Literature Review Example: Communication as a Problem in Clinical Practice

Objective: To establish the relationship between communication and medical errors.

Background: Communication has been highly attributed to failures in health institutions, particularly service delivery to patients. This has resulted in injuries of patients, complications, death and medical malpractice claims.

Methods: A systematic literature review approach was the used in searching for online databases such as PROQUEST, EMERALD, and Medline that helped in understanding the relationship between communication and medical errors among clinicians.

Results: Out of 1158 studies, only 18 studies were eligible for the study. Out of the 18, 17 showed that there is a relationship between communication and medical errors, while only one showed that there is no relationship between the two.

Conclusion: There is a relationship between communication among clinicians and medical errors. The study recommends that structured communication should be adopted by health institutions to mitigate medical errors caused by poor communication.

Relevance to clinical practice: The study is very relevant to clinical practices since it establishes a connection between communication and medical errors and recommends structured information to be used in health institutions to minimize such errors.

Abbreviations: SLR-Systematic Literature Review

Keywords: structured communication; health professional communication; medication; safety; pharmacist; medication error

Communication as a Problem in Clinical Practice

Introduction

The primary objective of this integrative review is to determine the relationship between communication and errors in medication, particularly to determine whether an implemented structured communication minimizes medication errors by using the systematic literature review (SLR). The topic of interest is the impact of communication in health institutions. Communication plays a fundamental role in medical institutions. The problem statement of the paper is to establish how communication is related to the errors in a health institution. PICO elements (Participants, Intervention, Comparators, and Outcomes) will be used for revision of the question. Participants will be all considered as health professionals who are responsible for communication of medication therapy within drug distribution in all medical fields. The intervention will be the structured communication among health professionals, particularly pharmacists.

Communication plays an integral role in the healthcare sector. It entails the exchange of information between medical practitioners and patients or among themselves, working together, sharing ideas in the decision-making process on matters relating to health and formulation of a collaborative patient care plan that measures the actual performance of the team. Effective delivery requires a clear and reliable transmission of information. The information should also be transmitted in a respectful manner and should satisfy the recipient. There are several causes of communication mishaps in health institutions. Some of these causes are; organizational factors, personal behaviors of medical practitioners and attitude of the nurses and doctors in relation to their work (Zacharova, 2015). As discussed by Zacharova, some of the organizational factors are lack of accountability, organizational culture, lack of proper team training and treatment plan, a culture of autonomy and hierarchy, lack of inter-professional meetings that would enhance communication skills and lack of properly defined roles and responsibilities of the clinicians (2015). It is also evident that working during the evening shift lowers openness of communication as compared to working during the day. Poor communication in health institution has adverse effects on service delivery to patients.

According to a research that was done by Rosenstein in 2009, the relationship between communication skills of medical practitioners and the ability of patients to successfully follow medical recommendations and adopt preventive health behaviors are strong. A clinicians communication skills play an integral role in the biological and functional outcomes of health and the satisfaction of patients on services that they receive. Communication in health institutions also influences the quality of working relationships and job satisfaction, and it also affects profoundly the safety of patients. The comparator will consider any structured communication in written or verbal format and medication safety against poor communication and medication errors. Ultimately, the outcomes will be integral in identifying whether structured communication reduced medication errors rates. The results will also be very useful in establishing if there is any relationship between communication and medication safety.

Literature search methods

The process of selection of suitable articles is made up of four phases of developed research strategy such as identification, screening, eligibility and phase inclusion. Some of the keywords, subject headings or a combination of both that I used in the initial search are; the impact of communication in health institutions, communication in health centers, "medication safety", "relationship between medical errors and communication" and "structured communication". The databases that I searched in an attempt to get the right articles were PubMed, CINHAL, EBSCO, EMERALD, ProQuest, and Medline. Most of the records that were potentially eligible were assessed for inclusion using the standard set criteria. To eliminate chances of duplicating the same article from different databases, EndNote software was used in automatically removing duplicates to minimize biases. The predetermined inclusion and exclusion criteria were generated using the key questions presented in the table below.

Table1: Inclusion and exclusion criteria of the study

Inclusion criteria Exclusion criteria

The population of the study:

All health professionals involved in patient pharmaceutical therapy The population of the study

All studies about patients which are not linked to health professionals

The settings of the study:

Studies conducted in the developed countries such as USA, New Zealand, and Europe The settings of the study:

Developing countries

Time period:

2007-2016 Time period

Before 2007

Language:

English Language

Non-English

Criteria of publication:

Peer-reviewed

Academic journal article

Full text and abstraction availability

Criteria of publication

Peer-reviewed

Studies were only limited to the sources that had reduced numbers of medical errors and outcomes and factors that relate to structured communication. The definitions of medication errors and health communication were made in relation to the studies that were done previously. To maintain relevance with the current world practices, only English articles that were published between 2002-2016 were used. The inclusion criteria were predetermined before data extraction and they were applied in the screening phase to the title and abstract of each study that was found in the searching process. The articles that were finally selected for review went through a close assessment, particularly quality assessment was employed in determining their quality based on the appropriateness of research question, research design, and justification, the relevance of methodology, results in analysis and logical presentation of research (Greenfield et al. 2012). The final samples of the research reports were determined by using a data extraction process to provide an overview of all the data from included and selected studies. The accuracy of data entry was controlled and monitored by independent researchers who revised the data extraction and data entry process. The initial search identified 1158 citations but after scanning, only 454 were selected for further screening. Ultimately, only 18 studies were eligible to be used in the systemic review. The other articles did not meet the required standards. The 18 articles were subjected to thorough quality assessment criteria and the result indicate that only seven studies met all the required assessment criteria.

Data Analysis and Critical Appraisal

The problem of the study is well formulated and it has a clear purpose. Based, on how the articles were selected and analyzed, the study approach is well designed and executed. The study also indicates an understanding of the related studies. According to the results, 17 out of the 18 studies showed a relationship between communication and medication errors. The findings of this research advance knowledge since they demonstrate the considerable cost implication of poor clinical communication and medication error. They also improve communication in relation to medication errors which is integral in providing organizations with measurable improvements in patient safety and quality.

The studys strengths and limitations are tabulated below

Ref. NO Author/Year Country Publication type Strengths Limitations

7 [66] United States Journal It contained useful data that was used in the analysis The study did not mention any limitation

13 [72] UK. Journal It met all the predetermined standards All the participants were from the same school

The questions asked about the role of the disclosure in medication errors were more general (they should be more specific).

14 [73] United States Journal Its method of data collection was effective since there were no biases in the final result. The study did not mention any limitations

17 [76] UK. Journal The study discussed limitations of the research There were distractions during the interview

The literature has numerous gaps. For instance, the method that was adopted in data collection was not effective since it was prone to bias. This could be explained using the PICOS framework. Information regarding the population was not adequately represented. There was also inadequate information in the evidence base regarding specific intervention and the duration of the intervention. The methodological rating was unknown and reliability of the study was not applicable. These gaps existed since the researcher did not adhere to the set standards of doing the research. Data collection methods also exposed the research to biases.

The studies had similarities and inconsistencies. According to five studies, there was a direct or indirect relationship between communication and medication errors at different stages of care provided to patients (Saxton, 2012). Both studies highlighted that failure in the transmission of clinical information from one healthcare provider to another has the potential for medication error. The studies also identified a breakdown in communication as the most significant factor relating to medication error and failure in information exchange within interdisciplinary team leading to medication error and patient harm. However, there were some differences in the results of each study. For instance, one study showed that the main cause of medication errors was prescription errors (42%) while another study indicated that the main cause of medication error was poor communication (30%) (Rosenstein, 2009).

Synthesis, Interpretation, and Presentation of Results

Most of the people that were interviewed were nurses. The studies also show major similarities in methods of data collection. The research reviewed majorly points at communication as the major cause of medical errors. Another major trend in the study is the commonality of methods of selection of the articles for review. It is easy to make a generalization of the study since the research findings are coherent. The methods of data collection, analysis, and interpretation of the results were similar for all the studies. The studies were also critically looked i...