REDUCING NURSE PRACTITIONER MEDICAL ERRORS: AN EBP GUIDELINE WITH A REFLECTIVE PRACTICE ALGORITHM

In 2000, medical errors (ME) leading to preventable deaths have been estimated to be 44,000 to 98,000 by the Institute of Medicine (IOM) and then revised to approximately 400,000 deaths annually in recent studies. These studies also reflected associated costs between $17 to 29 billion dollars. Failure to diagnose (FTD) is a type of ME and it is the most common type of diagnostic error committed in primary care outpatient settings. FTD represents 26.59% out of 47% of errors that have been linked to preventable deaths. As a result of these diagnostic errors, NPs experience increasingly higher medical malpractice claims. To mitigate this, experts strongly recommend strategies to reduce diagnostic errors. While education is available on how to diagnose medical conditions, there is limited education on strategies on how to reduce diagnostic errors. The purpose of the project was to develop, educate, and evaluate the effectiveness of a training workshop using an evidence-based educational guideline, titled Integrated Diagnostic Practice Guideline (IDPG). An evidence-based review of the literature was performed and an algorithm created by the synthesis of the Logic and Reflective Practice models. The objective was to educate NPs on IDPG with the aim of assessing their confidence pre-training and post-training as well as the NP’s intent to change by incorporating the IDPG into their practice. This was a quality improvement (QI) project using a descriptive, nonexperimental design with a convenience sample from the California Association of Nurse Practitioner (CANP) members, who were Adult/Primary Care NPs working in outpatient settings. The validated assessment tool, the Confidence Scale (C-Scale Survey) by Susan iv Grundy (1993) was utilized to evaluate knowledge level pre-training and post-training. A paired sample t-test was used to compare the mean scores between pre-training and posttraining. T-test results from the C-Scale assessments were used to determine if there was a significant difference in knowledge transfer and confidence with the training. Also, post-training, the validated evaluation tool called Organization Readiness for Implementing Change (ORIC Survey) by Shea et al. (2014) was utilized to assess the NPs intent to change practice by assessing their willingness to implement the IDPG. The demographic data of the NP sample, their practice settings, and post-training ORIC survey results were measured using descriptive statistics of frequencies counts and means. A post-training, Pearson correlational analysis assessed the sum scores of the post-training C-Scale and the sum scores of the post-training ORIC to determine if there was a relationship between knowledge gained and intent to change practice. A paired sample t-test revealed a statistically significant difference between the total C-scale pre-training and post-training (M = -6.971, SD = 5.351 t(-7.596) = 33, p < .001). Also, there were statistically significant differences across the five items of the C-Scale between the pre-training and post-training of the 34 participants. These results demonstrated that participants had an increase in confidence after the training. The analysis of the descriptive statistics of the ORIC survey post-training revealed the mean score of 4.29 to 4.41, with a standard variation range of .109 to .132 across the ten questions of the ORIC in the post-training. The results of the ORIC post-training surveys indicated a high level for intent to change by incorporating the IDPG into their practices. A Pearson correlation test between the sum post-C-Scale and the sum post-ORIC survey revealed a statistically significant relationship between the confidence level of the v participants on the IDPG and the intent to change post-training, (r(32) = .365, p = .034). The correlations indicate that the knowledge gained using the IDPG significantly correlated with increased confidence and the likelihood of intent to change practice.