principle of non-maleficence ensures that interventions do not cause harm to patients (Bradshaw & Vitale, 2021). Implementing BCMA is designed to reduce mediation errors, thereby enhancing patient safety (Bradshaw & Vitale, 2021). However, during the transition from non-scanning system to BCMA, there is potential for workflow disruptions, technical errors or resistance from staff that could inadvertently affect patient care (Bonkowski, et al., 2013). To minimize this risk, staff training system testing, and ongoing monitoring to ensure patient safety is not compromised during implementation (Bonkowski et al., 2013).

The second ethical concern is the principle of Justice. This principle requires that all patients receive equitable, high-quality, and self-care regardless of the system in place (Bradshaw & Vitale, 2021). If BCMA significantly improves medication safety, delaying its implementation or continuing with a non-scanning approach could lead to preventable medication errors and disparities in care quality (Gauthier-Wetzel, 2022). Ensuring all patients benefit from the safest medication practices aligns with the ethical obligation to promote fairness and equitable healthcare delivery (Gauthier-Wetzel, 2022). By addressing both ethical issues, the QI project can be conducted responsibly, ensuring that the transition to BCMA is both effective and ethically sound in improving patient safety and quality of care (Gauthier-Wetzel, 2022).

Steps for DNP project submission to the IRB

Submitting a DNP project to the institutional Review Board (IRB) requires careful planning to ensure the protection of human subjects and adherence to ethical guidelines (Bradshaw & Vitale, 2021). The first step is to identify if the project requires IRB oversight and determining its review category (Bradshaw & Vitale, 2021). Quality improvement projects such as implementing BCMA fall under exempt or expedited review because they aim to enhance existing care rather than conduct experiment research (Bradshaw & Vitale, 2021).  The second requirement is to complete ethics training such as the Collaborative Institutional Training Initiative (CITI program) before submitting an IRB application (Bradshaw & Vitale, 2021).  This requirement ensures that the researcher understands the ethical considerations related to human subject research (Bradshaw & Vitale, 2021).   IRB submissions are lengthy and include the following components (Bradshaw & Vitale, 2021).

1. Project proposal: detailed description of BCMA, background, objective, outcomes

2. Ethical concerns: BCMA ensures beneficence, non-maleficence, justice, and respect for persons

3. Predicted Risk/Harm. Mitigation Strategies: BCMA implementation poses minimal direct risk; potential concerns include workflow disruptions, increased staff workload, and medication delays. Mitigation includes comprehensive training and phased implementation.

4. Bias: Potential biases will be addressed by using objective data collection, clear protocols, and standardized training.

5. Limitations: Potential limitations might be technical difficulties, limited healthcare settings, and staff resistance to change and using BCMA correctly.

6. Data collection plan: How will data be collected, stored, and identified to the project confidentiality, running reports against non-identifying JASPERS.

7. Consent: This QI project and will use the waiver of informed consent when working with de-identified patient data.

The forms necessary for the approval process include IRB application form, project proposal, data use agreement, informed consent (if needed), and letter of support (Bradshaw & Vitale, 2021).   After the necessary IRB forms are submitted, the IRB review and process begins (Bradshaw & Vitale, 2021).  This reviews the application, and they may request modifications or send back with questions. Afte addressing IRB feedback, the revised application is resubmitted for final approval (Bradshaw & Vitale, 2021).

Federal Guidelines for IRB review Categories

The U.S. Department of Health and Human Services (HHS) and the Office for Human Research Protections (OHRP) have established federal regulations to classify research actives into different IRB review categories (Huddleston et al., 2010). BCMA implementation is minimal-risk research (Huddleston et al., 2010). For a DNP QI project implementing BCMA in the emergency department the research would likely be exempt or expedited review (Huddleston et al., 2010).

Important Components of the Consent Process/Form

The informed consent process ensures transparency, protects participants’ rights, and fosters ethical research practices (IRB, 2023).   For a BCMA implementation project in the emergency department, the consent for should address workflow changes, data -collection, confidentiality, risks, and voluntary participation while considering the possibility of a wavier for a minimal-risk QI project (Gauthier-Wetzel, 2022).

IRB Planning Checklist

1. For the application to implementation of BCMA, before submission, the checklist ensures that the project clearly states QI initiative not experimental research (Gauthier-Wetzel, 2022). This identifies any risk related to medication scanning compliance and staff workflow (Gauthier-Wetzel, 2022). A detailed data protection plan is provided to safeguard patient and staff information (Gauthier-Wetzel, 2022).

2. IRB Decision Tree is a tool that helps determine if a project requires IRB review (Bradshaw & Vitale, 2021).  BCMA QI would fall under exempt review, if it involves de-identified retrospective data on medication errors before and after BCMA implementation (Gauthier-Wetzel, 2022).Expected review could be analyzed identifiable by minimal-risk patient data (Gauthier-Wetzel, 2022). This intervention is standard of care (Gauthier-Wetzel, 2022).

3. Participant consent. Since this project would be retrospective, and use de-identified patient data used, a wavier of consent may be requested minimizing administrative burden (Gauthier-Wetzel, 2022).

Conclusion

Using the IRB planning checklist, Decision Tree, and Participation Consent Questions helps ensure a smooth and compliant IRB submission for a DNP project implementing BCMA in the emergency department (Bradshaw & Vitale, 2021).  These tools help ensure ethical considerations are met by addressing risks, benefits, and protections. They also help determine the correct IRB review level, and clarify consent requirements (Bradshaw & Vitale, 2021).

References

Bradshaw, M. & Vitale, T. (2021). Lesson 7.6 IRB, CITI TRAINING, AND ETHICAL CONSIDERATIONS. The DNP Project Workbook (1st ed.). Springer Publishing Company. https://www-r2library-com.mwu.idm.oclc.org/Resource/Title/0826174329/ch0007s0486

Bonkowski, J., Carnes, C., Melucci, J., Mirtallo, J., Prier, B., Reichert, E., Moffatt-Bruce, S., & Weber, R. (2013). Effect of barcode-assisted medication administration on emergency department medication errors. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 20(8), 801–806. https://doi.org/10.1111/acem.12189

Gauthier-Wetzel H. E. (2022). Barcode Medication Administration Software Technology Use in the Emergency Department and Medication Error Rates. Computers, informatics, nursing : CIN, 40(6), 382–388. https://doi.org/10.1097/CIN.0000000000000846

Huddleston, J. I., Wang, Y., Herndon, J. H., & Maloney, W. J. (2010). Epidemiology of Adverse Events after Total Hip Arthroplasty in Medicare Beneficiaries from 2002-2007. Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2010.01.025

Institutional Review Board (IRB). https://www.broward.edu/about/community/irb/

Oachs, P. & Watters, A. (2020). Protection of Human Subjects. Health Information Management (6th ed.). American Health Information Management Association. https://www-r2library-com.mwu.idm.oclc.org/Resource/Title/1584267259/ch0019s0767

• Veterans Administration

Professional Self-Evaluation DRNPG 1503

Name: _________Jessica O’Shea___________________________ Date: ­­­­­­­­­­­­­­__________02/18/2025____________

Directions: Place an X in each row for the column that best describes your performance in each Professional Quality Measure.Identify how the activities align with specific Essentials as noted in the End of Program Student Learning objectives and in course objectives. Complete your rationales for the applicable quality measure in the last column.

* This course addresses the following student learning outcomes to the degree shown on the table. These may not be included in all Professional Quality Measures.

Advanced Beginner (AB): Aware and Identifies. Requires guidance to perform and apply

Competent (C): Aware and Applies. Requires guidance to formulate in complex situations

Proficient (P): Recognize and Formulate. Integrate and apply evidence in complex situations. Minimal to No Guidance Required

Professional Quality Measures

Always

Mostly

Some

Seldom

Never

Rationales

Justify your scores with a clear, concise   summary/rationale below for applicable Professional Quality Measures.

Include AB, C, or P as you determine.

In addition, include a brief description of a   specific activity/ assignment or interaction.

Include your areas of strengths and opportunities   for improvement.

Score

4

3

2

1

0

End of Program Student Learning   Outcome #1

1.  Establish organizational and systems leadership objectives to facilitate quality improvement outcomes.

X

C-   I demonstrated the ability to establish organizational and system leadership   objects for my QI project by enhancing my evidence-based decision making   through the assignments and class interactions

End of   Program Student Learning Outcome #2

2.  Identify technological elements necessary to select, utilize, and appraise health information technology critical to advantageous client-centered outcomes.

X

AB-   I identified some technological elements that will be needed for my QI   project. Including. HER, BCMA, Data Analytics and reporting tools,   cybersecurity and compliance. Some other tools I learned were PPT and PAPERS   in library resources.

End of   Program Student Learning Outcome #3

3.  Lead   an interprofessional team focused on developing, implementing, and appraising evidence-based initiatives to enhance favorable client-focused outcomes.

X

AB-   I didn’t lead a team yet, but through this class I had many conversations   with teams focusing on EBP and favorable outcomes. I met with, management,   professors, and pharmacy

Course   Objective #1

Identify the fundamental value and utilization of information systems   to ensure the successful implementation of DNP projects. (I, VIII, X)

X

AB-   We worked to determine appropriate variable types, Demonstarted understanding   of stat tests,

Course Objective #2

Define the role of emerging technology, well-defined databases, and analytics as essential tools of the DNP nurse leader while transforming global health care. (IV,   VIII, IX, X)

X

AB-We   worked through the IRB process to learn about ethics, legal and social   considerations and concepts of ethics

Course   Objective #3

Identify database management systems, software programs, and big data utilization to collect and use data from various sources to improve daily operations, planning, and decision-making for Advanced Practice Nurses (APNs). (III, VIII, IX, X)

X

C-Working   with Intellects statistics, we covered choosing bias stat test, sample size,   components of power, we demonstrated understanding, we provided a paper and   completed a Quality metrics table and applied power analysis technique

Course Objective   #4

Distinguish best practices for selecting

quality measurement indicators utilizing

interprofessional collaboration for

improving patient health outcomes globally.

(III, V, VI)

X

AB-   continues improvement on data utilization to distinguish best practice and   increase on quality over quantity. I was able to use information systems to   support my choice for DNP project and provided evidence

Sri

X

C-   I updated my electronic portfolio to match course rubric. Also used   technology to update work history and skills

Professionalism / Participation

a. Arrived on time and attended all on campus classes   (N/A)

b. Demonstrated respectful communication to instructors   and peers with professional behavior during all online and on campus   activities

c. Met the online and on campus assignment requirements   and meeting deadlines with my group (N/A)

X

C-   I watched touchpoints, met with the professor a few times, communicated with   other classmates. If I was late on an assignment, I would communicate   reasons.

Lifelong Learning Practice Inquiry & Peer Review

a. When you didn’t understand assigned reading, class   or online content or assignments, you sought out information to learn on your   own, posted a question in the “Your course questions” tab in BB, or if a   personal question or matter emailed the instructor for assistance

Supported group   members and classmates in their learning needs during online and on-campus   class assignments using constructive feedback

X

P-I   worked with professors and sought out information. Via face-to-face and   emails

TOTAL POINTS

33/40

Additional comments:

I am not sure how to add the points, but I added   the numbers assigned at the top. Thank you!

Quality Metrics Table

Jessica O’Shea

Midwestern University

DRNPG 1503: Information Systems and the Transformation of Global Health

Dr. Kelly Vandenberg

January 26th, 2025

Quality Metrics Table Description

Key metrics include administering antibiotics on time (Kang et al., 2022). Ensuring antibiotics are delivered within the guideline recommendation by scanning the medication in the Emergency Department prior to hospital admission captures time efficiency process (Kang et al., 2022). This process metric reflecting adherence to workflow and can affect patient safety (Kang et al., 2022). Nurse compliance, and communication indicates adherence to BCMA protocols, which is critical for reducing delays (Van Wilder et al., 2019).

Quality Metrics Table

Variable

Brief Description

Data Source

Possible Range of Values

Level of Measurement

Timeframe for Collection

Statistical Test

Antibiotic

Administration

Time Compliance

percentage of abx

administered

within 1 hour

of order from

ED to Admission

BCMA System reports

60-90% compliance

Ratio

6 weeks

Chi-square test

Age

>18 years

EHR/BCMA

Continuous

Continuous

Ratio

6 weeks

t-test,

ANOVA

Race

White, black, Asian, other

EHR/ BCMA

Nominal

Categorical

6 weeks

Chi-square test

Gender

Male, Female

EHR/BCMA

Nominal

Categorical

6 weeks

Chi-square test

Source: Adapted from Polit, D. F., & Beck, C. T. (2012). Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

References

DNP_QI_BCMA_Proposal_Defense OSHEA.pptx

IRB Application – Section D

- Improve medication safety and reduce medication administration errors in the Emergency Department

- Implement barcode medication administration (BCMA) technology into nursing workflow

- Evaluate changes in medication error frequency before and after BCMA implementation

- Does BCMA implementation reduce the rate of medication administration errors in the ED?

- What is the difference in the number and type of medication errors before and after BCMA implementation?

- Introduce BCMA technology to standardize medication administration

- Collect and compare error data from the EHR during pre- and post-intervention periods

- Provide data-driven recommendations to enhance medication safety in the ED

This is not human subjects research. There are no vulnerable populations. There will be no direct contact with participants.

Medication errors are among the most preventable threats to patient safety in the emergency department. BCMA systems support verification at the point of care to reduce errors in time-sensitive, high-risk environments.

This QI project aims to reduce medication errors using technology-supported verification. Findings may contribute to sustainable safety practices and align with national patient safety goals.

- Quality improvement methodology

- Quantitative, quasi-experimental pre/post design

- Setting: Emergency Department at a hospital in the Southwestern U.S.

Baseline data will be obtained from the site EHR by designated leadership. Eight weeks of pre-intervention data will be collected. Post-intervention data will be collected for an additional eight weeks following BCMA implementation.

- Data analyzed using Intellectus Statistics decision tree

- Descriptive statistics for demographic data

- Chi-square test for error rates by category

- T-test for comparison of total medication errors pre/post

- Parametric and non-parametric methods based on distribution

- Start Date: June 1, 2025

- End Date: February 28, 2026

- Inclusion Criteria: Adults (≥18 years) treated in the ED who received medication

- Exclusion Criteria: Pediatric patients, patients not administered medication in the ED, or transferred prior to administration

- Data will be de-identified; no direct contact with participants

- No contact information will be obtained or accessed by the student inves