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