Nursing-Using a PICOT Framework and Evidence to Develop Care Practices

Nursing-Using a PICOT Framework and Evidence to Develop Care Practices

Using a PICO(T) Framework and Evidence to Develop Care Practices

Evidence-based practice is essential in nursing since it integrates the best nursing evidence into practice to enhance patient outcomes and safety (Boswell & Cannon, 2018). The PICO (T) research framework can be used to develop care practices for patients. PICOT involves Population/Patient, Intervention, Comparison, Outcome, and Time. This framework can be applied to develop a care plan which enhances patients outcomes. Using secondary sources, this paper will define a practice issue surrounding medication errors. The PICO (T) process will be applied, and sources of evidence identified to answer the clinical question. It will also explain findings from research articles and finally outline the relevance of the key findings.

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Use of the PICO(T) Approach for Reducing Medication Errors

The practice issue identified for solving is developing protocols that will reduce medication-related errors in inpatient departments. The PICO (T) question is: “In adults in inpatient settings, is technology effective in reducing medication errors compared to no intervention?” The population that will be of interest is adults in inpatient wards. The intervention is the use of technology such as the Bar Code Medication Administration (BCMA). BCMA technology involves scanning medications using barcodes to reduce medication-related errors during dispensing of medications (Shah et al., 2016). The comparison in the question is no interventions at all, and the outcome is the reduction of medication errors. This study will not consider sociocultural factors but only hospital-related factors.

Sources of Evidence

The are many sources of evidence that can be used in the EBP for reducing medication errors. This can include randomized controlled models in hospital settings, self-reported medication errors, patient medical chart audits, and competency testing for nurses. Scholarly articles are critical in determining the sources of medication errors and how medication errors can be reduced using EBP models. Medical records audits can be used to identify the things that are done correctly and areas that may need improvement (Azzolini et al.,2019). Incident reports can also be used to reduce medication errors. Incident reports will help identify safety issues and implement interventions to minimize these issues (Carlfjord et al., 2018). They help protect patients since healthcare professionals can learn from their mistakes and identify areas where they went wrong.

Finally, evaluating nurses’ competency in medication administration and dispensing can help address evidence-based factors and barriers that may result in medication-related errors. Education of nurses and clinical simulations can help reduce medication-related errors. The resources of evidence that can be used to answer this question will include scholarly articles related to medication errors, results from simulation models, randomized controlled trials, interviews from nurses, incident reporting, and medical records audits.

Findings from Articles

BCMA technology reduces medication errors through the electronic verification of the five rights of medication administration. The five rights are “right patient, right dose, right drug, right route, and the right time.” (Shah et al., 2016). At the patient’s bedside, nurses scan the barcode on the drug to be administered, their identification badge, and the patient’s identification tools such as a wristband. The data is sent to the software to check and give approvals or warnings (Shah et al., 2016). This information is given in real-time.

Shah et al. (2016) is a systematic review that analyzed articles related to BCMA. The results indicated that BCMA reduced non-timing errors from 11.5% to 6.8% (). It also reduced wrong drug errors, wrong dose errors, wrong route errors, and documentation errors. BCMA also reduced adverse drug events related to non-timing errors (Shah et al., 2016). The article, however, noted that human factors and technical issues should also be considered in the implementation of BCMA technology. BCMA is not effective in completely eliminating medication errors.

Thompson et al. (2018) conducted a study in inpatient nursing units. The results show that after implementing BCMA, decreased reported medication events by over 17%, while nonmedication events reporting increased by 20%. Thompson et al. (2018) also noted that BCMA reduced reported medication administration errors by 43.5%. There was a reduction of patient harm events by 55.4 %, and harmful medication errors decreased to 0.29 per 100 00 medications from 0.69 per 100 000 medications.

Truitt et al. (2016) noted that after implementing BCMA reduced from 0.26% to 0.20%. This was mainly due to the “wrong time” administration being reduced. There was also a remarkable reduction in the severity of medication-related errors. Shahin (2019) noted that BCMA reduced medication errors by 54% in the surgical medication unit from one of the articles it reviewed. Other articles reviewed in this paper also revealed that medication-related errors were significantly reduced by the implementation of BCMA.

Relevance of Findings

Shah et al. (2016) is relevant to my clinical question, and the information is related to my clinical question, and it outlines how BCMA reduces medication errors and enhances patient safety. The intended audience is nurses and healthcare institutions. The findings from this article are appropriate for my education, and I have looked at other sources. This source is relevant to me. Thompson et al. (2018) is also relevant. It is related to the clinical question I asked. It is intended for hospitals and nurses. The study was done in a hospital setup. The information in the article is appropriate for my level. I would use this article for my research paper. The study concluded that BCMA can reduce medication errors. This study was selected since it outlined the significance of BCMA in lowering medication errors.

Truitt et al. (2016) is relevant to my clinical question. It outlines how BCMA can reduce adverse drug events. It was conducted in a hospital set up, and the audience is nurses and hospitals. The article findings are relevant to the clinical questions. The findings reveal that BCMA effectively reduces medication errors. Shahin (2019) was a systematic review of articles, and it is related to my topic. The intended audience is nurses, and the information is appropriate. It, however, focuses on factors that affect the utilization of BCMA and may not be relevant for the clinical question.

Findings from Thompson et al. (2018) are the most credible since they involved fifty nursing units and 500 000 medications administered per month. The observation occurred from 2007 to 2013, and hence the findings are very credible.

Conclusion

Healthcare professionals and institutions should implement BCMA technology to reduce medication-related errors. The PICO (T) framework was used to determine if the intervention of BCMA technology was more effective than no intervention in reducing medication errors. This involved identifying evidence sources, explaining the findings, and determining the relevance of the findings. Thompson et al. (2018) provided reliable and relevant information that can explore the effectiveness of BCMA technology.

References

Azzolini, E., Furia, G., Cambieri, A., Ricciardi, W., Volpe, M., & Poscia, A. (2019). Quality improvement of medical records through internal auditing: a comparative analysis. Journal of preventive medicine and hygiene, 60(3), E250. https://dx.doi.org/10.15167%2F2421-4248%2Fjpmh2019.60.3.1203

Boswell, C., & Cannon, S. (2018). Introduction to nursing research (5th ed.). Jones & Bartlett Learning.

Carlfjord, S., Öhrn, A., & Gunnarsson, A. (2018). Experiences from ten years of incident reporting in health care: A qualitative study among department managers and coordinators. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-2876-5

Shah, K., Lo, C., Babich, M., Tsao, N. W., & Bansback, N. J. (2016). Bar code medication administration technology: A systematic review of impact on patient safety when used with computerized prescriber order entry and automated dispensing devices. The Canadian Journal of Hospital Pharmacy, 69(5). https://doi.org/10.4212/cjhp.v69i5.1594

Shahin, M. (2019). Improving intravenous medication administration and reducing medication errors among critical care nurses at Jordan University hospital. Journal of Bioscience and Applied Research, 5(3), 352-366. https://doi.org/10.21608/jbaar.2019.147401

Thompson, K. M., Swanson, K. M., Cox, D. L., Kirchner, R. B., Russell, J. J., Wermers, R. A., Storlie, C. B., Johnson, M. G., & Naessens, J. M. (2018). Implementation of bar-code medication administration to reduce patient harm. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2(4), 342-351. https://doi.org/10.1016/j.mayocpiqo.2018.09.001

Truitt, E., Thompson, R., Blazey-Martin, D., Nisai, D., & Salem, D. (2016). Effect of the implementation of barcode technology and an electronic medication administration record on adverse drug events. Hospital Pharmacy, 51(6), 474-483. https://doi.org/10.1310/hpj5106-474

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Nursing-Using a PICOT Framework and Evidence to Develop Care Practices

Please see attached the instructions and sample assignment.

Create a 3-5-page submission in which you develop a PICO(T) question for a specific care issue and evaluate the
evidence you locate, which could help to answer the question.
PICO(T) is an aqqqcronym that helps researchers and practitioners define aspects of a potential study or investigation.
It stands for:
P – Patient/population/problem.
I – Intervention.
C – Comparison (of potential interventions, typically).
O – Outcome(s).
T – Time frame (if time frame is relevant).
The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell &
Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are
starting to apply an evidence-based model or EBPs. By taking the time to precisely define the areas in which the
nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining
the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence
during their search.
You are encouraged to complete the Vila Health PCI(T) Process activity before you develop the plan proposal. This
activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue
at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own
practice and self-assessment and demonstrates your engagement in the course.

Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies
through the following assessment scoring guide criteria:
Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and
studies.
Explain the findings from articles or other sources of evidence.
Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
Explain the relevance of the findings from chosen sources of evidence to making decision related to a
PICO(T) question.
Competency 3: Apply an evidence-based practice model to address a practice issue.
Define a practice issue to be explored via a PICO(T) approach.
Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on
evidence.
Communicate using writing that is clear, logical, and professional with correct grammar and spelling
using current APA style.

As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly
resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement
skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing
practice outcomes are positively impacted.
PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are
going to use, and your predictions related the issue. Word choice is important in the PICO(T) process because
different word choices for similar concepts will lead you toward different existing evidence and research studies that
would help inform the development of your initial question.

Scenario

For this assessment, please use an issue of interest from your current or past nursing practice.
If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies
presented in the resources and select one of those as the basis for your assessment.

Instructions

For this assessment, select an issue of interest an apply the PICO(T) process to define the question and research it.
Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is
relevant and you should include that as well, when writing a question you can research related to your issue of
interest. After you define your question, research it, and organize your initial findings, select the two sources of
evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each
source’s specific findings and best practices related to your issues, as well explain how the evidence would help you
plan and make decisions related to your question.
If you need some structure to organize your initial thoughts and research, the PICOT Question and Research
Template document (accessible from the “Create PICO(T) Questions” page in the Capella library’s Evidence Based
Practice guide) might be helpful.
In your submission, make sure you address the following grading criteria:
Define a practice issue to be explored via a PICO(T) approach.
Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
Explain the findings from articles or other sources of evidence.
Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T)
question.
Communicate using writing that is clear, logical, and professional with correct grammar and spelling using
current APA style.
Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the
scoring guide would look like:

Your assessment should meet the following requirements:
Length of submission: Create a 3–5-page submission focused on defining a research question and
interpreting evidence relevant to answering it. A title page is not required but you must include a reference
list.

Nursing-Using a PICOT Framework and Evidence to Develop Care Practices

Number of references: Cite a minimum of four sources of scholarly or professional evidence that support
your findings and considerations. Resources should be no more than 5 years old.
APA formatting: Format references and citations according to current APA style.
Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you
complete the final capstone course.