Interventions to Minimize Medication Error by Nurses in Intensive Care: A Scoping Review Protocol

Round 1

Reviewer 1 Report

Dear authors,

Thank you for the opportunity to review the exciting paper "Interventions to minimize medication error by nurses in intensive care: a scoping protocol”.

The scoping review protocol is well written and organized. All parts of the review process are described without ambiguity. The background and relevance to this review is clearly presented with references to the relevant literature. I would recommend paying more attention to the timeliness of the cited literature (10 of 35 references are older than 10 years). For example, WHO Medication safety in high-risk situations (https://www.who.int/publications/i/item/WHO-UHC-SDS-2019.10) could also be cited. The research question could be specified to include medication errors that may occur at any stage of the medication management process. The methodological approach is well explained and appropriate to answer the research question, but the authors could also include the EMBASE database in their search. It contains, in addition to the titles indexed in MEDLINE, over 6 million records from 2900 predominantly European journals not currently covered by MEDLINE. Also included are all Cochrane Reviews and, since 2009, conference proceedings.

Many thanks and good luck with your research.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Thank you for allowing me to review this important topic to improve the quality of care administered to the most vulnerable population in healthcare. 

Structure of paper requires significant modification. Common thoughts/statement are redundant in numerous areas of the manuscript. (i.e., lines 53-55). Inclusion/Exclusion should be listed in a more concise manner for ease of reading vs. stated in multiple, separate sentences. 

Introduction needs further development with statistical evidence to support "why" medication errors are significant and avoidable (i.e., mortality risk, cost burden). Suggest stating how many medications on average per day is an adult ICU patient receiving. Define clearly what a medication error "is" as many definitions have been used to describe. (suggest moving lines 26, 64-65 into the intro section). The well-known, 5 medication "Rights" should be cited and outlined early in the manuscript. 

Line 59: number of people? who is this referring to?

Lines 74-79: citation(s) needed to support statement(s).

Lines 99-101: not accurately stated, suggest revision as bedside barcoding and use of smart-pump technology has been proven to reduced medication errors. 

Line 110: predispose whom/what to errors, patients?

Section 3: clearly define inclusion/exclusion criteria with use of headings and content. 

Overall, structure of manuscript can be improved. Would suggest formatting to the evaluation in terms of specific 'types' of medication errors by section. (i.e., wrong medication removed from the automated dispensing cabinet + mitigation strategies, incorrect route of administration data + mitigation strategies, incorrect rate of intravenous medication administration, delayed time of administration, etc). In doing so, this will provide ease of reading and continuity as to "how" particular interventions will lend to medication error reduction. 

Methodology: due to the wide scope of evaluating multiple varying trial designs, accurate concluding statements and results will lead to significant interpretation biases. Suggest ranking/weighing/comparing quality of evidence based upon trial design vs. lump sum conclusions. 

The quality of the content, sentence structure, and connecting ideas to improve flow and continuity has considerable work to be completed and clarified. Sentences and flow are at times incomplete and disjointed. 

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

The scoping review protocol is well developed, complies with standards and conforms to requirements. The review is registered in the Open Science Framework. 

Medication errors represent a major problem for both the patient and the nurse due to their negative consequences. Patient safety is a major objective to be met by hospital facilities.

 

Modifications: it is important to specify more specifically the inclusion criteria. Wouldn't specialist nurses in practice not be part of the study? The duration of professional practice is an important variable that should be taken into account when drawing conclusions.

 

Search strategy: studies published from January 2012 to April 2023. Important to take into account data deviation from the 2019-2021 period due to the global pandemic.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 4 Report

I appreciate the possibility to review the manuscript entitled “Interventions to minimize medication error by nurses in intensive care: a scoping review protocol”. The authors provide a scoping review protocol where they intend to identify factors contributing to medication errors by nurses in intensive care units by analysing existing literature. The manuscript is conclusive, with the methodology sound and reasonable. The field of research is of paramount importance and worth of investigation.  

 

 

1.) Major issues: 

None.

 

 

2.) Minor issues: 

The protocol manuscript should be written with more detail and precision overall. It must be possible for the reviewer or reader to replicate the study themselves using the methodology described and arrive at the same results as the authors. 

 

2.1.) Abstract: 

"carried out by reviewers" - by how many reviewers? (line 19) 

"This review will allow the mapping" - The reviewer hopes so, but whether a later study can actually allow this, we do not know at this point. 

 

2.2.) Introduction: 

The introduction is making up nearly half of the manuscripts' text - this is too long. Get you readers' interest, tell them the background of your topic and why it is important, specify your objectives. 

The taxonomy (line 46 ff.) and definitions (line 49 ff.) should be part of the methods section. When is something considered "error" or "harm"? 

The paragraph about medication administration in ICU (line 63 ff.) might be part of a discussion section where the authors justify – more detailed than in the introduction – the need for their scoping review. 

The remarks about literature search appear a little confusing: Literature searches are described in lines 99 ff., 160 ff., 170 ff. and 196 ff. - what is the function of this first search described in line 99 ff.? This might be better placed in the methods section. 

The research question is usually the last paragraph of the introduction (line 107 ff.). 

 

2.3.) Methods: 

Inclusion criteria is part of the methods section (line 113 ff.). The term "Materials" does not fit here (line 148). 

What about studies considering both, nurses and the group specified in line 117 ff.? 

Why are studies in paediatric ICUs excluded? With the possible calculation errors of dosages related to body weight, paediatric studies should be able to demonstrate a particularly high potential for medication errors, often by factor 10 (line 119)? 

The paragraph on types of studies appears unusual - Primary literature is included, but also reviews, which in turn are subjective assessments of primary literature. This creates a bias by including study results multiple times into the assessment - first as primary literature, then as part of reviews. 

The reviewer does not understand the meaning of the paragraph (line 141 ff.). 

The first sentence of chapter 4 is discussion, not methods (line 149 ff.). 

The reader might profit from a short description of the JBI methodology (line 152). 

What does PCC mean (line 154)? 

Please provide the registration number in the Open Science Framework (line 157). 

 If there are not enough reviewers, the authors might consider to extend their team (line 165 f.). 

The authors assume that their "time limit will not harm the quality..." (line 167 ff.) but how do they arrive at this assessment? It might be possible that this approach could very well influence the results. This should at least be mentioned. 

Please specify your preliminary search (line 170 ff.) and distinguish it from the preliminary search described in line 99 ff., and 196 ff. (or if it is the same, please discuss it at one point). 

The reviewer does not understand the meaning of the paragraph (line 174 ff.). 

Please specify CINAHL, EBSCO, MEDLINE, RCAAP, and Dart Europe (line 176 ff.). 

What is considered a "reference list" (line 181)? 

What is "screening and selection work" (line 189 f.)? 

In which way will reviewers be blinded (line 192 ff.)? 

Authors should provide a coherent explanation of why they chose such an unusual strategy of selecting 25 publications at random (line 196 ff.). 

What is a "document with a final decision" (line 203)? 

The data to be extracted should be listed here in full, but not as "among other things" (line 205). 

In which way is data analysed an standardised (line 213)? 

It needs no explanation that in a review data is "presented using tables and diagrams supported by narrative descriptions". Incidentally, tables and charts should support the text, not the other way around (line 222 ff.). 

The reviewer does not understand the meaning of the paragraph (line 226 ff.). 

"… whether evidence supports or contradicts the interventions…" (line 227 ff.) is not part of the study question as stated by the authors. 

 

2.4.) Results: 

n/a 

 

2.5.) Discussion: 

In a discussion section, the authors should  justify their methodology according to existing evidence and previous publications on the topic. 

 

2.6.) Conclusion: 

n/a 

 

2.7.) Disclosures: 

n/a 

 

 

3.) Formatting and Language: 

The authors should pay attention to format the references consistently and uniformly throughout the reference list. 

• Throughout the reference list, sequence and formatting of information should be used consistently and according to the manuscript guidelines. In this case, the authors should pay attention to use either abbreviations or the full name of journals cited and revise their reference list. 

 

Terms included in the title are not repeated as keywords. 

 

The manuscript should be proofread carefully, as some formulations seem unusual to the reviewer and there are several typos. These include (but are not limited to): 

• patient's vs. patients' 

• singular vs. plural 

• medicine vs. Medication 

• state organisms vs. state organs (better: government bodies) 

• a systematic (review ?) found... (line 40) 

• excluded from the outset (line 130) 

• adult intensive care unit vs. ICU for adults (line 132) 

• contributing to conduct that promotes (line 235 f.) 

 

 

4.) Miscellaneous: 

To improve the manuscript quality, the authors should consider to structure their protocol according to the PRISMA-P statement and provide the checklist as supplementary material. 

see above.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

The content and robustness of the review has increased significantly since the previous submission. The conclusion at the end of the discussion and the conclusion section are similar in nature. Suggest to remove/profoundly edit the end of the discussion section and only focus on the impact of the findings within the conclusion section (e.g., "take aways of importance). 

Sentence fragments and flow remains to be improved. 

Author Response

Dear Reviewer,

We would like to thank you one more time for all the time you spent reviewing the article "Interventions to minimize medication error by nurses in intensive care".   We appreciate your suggestion and understand your point of view, so we have made changes, which we recognize as very relevant. We are grateful, and we consider that they have helped to improve the performance of our article.   Thank you very much

Best regards

Author Response File: Author Response.pdf