PICO(T) Evidence Review
PICO(T) Evidence Review
The Joint Commission has predicted an estimate of 80% of serious level medical errors as being associated with the miscommunication between the caregivers during hand-off among the patients. The implication of the handoff is the transfer as well as the acceptance of the responsibility for the care of the patient attainable by means of enhancing communication effectiveness (Halms, 2013). In most cases, crucial information about the care of the patient is lost during changes in shifts. There is thus a need for enhancement of the safety and quality of handoff that requires the implementation of strategies that can support that initiative (Gordon & Findley, 2011). This assignments posits to shed light on the issue of hand-off and identify potential solution through the PICO(T) question formulation. It is also prudent to make use of information technology in searching the databases that offer evidence and select the suitable evidence that support the PICO(T) question as well as a critical appraisal of the evidence. PICO(T) Evidence Review
Most facilities lack information standardization that is essential during handoff in intensive care units that translates to high degree of inaccuracy in information exchange. The situation leads to inconsistent patient care with a high degree of dissatisfaction among the patients as well as the staff responsible for the patient care. The family members of the patients can also be affected and it can be catastrophic to the patients. The Joint Commissions and the National Patient Safety Goals suggests the need for improvements in communication effectiveness among the caregivers (The Joint Commission, 2018).
ORDER A PLAGIARISM FREE PAPER NOW
The evidence search shall be guided by a PICO(T) question that is developed for the purpose of executing evidence review on the best practices that entails the adult patients who are discharged with instructions as well as follow-up post disacharge in the emergency department.
Among the adults in the intensive care unit (P), does the handoff among the nurses that incorporate the patients with the family members (I), relative to the handoff that involves the nurses only (C), leads to improved nursing and the clinician satisfaction in communication (O) during the length of stay in the ICU (T). PICO(T) Evidence Review
In the above PICO(T) question, the population, P includes the adult patients in the ICU. The intervention, I is the nursing handoff at the end of the shift that involves the patient and the family members. The standard practice –comparison is the nurse handoff report. The outcomes, O entail the enhanced collaboration of care as well as the comprehension of the patient, the patient safety as well as satisfaction. Time, T is the length of stay in the ICU.
Description of Search
The search of evidence entails the utilization of the HS/HSL instructional librarian, the faculty, the feedback from the discussion board and module 3 as the guide to the search as well as the choice of evidence. It is appropriate to account for five studies that shall contribute in responding to the PICO(T) question and four out of the total are primary sources while the rest can be secondary or even primary sources. The prospective intervention studies coupled with the randomized controlled trials can form the best and ideal primary sources and thus, they deserve to be accorded priority. The evidence review also required the use of the CINAHL and the PubMed databases in the identification of the literature that addresses the PICO(T) question.
Specifically, the following were the search terms that formed the basis of evidence search: hand-off, change of shift, patient information, care safety, nurse staff satisfaction. The access to updated data was a crucial consideration that prompted limiting of the search to recent publications, not older than 5 years (2013 – 2018) that addressed issues relating to adult populations only. There was a further restriction to the peer reviewed articles when using CINAHL and PubMed. Apart from the searches in the databases, some articles were also resourceful that were located through the background research on the topic of handoff and due to the relevance to the PICO(T) question. PICO(T) Evidence Review
It is prudent to consider placing a greater echelon of emphasis on the high-quality of the outcomes in the handoff studies that focuses on the system factors in addition to the human performance relative to the effectiveness of the structured protocols, evaluation as well as education. The current research focuses on particular departments and institutions with much of their emphasis on the convenience use of designs, samples as well as outcome measures. The starting point in the future research in handoff must be the development of the conceptual framework that places the PICOT questions within the theoretical framework on the basis of the previous evidence search. It is also suitable to isolate the articles identified through evidence search that are not particular to the items of the PICOT questions. Only the articles that address all issues as suggested in the PICOT questions can be considered for use in the research. PICO(T) Evidence Review
Reference
Benham-Hutchins, M. M., & Effken, J. A. (2010). Multi-professional patterns and methods of communication during patient handoffs. International journal of medical informatics, 79(4), 252-267.
Butcher, L. (2015). The high-stakes handoff. Trustee, 68(3), 8-10,12. Retrieved from https://search.proquest.com/docview/1667959809?accountid=45049
Gordon, M & Findley, R., (2011). Educational interventions to improve handover in health care: a systematic review. Med Educ. 45(11):1081–1089.
Halms, M. A. (2013). Nursing handoffs: Ensuring safe passage for patients. American Journal of Critical Care, 22(2), 158-161
Halms, M. A. (2013). Nursing handoffs: Ensuring safe passage for patients. American Journal of Critical Care, 22(2), 158-161
The Joint Commission. (2018). The National Patient Safety Goals. Retrieved February 06, 2018 from http://www.jointcommission.org/standards_information/npsgs.aspx PICO(T) Evidence Review
For this evidence review, both the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed databases were used to find literature surrounding the PICO(T) question. Specifically, the following search terms were used within both databases: “emergency” AND (“follow up” or “discharge”) AND (“telephone” or “phone call”). Results of both searches were limited to the last five years (2012-2017) and for adult human populations only (to exclude pediatric studies); the CINAHL search was further restricted to peer reviewed articles only. Based on this search criteria, CINAHL yielded a total of 94 articles and PubMed yielded a total of 306 articles. In addition to the database searches, two additional articles were identified through background research on this topic and included in this review, as they were relevant to the PICO(T) question.
After 61 duplicates were removed, 341 article titles were reviewed and screened to determine if the article should be included within the full text article review for eligibility for this evidence review. Refer to Appendix A for a PRISMA flow diagram and additional details about the inclusion/exclusion criteria. Most of the articles were excluded as either the study population was not in the emergency department, or the intervention was non-telephone follow-up (e.g., telephone surveys may have been administered as part of study methods). Of the 21 articles identified for full text review, seven articles were excluded as the patient population was too specific, three were excluded as they were exploratory in nature, two were excluded due to non-telephone interventions, and three were excluded as they were either a repeat study, did not involve emergency department population, or involved a pharmacist only follow-up. After the full text review, six articles were eligible and all six are included in the evidence review process. Refer to Appendix B for the evidence review table of these six articles.
