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The process of identifying a researchable problem can significantly impact the following steps of conducting a study. The feasibility of the final question and its elements can either simplify or complicate the search of information and the outcomes of research. Thus, prior to formulating the main research problem, it is vital not only to describe the sphere of interest and its possible issues but also to analyze possible frameworks which can be used for developing a topic that produces measurable results.
Area of Interest
Clinical practice has many areas where one’s errors can negatively impact patient outcomes and their overall health. For example, the high rate of medication administration errors (MAEs) is an issue that has a direct impact on an individual’s health. MAEs may include incorrect dosage and missed or repeated administration, which may lead to such negative outcomes as an overdose. According to Keers, Williams, Cooke, Walsh, and Ashcroft (2014), a major part of all adverse events leading to patient harm is connected to medication. The rate of MAEs is also high in hospitals, contributing to almost 20 percent of all possible opportunities for error. Thus, the problem of medication administration has to be analyzed in more detail. Insulin administration errors, while considered less dangerous as opposed to intravenous injections, can still significantly impact patients’ health.
Medication errors that involve nurses administering insulin to a patient are common. According to Nguyen, Nguyen, Haaijer-Ruskamp, and Taxis (2014), the error rate for insulin administration at the investigated hospitals reached almost 30 percent. Currently, the number of patients treated with insulin continues to grow, which makes the problem more pressing than before (Geller et al., 2014). Thus, some ways of error prevention have to be considered. One of the potential interventions is a double-checking process (Alsulami, Choonara, & Conroy, 2014). It is standard practice in many healthcare organizations, although it is unclear how significantly its implementation contributes to decreasing error rates (Hewitt, Chreim, & Forster, 2016). This procedure may have its benefits and drawbacks and should be investigated further to establish if it helps to reduce the occurrence of MAEs related to insulin.
The problem of insulin administration errors needs to be addressed because of the growing prevalence of patients with diabetes who need to be treated with insulin in a hospital setting. The number of individuals who require insulin injections or other types of administration continues to grow (Geller et al., 2014). The rates of errors may also increase due to the rising workload of nurses and the admission of patients lacking education about self-administration (Nguyen et al., 2014). Incorrect use of insulin may lead to patients developing hypoglycemia, characterized by sweating, weakness, and loss of consciousness (Geller et al., 2014). Some more severe consequences include seizures and even death. Thus, it is vital to address the problem of administration errors and find a way to decrease their rate.
Developing Research Questions
What differences exist between errors in insulin injections and infusion?
This question, while introducing a possible area of research, does not lead to the introduction of any solutions to the problem of MAEs. Thus, it is not feasible, although it relates to the area of interest for this study.
What causes errors in medication administration in a hospital setting?
This example encourages a discussion about common reasons behind mistakes related to medication administration. It corresponds with the topic of interest and allows one to see which concerns need to be addressed for future improvements. However, it does not present a strategy that can be evaluated for implementation. This question should be eliminated because it is not a feasible foundation for a PICOT question, although it can be researched in more detail.
What differences exist between various interventions for reducing MAEs?
Here, the possibility of introducing solutions for the discussed problem is present. However, the scope of research does not allow developing a study that tests a specific intervention and produces measurable and usable results. Thus, this question cannot be reformulated to become a useful PICOT topic.
What are the consequences of using interventions such as double-checking for MAEs?
This question relates to the area of interest and connects it to a possible intervention strategy. Nevertheless, its focus does not provide any measurable outcomes, which could be used for further assessment and future improvements. A study by Raban and Westbrook (2014), for instance, shows that studies with no measurable outcomes should be used in practice with caution. This question indicates that double-checking may be used for reducing errors, but it does not ask how advantageous this procedure may be.
How effective is the implementation of a double-checking method for reducing errors in the process of insulin administration?
The effectiveness of an intervention is a topic that can be reformulated into a PICOT question. This example has all elements for choosing it as a possible research problem because it creates a situation to measurable outcomes and the possibility for an assessment of future options.
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Based on the discussed research problem and the chosen focus, a PICOT question can be developed.
Q: In the process of insulin administration, does the implementation of a dual insulin check by two nurses, as opposed to no double-checking, decrease the rate of medication-related errors per year?
- P – Problem: The process of insulin administration. This problem corresponds to the area of interest.
- I – Intervention: Double checking by two nurses. Here, one intervention is suggested to see whether it can be valid for practice or not.
- C – Comparison: No double-checking. The comparison with another intervention could complicate the process of measuring the change. On the other hand, contrasting a new strategy with an absence of intervention can show the changes that it may bring.
- O – Outcome: Decreased rate of medication-related errors. The desired outcome is the lowered number of errors that nurses make while administering insulin to patients.
- T – Timeframe: One year. Annual results can be represented in a report and shown to the administration in order to create a new policy for further implementation.
The literature search for this topic can be based on the following keywords: medication, medication administration, insulin administration, insulin, medication errors, nurse, nursing care, double-checking, patient safety, quality improvement, hospital.
The chosen phrases and words are based on the topic of research. The combination of these terms allows one to understand that the study is focused on improving patient safety by evaluating a practice connected to a way of reducing medication errors. The words related to nursing were selected to highlight the discussed area of interest.
The issue of medication errors during insulin administration is a topic that can be researched from various angles. Nevertheless, an approach that focuses on improving the quality of care seems to be the most crucial one, as it can produce positive results for patient safety – one of the most critical aspects of health care. Thus, a PICOT question concerning an introduction of a possible intervention into the practice was developed. Finally, keywords pertinent to the topic were selected
Alsulami, Z., Choonara, I., & Conroy, S. (2014). Paediatric nurses’ adherence to the double-checking process during medication administration in a children’s hospital: An observational study. Journal of Advanced Nursing, 70(6), 1404-1413.
Geller, A. I., Shehab, N., Lovegrove, M. C., Kegler, S. R., Weidenbach, K. N., Ryan, G. J., & Budnitz, D. S. (2014). National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations. JAMA Internal Medicine, 174(5), 678-686.
Hewitt, T., Chreim, S., & Forster, A. (2016). Double checking: A second look. Journal of Evaluation in Clinical Practice, 22(2), 267-274.
Keers, R. N., Williams, S. D., Cooke, J., Walsh, T., & Ashcroft, D. M. (2014). Impact of interventions designed to reduce medication administration errors in hospitals: A systematic review. Drug Safety, 37(5), 317-332.
Nguyen, H. T., Nguyen, T. D., Haaijer-Ruskamp, F. M., & Taxis, K. (2014). Errors in preparation and administration of insulin in two urban Vietnamese hospitals: An observational study. Nursing Research, 63(1), 68-72.
Raban, M. Z., & Westbrook, J. I. (2014). Are interventions to reduce interruptions and errors during medication administration effective?: A systematic review. BMJ Quality and Safety, 23(5), 414-421.