NURS2006 Clinical Question Based Pon ICOT Structure Assessment 1 Answer

INTRODUCTION

Many evidence-based studies have emphasized on the importance of medication administration and medication errors. Researchers have also found a strong relationship between the 12-hour shift and its impact on medication administration process causing medication errors as the result of burnouts. With increasing cost and question on patient safety and quality care, the attention needs to be paid on the negative outcomes of medication errors in the healthcare system. This paper describes a clinical question based on population/ Patient, intervention, comparison, outcome and time (PICOT) structure. The clinical problem related to medication error and its relation with 12-hour shift among nurses is supported through relevant researches and literature. 

CLINICAL PROBLEM

In today's health care community increasing cases of medication, the error is a major concern. It does not only affect the safety of the patient but also raises threat to the wellbeing of nurses and question on their compliance (Vaismoradi et al., 2020). The medication error is used for any preventable event which may cause inappropriate medication resulting in patient harm (Jember et al., 2018). Researches have suggested that 16 percent of inpatient setting have episodes of medication errors ending up in harmful events and in a primary healthcare setting this ranging from 1 in every 20 prescriptions (Hall et al., 2016). Improving medication safety is the key area of focus for Australian commission on safety and quality in healthcare, department of health, the Australian government ("Australia joins international push to halve medication errors", 2017). Safe medication administration represents one of the highly complex, essential and routine responsibilities expected from nurses. Over the past, there has been a rising debate on 12 hours shift for nurses and its negative consequences in the form of medication errors. The medication error is a major problem in Australia where the cost of medication error is 1.2 Million Dollar annually ("Australia joins international push to halve medication errors", 2017).

It has been reported that about 65 percent of nurse are over-burdened and have 12-hours shift either due to scheduling or by choice (Martin, 2015). As the recognized association has been observed between 12 hours shift and accidents, injuries and medication errors. 12-hour shift is directly linked to major implications affecting the patient’s satisfaction and safety (Hall et al., 2016). Nurses experience fatigue, burnout and reduced clinical judgement when they supposed to work for longer shifts. The loss of alertness and fatigue were some of the registered consequence of long hours of work which might cause the medical error (Stimpfel, Sloane, & Aiken, 2012). Long working hours among nurses known to compromise the nurse ability to provide compassionate and connected caring to the patient (Kunaviktikul et al., 2015). Medication administration is a task as inherited in the scope of practice of nurses placing nurses at significant risk of experiencing the error. Most of the medication errors that result into the fatal outcome are due to wrong doses, misinterpretation of prescription, the omission of drug or delayed medication due to prolonged shift hours among nursing staff (Griffiths et al., 2016).

PICOT QUESTION

 In nursing research, evidence-based routine practice must find clinical information by asking the relevant clinical question. PICOT questions enable finding the best available and precise information in the appropriate time (Riva et al., 2012). PICOT is the acronym used for five key essential components of a clinical research question which includes population, intervention, comparison, outcome and time frame.

QUESTION: How does within the intensive care unit 12 hours nursing shift contribute to medical error in comparison to 8 hours shift?

In the picot question, the population selected are the patients of the intensive care unit. As an intensive care unit is one of the stressful workplace environments hence selection of this particular setting will provide better-contrasting information regarding the clinical problem. The selected intervention is the reduction in the nursing working schedule from 12 hours shift to 8 hours shift. The comparison component of the PICOT question has two subgroups one nurse working in the eight-hour shift in the intensive care unit and the other are the 12-hour shifts. The outcome is measured in terms of the prevalence of the medication error or decrease in the medication dispensing compliance. Using the search engine, research was identified regarding the 12-hour shifts and 8-hour shift within the nursing profession and they further contribute to a medication error.   The rationale for selecting this question is to enable a review of various literature researched on the relevancy of the topic. The selection was made based on increased medication error risk associated with a long working schedule. 

Various studied conducted infers that nurses working in 12 hours experience sleep deprivation which affects their working efficiency (Gorgich, et al., 2016). 

The study conducted by Stimpfel, Sloane & Aiken,2012 has looked into the correlation between the shift length and the patient outcomes. The study found that working longer in 12-hour shifts have effects on patient care. Another study conducted by Son, Lee, & Ko, 2019 indicated that patient negative outcomes and dissatisfaction along with medical errors are decreased in the proportion of nurses working in shifts on 8 hours and increases with 12-hour shifts. Martin, 2015 conducted another study and established the relationship between long schedule hours of 12-hour shift and insufficient quality of care in form of medication error which could occur secondary to memory, coordination, judgment, attention to details and reaction time affecting the quality of patient care. These two studies have indicated the increased incidence of medication errors by nurses due to the longer working shifts from 8 hours to 11-12 hours shifts. Increased working hours to 12 hours shift from 8 hours shift has resulted in fatigue-related medication errors among nurses in the studies done by Caruso, 2014. A study done by Olds & Clarke,2010 found a relationship between medication errors and the work hours. The author has found a relationship between the extended working hours durations and adverse events and errors including medication errors, nosocomial injections, fall and needle-related injuries.

CONCLUSION

An appropriately formed clinical research question under the PICOT framework can subsequently provide evidence-based strategies required to decrease the adverse effect of nursing long shifts including medication error. Several studies have established the relationship between extended working shifts from 8 hours to 12 hours and the occurrence of medication errors. It was found that the outcomes related to the extended nursing shifts results in medication errors are due to effects like fatigue, inadequate sleep, stress. In hospital care setting long working hours (11-12 hours) are found to be the reason for increased patient dissatisfaction and incidences of medication error.