PICO(T) Questions and an Evidence-Based Approach – Medication Administration Errors

PICO(T) Questions and an Evidence-Based Approach – Medication Administration Errors

Medication administration errors (MAEs) compromise patient safety, quality of care, and the patient and provider experiences. To address the issue of and the occurrence of MAEs, it is important that nurses utilize evidence from credible resources to develop practices that effectively prevent the risk of MAEs. The PICOT (Population/Patient, Intervention, Comparison, Outcome, and sometimes Time) framework helps develop a clinical research question support to support evidence collection. This paper applies the PICOT framework to define MAEs and help identify credible resources of evidence to answer the question developed. The paper will also discuss the major findings from identified credible resources and define the relevance of these findings to understanding and preventing MAEs.

Definition of Medication Administration Errors via a PICO(T) Approach

Medication administration errors occurring among inpatient patients due to their associated risk of patients developing adverse drug events (ADEs) have been the most focused element of improving patient safety for the longest (MacDowell et al., 2021). However, MAEs remain an issue of concern in nursing care, mainly due to their frequency in hospitalized patients under nurse care. The major interventions include using a standard approach to communication, improving patient education, optimizing workflow, focusing on major causes, and using barcode medication administration (BCMA), among others(MacDowell et al., 2021). The use of standardized communication is selected as an intervention in this paper, while barcode medication administration (BCMA) is selected as a comparison to determine its effectiveness in 6 months. Notably, exploring this issue via the picot approach will be most helpful because it ensures the selection of the most suitable evidence to support the development of evidence-based interventions to prevent MAEs

For the PICOT question, the population is hospitalized patients at risk of MAEs. The intervention is standardized communication in nursing, while the comparison intervention is the use of barcode medication administration (BCMA). The outcome is the reduction and prevention of MAEs, while the time for the effectiveness test is six months. Therefore, the developed PICOT question is: For hospitalized patients at risk of experiencing MAEs, is the use of standardized communication in nursing more effective than barcode medication administration (BCMA) in reducing and preventing MAEs in 6 months?

Identification of Sources of Evidence to answer the PICO(T) Question

There are various resources can be utilized to search for sources of evidence required to support the effective answering of the PICOT question developed. Answering the PICOT question will support the development of an evidence-based intervention to sort out the issue of MAEs in inpatient care settings. The main sources of evidence include databases, journals, and websites, among others. The search across various databases using search terms such as “medication errors,” “causes of medication errors,” and “communication in medication,” among other search terms and phrases, resulted in multiple credible articles. However, not all resources were credible. The focus was paid to peer-reviewed journals with authoritative authors published within five years, and the accuracy of the results is based on the methods applied in the peer-reviewed journal. Three journal articles were selected: a cross-sectional study by (Shitu et al., 2020), a literature review by (Brigitta & Dhamanti, 2020), and a pre-post design project by (Murphy et al., 2022).

Findings from the Selected Sources of Evidence

The article by Brigitta and Dhamanti (2020) conducted a review of the literature focusing on a cause factor analysis to identify common causes of MAEs and the possible methods to prevent the occurrence of such errors. MAEs were mostly linked to factors related to poor and ineffective communication, the work environment, and individual human errors. The authors identify various MAE prevention methods, such as the improvement of nurse management resources, a clear chain of command, SBAR-like communication, a better work environment, staff training, and the use of clear schedules.

The article by Shitu et al. (2020) aimed to determine the frequency of MAEs, types of common MAEs, and major factors among patients in the emergency department in a teaching hospital. The study found that MAEs were common in ED and inpatient settings. The common MAEs are wrong time errors, unauthorized drug errors, drug omission errors, and dose error dosage errors. Consistently, the article by Murphy et al. (2022) focuses on the implementation of a Standardized Communication Tool in ICU settings. The study links poor communication to the occurrence of errors in ED and other care settings. Besides all other interventions, the authors note that effective communication is the most essential tool for effective and safe care in critical settings.

Relevance of the Findings

The findings from the selected articles are relevant to the PICOT questions for various reasons. The first step towards developing an effective evidence-based intervention is to understand the causes of the clinical issue addressed. The articles selected identify both the causes of the occurrence of medication errors and the nature of the medication administration errors in various care settings, such as in ED settings (Shitu et al., 2020) and in the ICU (Murphy et al., 2022). The next step is developing and selecting a suitable intervention. The selected articles, such as those of Brigitta & Dhamanti (2020) and Murphy et al. (2022), provide clear evidence-based interventions. Standardised communication is the most effective intervention to solve MAEs in inpatient settings (Brigitta & Dhamanti, 2020; Murphy et al., 2022).

Conclusion

MAEs are an issue of concern in relation to patient safety and quality of care. The use of evidence-based approaches can help nurses reduce and prevent MAEs, especially in inpatient care settings. The PICOT framework is a great tool that ensures the selection of the most suitable evidence to support the development of evidence-based interventions to prevent MAEs. The use of standardized communication can improve the efficiency of nurses in preventing MAEs.

 References

Brigitta, I. R., & Dhamanti, I. (2020). Literature Review: Cause Factor Analysis and an Effort to Prevent Medication Administration Error (MAE) at Hospital. Unnes Journal of Public Health, 9(2), 98–107. https://doi.org/10.15294/UJPH.V9I2.36470

MacDowell, P., Cabri, A., & Davis, M. (2021). Medication Administration Errors. In Patient Safety Network. PSNet. https://psnet.ahrq.gov/primer/medication-administration-errors

Murphy, M., Engel, J. R., McGugan, L., McKenzie, R., Thompson, J. A., & Turner, K. M. (2022). Implementing a Standardized Communication Tool in an Intensive Care Unit. Critical Care Nurse, 42(3), 56–61. https://doi.org/10.4037/CCN2022154

Shitu, Z., Aung, M. M. T., Tuan Kamauzaman, T. H., & Ab Rahman, A. F. (2020). Prevalence and characteristics of medication errors at an emergency department of a teaching hospital in Malaysia. BMC Health Services Research, 20(1), 1–7. https://doi.org/10.1186/S12913-020-4921-4/TABLES/4

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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.

Introduction
PICO(T) is an acronym 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. When applying the PICO(T) approach, the nurse can isolate the interventions of interest and compare to other existing interventions for the evidenced impact on the outcome of the concern.

You are encouraged to complete the Vila Health PICO(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.

Reference
Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.

Professional Context
As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence to enhance clinical reasoning and judgment skills. When reliable and relevant evidence-based findings are utilized, patients, healthcare systems, and nursing practice outcomes are positively impacted.

PICO(T) is a framework that can help you structure your definition of the issue, a potential approach that you are going to use, and your predictions related to 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 develop your initial question. When writing a PICO(T)-formatted research question, you want to focus on the intervention’s impact and compare the outcome you desire.

Scenario
For this assessment, please use a healthcare 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 a healthcare issue of interest and apply the PICO(T) process to develop and research the research question.

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 more deeply. Specifically, interpret each source’s specific findings and best practices related to your issues, as well as 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. Create a PICO(T)-formatted research question
Identify sources of evidence that could be potentially effective in answering a PICO(T) question (databases, journals, websites, etc.).
Explain the findings from articles or other sources of evidence as it relate to the identified healthcare issue.
Explain the relevance of the findings from chosen sources of evidence to making a decision related to a PICO(T) question.
Communicate using writing that is clear, logical, and professional with correct grammar and spelling using the 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:

Assessment 3 Example [PDF].
Additional Requirements
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.
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 the 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.

Competencies Measured
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 that are relevant to the health care issue.
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 a 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 and develop a PICO(T)-formatted research question.
Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
Organize content so ideas flow logically with smooth transitions; contain few errors in grammar/punctuation, word choice, and spelling.
Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.

CREATE PICOT QUESTIONS – TEMPLATE
Use this Word document to help you form your PICO(T) question and get started with your library research strategy.

Refer to the other boxes on this page and the “Find EBP Articles” page for additional tips and strategies.

PICOT Question and Library Search
PICOT QUESTION PROCESS
Creating a question using the PICOT elements will provide a framework for the research you need to conduct an evidence-based study or to make an evidence-based decision.

PICOT Elements:
(P) – Population, Patients, or Problem: The sample of subjects used in a study or the problem being addressed.

(I) – Intervention: The treatment that will be provided to subjects enrolled in your study.

(C) – Comparison or Control: Identifies an alternative intervention or treatment to compare. Many study designs refer to this as the control group. If an existing treatment is considered the ‘gold standard’, then it should be the comparison group. A control group is not required for every type of study.

(O) – Outcome: The clinical outcome that measures the effectiveness of the intervention.

(T) – Time: Duration of the data collection. Some versions don’t include this element, and time may not be specified in cases where the question is focused on prediction or diagnoses.

PICOT Question Format Examples:
Please be sure to check your assignment, as it may direct you to use a different format.

Intervention: In _______ (P), how does _______ (I) compared to _______ (C) affect _______ (O) within _______ (T)?

Prognosis/Prediction: In _______ (P), how does _______ (I) compared to _______ (C) influence/predict _______ (O) over _______ (T)?

Diagnosis or Diagnostic test: In _______ (P), are/is _______ (I) compared to _______ (C) more accurate in diagnosing _______ (O)?

Aetiology: Are _______ (P), who have _______ (I) compared to those without _______ (C) at _______ risk for/of _______ (O) over _______ (T)?

Meaning: How do_______ (P) with _______ (I) perceive _______ (O) during _______ (T)?

Example PICOT Questions:
For residents of long-term care facilities (P), how does the implementation of a hydration assessment tool (I) compared to current practice (C) affect the number of hospital admissions with the diagnosis of dehydration (O) during three months (T)?
In acute care hospitals (P), how does having a rapid response team (I) compared with not having a response team (C) affect the number of cardiac arrests (O) during a three-month period (T)?
In women with gestational diabetes (P), how does a monitored diet and exercise program over the course of pregnancy (I &T), compared to the use of metformin only (C), reduce the incidence of high birth weight babies(O)?
In patients admitted for acute myocardial infarction (P), how well does the hospital’s new data model created from EMR data (I) compared to current practices (C) predict readmission rates (O) within 30 days after initial discharge (T)?
For patients of a rural health clinic (P), does the use of text message reminders (I), compared with telephone calls (C) reduce the number of missed appointments (O) over a six-month period (T)?

References:
Melnyk, B.M., Fineout-Overholt, E., Stillwell, S. & Williamson, K. M. (2010). Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice. AJN, American Journal of Nursing, 110, 51-53.
Posing the research question: Not so simple
To make your case, start with a PICOT question
What is your research question? An introduction to the PICOT format for clinicians.
Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice.