Chapter 2 of the Direct Practice Improvement (DPI) Project Proposal is titled "Literature Review" and expands upon work you completed in DNP-820 in the Develop a Literature Review assignment. Synthesi

Running head: DNP- TRANSLATIONAL RESEARCH AND EVIDENCE-BASED PRACTICE 

DNP- Translational Research and Evidence-Based Practice

Name of Student

Institution Affiliation

Literature Review

Literature review of scholarly articles will entail synthesizing and analyzing information on the impacts of medication administration errors in children between the age of 3-4 years. The review will cover major concepts in the identified theme of the PICOT question. The sensitivity of the PICOT question is that children under the age of 3-4 have little power of choice or identification of wrongdoing against them during medical administrations. The sub-themes to be tackled in this study include prescription of both drugs and chemotherapy doses, the dispensation of drugs, and the parental administration of the said drugs.

Under the prescription of drugs and chemo doses, it is essential to make considerations of several aspects. The body compositions matter in the prescription of drugs. The weight, build, and physical conditions are crucial. When the wrong doses of drugs or chemo are prescribed, adverse effects may be encountered (Pui, Pei, Raimondi, Coustan-Smith, Jeha, Cheng, & Inaba, 2017). Besides the body compositions, age matters. In this case, the consideration being made is that of children between 3-4 years. Therefore, it is critical to note that organs are not fully developed. Relatively smaller doses should be administered. Other issues of consideration, while prescribing drugs include metabolism and fluid retention. Considering these issues promote evidence-based treatments of leukemia in the said age group.

In drug dispensations, several errors may emanate as a result. Sometimes, dispensing physicians may prescribe similar drugs rather than the correct medicines. These errors may lead to the contraindications of drugs as well as poor outcomes of treatment. Abbreviations from prescriptions may be detrimental to patients. Patients may suffer adverse outcomes as a result of being abbreviated wrongly. The impacts of such occurrences will be assessed through scholarly materials. Research indicates that at least 15% of prescription errors result from incorrect entry of prescriptions. The effects of these errors will also be assessed through scholarly materials.

Parental administration of the said drugs is vital. Better outcomes are only to be realized when parents administer prescriptions correctly. Critical considerations such as physician advise on the administration of drugs to children play a fundamental role (Millot, Guilhot, Baruchel, Petit., Bertrand, Mazingue. & Sirvent, 2014). With the proper advice, parents can administer drugs efficiently. Considerations such as time intervals of prescriptions play a significant role. This literature review will help in the establishment of the impacts such actions have on patients' outcomes.

Drug Prescriptions

The role of antibacterial prophylaxis use has been misunderstood over time. Commonly, antibacterial prophylaxis has been used in preoperative procedures. Antibacterial prophylaxis has often been used for children as it harnesses the recovery while undergoing chemotherapy (Saxena, Jain, & Gupta, 2018). However, the dosage and manner of practice contribute highly to the efficiency of the procedure. In cases where regiments are offered appropriately, the outcomes are good. However, for improper regiments, patients suffer increased risks for morbidity and mortality. Results from various studies have indicated that antibacterial prophylaxis is essential for treatment with leukemia. However, the prescription of drugs used during the prophylaxis process is critical in determining the success of the ttherapy (Yeh, Liu, Hou, Chen, Huang, Chang, & Liang, 2014). Therefore, from these researches, prescriptions of drugs are vital for better outcomes of treatment for leukemia patients.

Research indicates that children who have leukemia are prescribed broad-spectrum antibiotics. The antibiotics are used to prevent the contraction of bacterial infection (Sulis, Blonquist, Stevenson, Hunt, Kay‐Green, Athale, & Leclerc, 2018). Alternately patients receive fluoroquinolone prophylaxis for the same purpose. Results of the research indicate that fluoroquinolone prophylaxis patients reported fewer rates of bacterial infection than counterparts who received broad-spectrum antibiotics. The importance of prophylaxis is underlined by more research that shows that fluoroquinolone prophylaxis is essential for pediatric leukemia patients suffering from acute bacterial infections. Bacterial infections become resistant to antibiotics (Hallböök, Lidström, & Pauksens, 2016). Thus, the prescription of treatment of bacterial infection is essential considering the efficiency of the two methods of treatment.

Research has made it factual that children with down syndrome are likely to contract myeloid leukemia and, subsequently, lymphoblastic leukemia (Murphy, Roth, Kolb, Alonzo, Gerbing, & Wells, 2019). The inferences of research have it that there is a connection between down syndrome mutations and leukemia. These mutations have been proven to promote leukemia mutations. GATA1 mutations of the down syndrome have been confirmed to have more overly sensitivity to cytosine arabinoside, a cancer-fighting drug. Overall, the GATA1 protein is less sensitive to leukemia drugs (Ono, Hasegawa, Hirabayashi, Kamiya, Yoshida, Yonekawa, & Ito, 2015). With these indications of research, prescriptions of children with a history of downs syndrome are critical as GATA1 mutation may increase risks for leukemia or promote better rates of survival.

Radiations provide an increase in the development of secondary cancer in children. There are cases where patient-specific apertures are put in place in diagnosis (Geng, Moteabbed, Xie, Schuemann, Yock, & Paganetti, 2015). At the point of developing these apertures, the radiation subjected to patients mustn't be destructive. Destructive emissions may lead to secondary cancers. Besides, exposure to dexrazoxane may lead to secondary cancer for leukemia patients. With this in mind, it is therefore critical to consider the safe practice of chemotherapy for children who have leukemia (Seif, Walker, Li, Huang, Kavcic, Torp, & Aplenc, 2015). Conclusively, prescriptions of chemotherapies should be done with care to avoid secondary cancers for patients.

Dispensation of Drugs

Getting the right prescription is one thing: a dispensation is another. Allocation of prescribed drugs plays a significant role in the management of Leukemia (Toft, Birgens, Abrahamsson, Griškevičius, Hallböök, Heyman, & Quist-Paulsen, 2018). Therapies are commonly used in the management of leukemia. These therapies being so, physicians dispensing therapies through their skills are needed to be watchful. Research indicates that the success of outcomes of treatment solely lies in the dispensation of therapies; the better the dispensation, the better the results observed. Targeted therapy presents the best approaches to dispensing medicine. Targeted therapy is specific to the problems facing patients. Guidelines for administering targeted drugs should be followed (Byrd, Jones, Woyach, Johnson, & Flynn, 2014). It is, therefore, evident that the choice of therapy dispensation contributes immensely to patients' outcomes.

Medical safety practice is among the critical considerations for drug dispensations. Research indicates that pediatric oncology is high risk and requires a lot of attention (Mulatsih, & Iwan Dwiprahasto, 2018). Research carried out on children who have leukemia indicates that patients who received controlled interventions had better outcomes than those who received uncontrolled interventions. These results were obtained through pretest and posttest trials. Further research reported that patients who bought drugs from pharmacies with electronic systems had better outcomes than those who bought from pharmacies without automated systems. This phenomenon is attributed to the accuracy of dispensing drugs promoted by electronic methods (Schmidt, 2019). These indications, therefore, prove that accurate dispensation of drugs promotes better outcomes for patients.

Administration of Drugs

Research attributes at least 40% of the medical errors to be administrative. In this regard, parents are most responsible for this as they spend the most significant percentage of time with their kids. Administrative errors established included wrong doses (Oberoi, Trehan, & Marwaha, 2014). Research indicates that among the wrong doses administered, more than 60% were above the recommended amounts, while the latter stated fewer doses than recommended. More analysis suggested that the forgetfulness of parents was among the significant administrative errors (Neuss, Gilmore, Belderson, Billett, Conti-Kalchik, Harvey, & Olsen, 2016). These errors were attributed to lead to irregular administration of doses. The problems to do with mistakes harm drug administration.

Proper administration of drugs affects leukemic pediatric patients. Research indicates that appropriate medication administration promotes the chances of surviving the condition by 30%. However, survival has an impact on the physical and social functioning of children (Taverna, Tremolada, Bonichini, Basso, & Pillon, 2016). Research indicates that drugs affect the development of children's physical functions. As a result, children may experience slow growth. Communication, social, and motor abilities are adversely affected. More research indicates that parents have a more prominent role in the development of leukemia surviving patients. Interventions obtained through research propose that parents provide therapies that alleviate these problems (Zhang, Rodday, Kelly, Must, MacPherson, Roberts, & Parsons, 2014). Treatments such as occupational therapy are highly recommended. Post-drug administration is vital in leukemia survivor children.

More results of the successful administration of drugs for pediatric leukemia patients are examined. Research indicates that children with leukemia history inhibit cognitive development (Taverna, Tremolada, Bonichini, Tosetto, Basso, Messina, & Pillon, 2017). Therapies of treatment of leukemia can, in certain instances, affect the acquisition of new skills n children. Children fail to grasp reading and communication skills. More research in this field indicates that children who have undergone Hematopoietic Stem Cell Transplantation indicate problems with mastering movements. These children take longer to walk. Other therapies and interventions administered on patients reported better results in motor advancements (Akyay, Olcay, Sezer, & Sönmez, 2014). These indications, therefore, prove that drug and therapy administration play a significant role in the mobility of children.

Errors of failure to adhere to prescription rules are a significant concern in the administration of drugs. Research has it that mistakes in the administration of oral chemotherapy play a substantial role in adverse effects experienced by patients (Taylor, Winter, Geyer, & Hawkins, 2016). In research carried out, the parent was observed to administer one tablet of mercaptopurine per day rather than the recommended one tablet per five days per week. Research further indicates that interventions would have better outcomes if errors of adherence are minimized. Further research associated negligence and drug unavailability to be factors contributing highly to failure to adhere to prescriptions (Khalek, Sherif, Kamal, Gharib, & Shawky, 2015). These inferences indicate that adverse outcomes of treatment are experienced as a result of nonadherence in the administration of drugs.

Administration of interventions for leukemia may be painful. The research comes handy in determining methods of dealing with pain for children undergoing interventions for leukemia (Tremolada, Bonichini, Basso, & Pillon, 2015). Research indicates that several parameters determine the levels of pain experienced by children. Cognitive factors play a huge role. In the administration of interventions, physicians are required to consider responses that may not lead to post-traumatic disorders. Research indicates that pediatric leukemic patients may experience painful dental formulas. This dental problem becomes a key consideration during treatment (Padmini & Bai, 2014). Chlorhexidine mouthwashes are proven to be among the success of alleviating pain during the administration of interventions of leukemia in children.

Families play a huge role in the administration of interventions of leukemia in their children. Research indicates that the stressful conditions family members find themselves in may lead to post-traumatic disorders (PSTD) (Tremolada, Bonichini, Basso, & Pillon, 2016). Research results indicate that family members may continue to suffer even after successful interventions are administered. Dealing with Post-traumatic disorders is among the primary considerations of the administration of interventions. Further research indicates that responses such as theoretical models and post-traumatic stress symptomatology helps family members recover from PSTD (Neu, Matthews, King, Cook, & Laudenslager, 2014). Significant indicators of PSTD include acute stress symptoms. In summary, negative impacts such as PSTD are bored as a result of the administration of leukemia interventions.

Studies also assess the impact of perceptions of parents of children undergoing bone marrow aspiration. Procedural pain experienced by children undergoing leukemia treatment is observed to harm parents (Wang, Liu, Yu, Wang, Gao, Dai, & Mu, 2017). These negative impacts are attributed to the failure to know the usage of analgesia. This failure causes immense pain in children. Besides, parents and particularly mothers face the problem of psychological distress. Studies further indicate that there is a need to reduce procedural pain for leukemic patients. Research suggests that topical analgesia is capable of significantly reducing pain (Whitlow, Saboda, Roe, Bazzell, & Wilson, 2015). In summary, procedural pain has negative impacts on parents of leukemic parents.

Studies have moved a step further in investigating the impacts of childhood leukemia among surviving adults (Zannini, Cattaneo, Jankovic, & Masera, 2014). The results of the study indicate that most adults have kept dark memories of their experiences with leukemia at an early age. The aspect of pain is very much in the domain of surviving patients, with most recounting that they had never experienced such pain in their lifetimes. However, results of studies indicate that some surviving adults hold positive lessons from their experiences (Phillips, & Jones, 2014). These researches show the success of interventions of leukemia in childhood.

Administration of leukemia on children has effects on the Neurocognitive abilities of children (Darling, De Luca, Anderson, McCarthy, Hearps, & Seal, 2018). Studies carried out indicate that survivors of leukemia at an early age have problems with their processing powers. The results of the studies suggest that survivors had decreased fractional anisotropy. These results are attributed to the influence of white matter microstructure interactions. White matter microstructures affect the processing speed of individuals. Further research attributed low processing power to poor parenting styles (Sheikh, Joanisse, Mackrell, Kryski, Smith, Singh, & Hayden, 2014). Poor parenting styles, coupled with the derailed mobility issues, make it even more difficult for kids to handle.

A review is done to find out how medication prescribed on children can affect their well-being. It is also essential to counter check possible errors that may occur while a doctor is administering drugs to children between 3 and 4 years of age. Most of the children who are within this age gap cannot be able to spot any mistakes made during the process of drug administration for the kids. A study to look at the mistakes made during administration, including chemotherapy doses and how the children are giving the drugs together with how parents administer the medications to the children. It is essential to check at the health of the children before applying remedies to them especially if the child is allergic to the drug or is not of the required weight. A common mistake done during drug administration is giving similar drugs rather than the exact medicine. Parents are advised to take precautions when giving medications to avoid an overdose or underdose of drugs. The advice goes further to say that medicine should be taken out of the reach of children to prevent mishandling by children.

The role of some drugs has been misunderstood over the years, and that is the first issue of concern that should be addressed by the physicians. Some medications like Antibacterial Prophylaxis are used to harness recovery in children as they undergo chemotherapy, but the dispensation of the drug is also essential to maintain the efficiency of the process. Proper allocation of drugs plays a critical role in the management of diseases such as leukemia. Errors that occur due to wrong prescription of drugs are of concern and need to be looked into while looking at medical safety. Parents who have children who have leukemia should make sure that the children do not live in stressful conditions for faster recovery.

Medication Administration Errors

Summary of research questions

Research articles analyzed cover several subthemes of medical errors in the treatment of Leukemia in children. Research questions explored acknowledge that medical procedures are prone to mistakes. Subsequently, research questions aim at investigating the sophistication of medical procedures and drug administration in young children who have Leukemia. Among the critical areas tackled through research, items include prescription of drugs. Research questions delve into identifying the effects caused by wrong prescriptions of drugs on pediatric leukemia patients. Studies further post research questions that seek to investigate the impact of dispensation errors on children who have Leukemia. Some studies also focus on the mistakes and effects created by those errors in the administration of drugs. The scope of error covered by studies include both physician errors and parental errors.

Summary of the Sample Populations Used

Overview of the sample populations used various research papers used in this analysis; most of them used Pretest and posttest methods of getting data. These methods, therefore, required sample populations for study. Depending on the objective of the research, different research papers used different sample sizes. Research papers aiming at looking at the impacts of medical errors in children used a sample population of children below the age of five. However, some studies were interested in the identification of the impact medical errors had on grown-ups during their childhood. These studies subsequently required adults as sample populations. Most of the research papers analyzed used a sample size of at least fifty to three hundred people. All the studies analyzed followed the ethical requirement of performing research in obtaining sample populations. All adult participants in the sample populations were aware of them being involved in the study. For children, consent was obtained through parents.

Summary of Limitation of Studies

Different researches experienced different limitations. First, the reaction of children to a medical error was observed to be different for different children. For prescription errors, for example, children reacted differently to the wrong medication. As a result, this led to researchers generalizing observations. Most researches were also restricted to remarks and testimonials. These cases are because most of the data in treatment were considered private, and therefore, researchers were not allowed to access it. Small samples also made it difficult for researchers to obtain more substantiated research. Short periods of the study also acted as a limitation towards collecting and performing an in-depth analysis of research. Additional health problems apart from Leukemia made it difficult for researchers to identify the impacts of medication errors.

Summary of the conclusion and recommendations for further research

Studies used in this research used an approach of providing findings based on the analysis of data obtained from research. However, the data used by various researchers in the study were recorded differently. Besides, the analysis of data was carried out in different methods. Moreover, qualitative and quantitative methods of research were used. These methods made various examinations have different ways of concluding on their results. On recommendations, the majority of research articles made recommendations based on the conclusions obtained from results. Some studies did not make any recommendations. Researchers also provided insights into what further studies could explore. These insights were derived from limitations and elements of research deemed out of the scope of research.

Prescription Errors

Summary of research questions

A majority of the studies assessed in this research used research questions as a guide to the goals and objectives of the investigation. Most of the studies have research questions wired to enable researchers to keep track of their systematic approach to research. Articles covering the impacts of medical errors on children who have Leukemia aimed at making several substantiated inferences. Among the most common research questions in many studies aimed at investigating the role of physicians in errors of prescription. Some studies went further to assess the factors in clinical settings that lead to prescription errors. The research was specific at identifying the impact of how errors made an impact on the overall treatment of Leukemia.

Summary of the Sample Populations Used

Studies used to identify prescription errors in leukemia patients used different samples. Among the most common samples used were obtained through medical records obtained from various health facilities. Some studies were used as a method contrary to having a fixed sample size. These studies analyzed prescriptions offered to patients over some time. This way, the sample population varied with time. However, the overall sample population was determined at the end of the research. Moreover, some research papers used random sampling techniques where sample populations were collected without following a particular order. However, studies that used specific sample populations used samples of about 100 to 300 children. In all the studies, due processes of obtaining consent from sample populations were carried out. With the sample sizes uses, the data from the researches is deemed sufficient to provide reliable results.

Summary of Limitation of Studies

Researches investigating prescription errors indicated several limitations. The field of prescription of drugs is broad, and therefore, researchers aimed at reducing the scope to a manageable range. Access to resources of research was among the most common limitation cited by many studies. Considering the sensitivity of private data, many researchers indicated to have been denied access to sensitive information of patients. Besides, some researchers cited rebellion by physicians to the approaches of research. Many physicians felt that the study would be detrimental to them. Physicians indicated that the results of the research would put their jobs on the line. These limitations are cited by researchers to be the greatest hindrance to efficient data collection.

Summary of the conclusion and recommendations for further research

Findings of research were observed to be helpful as they provided reviews of the data collected through research. All studies provided outcomes. These conclusions provided the researchers' opinions about the survey. Besides, findings gave a brief indication of the success of research carried out. From the results, researchers drew recommendations of the study. The recommendations made revolved around the alternate opinions that the researchers thought would have helped in promoting further research. As observed from the recommendations made, it was evident that researchers aimed to support new research by using the concluded inquiries as a base.

Dispensation of drugs

Summary of research questions

Virtually all the studies reviewed incorporated used research questions to guide their researches. In the allocation of drugs, there were consistent patterns observed for research questions. A fair share of researches made inquiries on the role of the patient or the accompanying caregiver in ensuring the correct dispensation of drugs. Another percentage of research question aimed at investigating the methods of dispensing drugs that were more prone to errors. Other research papers talked about different topics in drug dispensation, such as the role of technology in distributing medicine. Other research papers sought to identify the relationship between dispensing errors and prescription errors. These research questions guided the direction of research. The inquiries of research questions were reflected in the entire process of research.

Summary of the Sample Populations Used

The studies within which this research inquired had sample populations of research. The target population of research for these studies was pediatric patients who have Leukemia. However, the target population was not entirely accessible. Different studies used different sample sizes. The difference in sample sizes can be attributed to the research constraints, such as the location of study that affect the accessibility of samples. However, most of the reviewed articles used sample sizes of between one hundred and five hundred the general scenario of the topic of research. This sample size is deemed sufficient. From the analysis of the descriptive studies, it is observed that most research articles used ethical considerations of research. The consent of children used in the study was obtained from their parents. Permission was obtained from various health facilities covered in the study.

Summary of Limitation of Studies

Studies in this research indicated various limitations of research. Limitations of the research are the hindrances that researchers encountered in the course of their research. The most common shortcomings of research are the inaccessibility of materials. Identifying errors of drug dispensation lie on the records in place. Researchers indicated that some health facilities denied them access to records of drug dispensation. Some stated that they were allowed to access the files of research but were not given access to patient's records. This denial made it difficult for them to match singles with individual patients. Besides, a fair share of parents of children who have Leukemia did not have the documentation of drugs prescribed at the hospital. This phenomenon made it difficult for researchers to collect data from either the parents or the health facilities. This aspect exemplifies the impact of the inaccessibility of research materials on research.

Summary of the conclusion and recommendations for further research

A majority of the studies analyzed provided outcomes to their findings. Conclusions from results indicated that there is a strong relationship between dispensation errors and prescription errors. A significant proportion of errors are attributed to prescription errors. Besides, the inference drawn from research indicates that dispensation errors have adverse effects on pediatric patients who have Leukemia. However, a vast majority of studies make sentiments on the inaccessibility of data for research. The researchers recommend that regulations are put in place to support research. Upon identification that dispensation errors have negative impacts on the outcomes and health conditions for pediatric patients, researchers recommend more research is done on methods of alleviating dispensation errors.

Administration of Drugs

Summary of research questions

The studies analyzed in this research uphold the use of research questions. In this regard, research questions explored explore various topics of drug administration for pediatric patients. A majority of studies focus on the role of parents on drug administration. Leukemic children are identified as a vulnerable group who cannot administer drugs on themselves. Therefore, parents play a critical role. A fair share of researches delves into checking the role of physicians in educating parents on the administration of drugs on leukemic children. Previous inferences of research motivate these research questions that it is the fundamental role of physicians to inform patients and families on patient care and patient families. These research questions help drive the objectives and keep the researcher focused on the goal of research. The majority of research questions fulfilled their purpose in their respective studies.

Summary of the Sample Populations Used

According to the majority of studies reviewed, the target population of the research was pediatric children under the age of five who were suffering from Leukemia. However, several inquiries targeted adults. Inquiries that focused on adults aimed at identifying the influence of drug administration had on adults who had survived Leukemia during childhood. However, the target population could not be covered through researches, and therefore, an accessible population had to be assessed. It is paramount to note that the bigger the accessible population is concerning the target population, the better the outcomes of the research. Most researches used about fifty to two hundred. This sample was deemed sufficient in consideration of the prevalence of pediatric Leukemia.

Summary of Limitation of Studies

The various studies assessed indicated to have limitations in accessing data for research. Among the limitations noted circled the accessibility of homes with leukemic patients. Most researchers reported that leukemia patients live far part and from each other, and therefore, it was hard to cover a significant sample population. Some researchers showed problems with language barriers. Some parents were not fluent in the English language, which was commonly used by many researchers. Some researchers suggested that some resource persons could not converse in English at all. These limitations had an overall effect on the collection of data.

Summary of the conclusion and recommendations for further research

Conclusions drawn from the study indicated that there were many cases of drug administration errors. Administrative errors were attributed to poor family advises by the doctors. Besides, there were many cases of physicians’ recklessness in their job that caused a fair share of drug errors. In many conclusions, many connections between prescription, the dispensation of drugs as well as the administration of medications. Researchers go further to recommend solutions. Many researchers indicate that patient and family education could effectively reduce the administration of drug errors. Besides, most findings suggest further research should be done for sufficient causes of actions to be taken.

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