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 occurr