PICOT STATEMENT PAPER
PICOT Statement Paper
Grand Canyon University: NRS-490
Professional. Capstone and Practicum
Ms. Barbara Pridgen
March 10, 2019
PICOT Statement Paper
In order to provide a higher quality of patient care, nurses should implement evidence-based practice. To begin this process, a clinical question needs to be formulated using the PICOT format. Then the search for the best evidence begins with searching in databases such as Proquest, MEDLINE, and CINAHL for relevant qualitative and quantitative articles or journals. Once the journals and articles are obtained, they must be critically appraised to determine which ones are the most valid, reliable, and relevant to the PICOT question (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010).
When transferring the care of labor and delivery (L&D) patients to the post-partum couplet care (PPCC) unit (P), does implementing a standardized bedside report (I) compared with not implementing a standardized bedside report, (C) increase patient and nurse safety and patient satisfaction rates (O) during a 10-week period (T)?
Typically, the transfer of care report is conducted away from the patient. It is either done by an inconsistent handwritten report or by a telephone call from a nurse that was not taking care of the patient and was not fully informed of all the patient details. Therefore, there is substantial potential for miscommunication, which can lead to medical errors. Implementing a standardized bedside report, such as a situation, background, assessment, recommendation (SBAR) format, would ensure a safe transfer of care, decrease patient vulnerability and miscommunication, and increase patient satisfaction and patient and nurse safety (Rosas, 2017; McAllen, Stephens, Swanson-Biearman, Kerr, & Whiteman, 2018).
Medical errors resulting from ineffective and inconsistent exchange of information between nurses during transfer of care can lead to adverse events that costs the nation billions of dollars each year. Consequently, the Agency of Healthcare Research & Quality (AHRQ), the Joint Commission, and the World Health Organization (WHO) have recognized communication via handoff report as a National Patient Safety Goal. Furthermore, they have recommended that a standardized bedside handoff approach be implemented by nurses in all health care organizations. This approach provides a consistent face to face method of communication at the bedside which can also promote patient and family engagement, leading to increased provider trust. This intervention decreases the occurrence of misinformation, improves patient safety, and decreases hospital costs (Usher, Cronin, & York, 2018).
Nurses are accountable for the patient’s safety and the communication that transpires during the transfer of care report (Ofori-Atta, Binienda, & Chalupka, 2015). Effective communication is essential to provide safe patient centered care. When bedside report is implemented, patient and family satisfaction improve, and their anxieties decrease because they are able to visualize and engage in the transfer of information between the nurses. Moreover, bedside report allows the oncoming nurse to visualize and assess the patient and environment, verify pertinent details of the patient’s history and current details with the off going nurse which will increase quality of care and patient and nurse safety. (Sadule-Rios, Lakey, Serrano, Uy, Gomez et al., 2017; Ofori-Atta, Binienda, & Chalupka, 2015; McAllen, Stephens, Swanson-Biearman, Kerr, & Whiteman, 2018).
Health Care Agency
Currently, there is not any policy in place that mandates the way shift report or transfer of care report is given. The PPCC nurses have been pushing for a change. The nurse manager suggested implementing a bedside report using SBAR to the L&D charge nurse, but the charge nurse was resistant to the idea. One reason may be because L&D is not on the same floor as post-partum care, which would make it more time consuming. If evidence-based practice supporting bedside report was presented, the L&D charge nurse may be more easily persuaded to implement this change.
The switch from the customary methods of handoff report to bedside report is a substantial challenge, mostly because it is thought to be time consuming. When an intervention or procedure has been done a certain way for a period of time, it is difficult to make a change. Nurse managers will need to monitor the bedside report to ensure that the nurses do not revert back to an inconsistent written report (Chapman, Schweickert, Swango-Wilson, Aboul-Enein, & Heyman, 2016). Once bedside report is in place, it strengthens communication between nurses and the interdisciplinary team, improves teamwork, and ensures nursing accountability (Sadule-Rios, Lakey, Serrano, Uy, Gomez et al., 2017; Dorvil, 2018; Ofori-Atta, Binienda, & Chalupka, 2015).
Chapman, Y. L., Schweickert, P., Swango-Wilson, A., Aboul-Enein, F., & Heyman, A. (2016). Nurse satisfaction with information technology enhanced bedside handoff. Medsurg Nursing, 25(5), 313-318. Retrieved from https://lopes.idm.oclc.org/login?url=https://search-proquest-com.lopes.idm.oclc.org/docview/1827241809?accountid=7374
Dorvil, B., (2018). The secrets to successful nurse bedside shift report implementation and sustainability. Nursing Management, 49(6), 20-25. doi: 10.1097/01.NUMA.0000533770.12758.44
McAllen, R., Stephens, K., Swanson-Biearman, B., Kerr, K., & Whiteman, K., (2018). Moving shift report to the bedside: An evidence-based quality improvement project. Online Journal of Issues in Nursing, 23(2), 1-12. doi: 10.3912/OJIN.Vol23No02PPT22
Melnyk, B., Fineout-Overholt, E., Stillwell, S., & Williamson, K., (2010). The seven steps of evidence-based practice. Retrieved from http://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/NCNJ/A/NCNJ_165_516_2010_08_23_DGSODKGNM_1651_SDC516.pdf
Ofori-Atta, J., Binienda, M., & Chalupka, S., (2015). Bedside shift report: Implications for patient safety and quality of care. Nursing 2015, 45(8), 1-4. doi: 10.1097/01.NURSE.0000469252.96846.1a
Rosas, E. (2017). Standardized communication at the bedside: A review for reimplementation. Available from ProQuest Dissertations & Theses Global: Health & Medicine. (1936368034). Retrieved from https://lopes.idm.oclc.org/login?url=https://search-proquest-com.lopes.idm.oclc.org/docview/1936368034?accountid=7374
Sadule-Rios, N., Lakey, K., Serrano, M., Uy, E., Gomez, J., Bezner, P., & Acosta, J. (2017). Off to a good start: Bedside report. Medsurg Nursing, 26(5), 343-345. Retrieved from https://lopes.idm.oclc.org/login?url=https://search-proquest-com.lopes.idm.oclc.org/docview/1953851029?accountid=7374
Taylor, J., (2015). Improving patient safety and satisfaction with standardized bedside handoff and walking rounds. Retrieved from https://search-proquest com.lopes.idm.oclc.org/central/docview/1701283769/D20C18F5398847B1PQ/6?accountid=7374
Usher, R., Cronin, S. N., & York, N. L. (2018). Evaluating the influence of a standardized bedside handoff process in a Medical–Surgical unit. The Journal of Continuing Education in Nursing, 49(4), 157-163. doi: http://dx.doi.org.lopes.idm.oclc.org/10.3928/00220124-20180320-05