Running head: IDENTIFYING A PROBLEM

Identifying a Researchable Problem

Diana Bryant
Walden University
NURS 5052, Section 1, Essentials of Evidence Based Practice
September 10, 2015

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Identifying a Researchable Problem

Identifying a question that can be researched for relevant information is a difficult task
that takes experience and practice to perfect (Davies, 2011). Just because a question is relevant
and useful does not mean that evidence has been gathered to address the problem. The purpose of
this paper is to follow the development of a PICOT question that identifies a genuinely
researchable problem that will lead to decisions based on evidence-based practice.
Summary of Area of Interest
The area of interest I chose directly relates to my day-to-day job duties working as a
nurse informaticist and an emergency room nurse. Obtaining an accurate medication history can
have specific bearing on care that is provided to the patient. Many medication side effects can
indication laboratory test that should be explored for correct levels. Ideally, the patient should be
interviewed and a list should be obtained from the prescribing physician or pharmacy (Gimnez
Manzorro et al., 2011). Additionally, patients who are received through the emergency room
have been shown to encounter a higher rate of error in the medication history (van den Bemt et
al., 2013).
Identification of the Problem
The problem with obtaining medication history in the emergency room can be
compounded when the patient comes from a long-term care center. Many elderly patients have
complex medication regiments in addition to polypharmacy (Wimmer et al., 2014) Comorbidities
experienced by patients who come from a nursing home along with the dementia many
experience lead to multiple prescriptions. Many times the patients are poor historians and it can
be difficult to acquire a current medication list (Michalik et al., 2013). Although providers may
include the medication history in their portion of the medical record, many times it is the nurse

IDENTIFYING A PROBLEM

who is responsible for compiling the list. Furthermore, it is especially important that the research
be examined in the development of evidence-based practice. In my facility, errors are discovered
when physcians attempt to continue home medications and are unable to perform this task
without reviewing the sources of the medication history before it became a part of the electronic
medical record.
Five Questions
Questions that I generated included:
1)What is the incidence of errors in medication reconciliation at my facility? Currently,
two out of ten emergency room patients have errors in reconciliation. This is most prevalent
among nursing home patients who have larger numbers of medications.
2) Does my facility have processes in place based on EBP? Processes were created to
meet the Meaningful Use measure initially without regard to EBP.
3) What increases the accuracy of medication reconciliation? Currently, only anecdotal
evidence suggests fewer errors occur when pharmacy or clinical IT staff assist in medication
reconciliation.
4) How many medications do nursing home patients have included on their medication
histories? It is not uncommon for nursing home patients to have twenty or more medications
listed on the medication administration record that is sent from the nursing home. Accurately
entering each of these medications can sometimes take over an hour.
5) Who is available to help the emergency room nurse input the large number of
medications into the electronic medical record? A nurse that works in the pharmacy can be pulled
to help and the two nurses who work in clinical informatics can be called to assist with the input
of the data.

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PICOT Question

The preliminary PICOT question I developed is: In nursing home residents admitted to
the ED, what is the effect of data entry of medications into the electronic medical record by
nurses with pharmacy or clinical IT staff assistance compared to data entry of medications by
nurses without assistance, on accuracy of patient medical history in electronic records, after four
weeks?
Population: Nursing Home Residents
Intervention: Data Entry of Medication History
Comparison: Using Ancilary Staff to Assist the Emergency Room Nurse
Outcome: Greater Accuracy
Time: Four Weeks
Ten Keywords with Rationale
1)Medication Reconciliation: This is the common term for obtaining a medication history
and inputting the information in the electronic medical record.
2) Nursing Home: Patients from this population are the target of the question due to the
polypharmacy and complicated medication regimens
3)Errors: To obtain data for comparison and studies that will indication reduction of
errors when an infervention is applied.
4)Emergency Room: This is the location that experiences a higher volume of nursing
home patients and does not have additional nursing support for input of medication history.

IDENTIFYING A PROBLEM

5) Intervention: This term can help to obtain data relating to practices by nurses based on
evidence to change or enhance current workflows.
6) Nurses: By using this term, information can be gathered relating to the role of the
nurse in locating the patients medication history.
7) Pharmacy Staff: Many hosptials are using pharmacy staff, including pharmacy
technicians and pharmacy students to create the master medication list.
8) Electronic Medical Record: CMS has mandated that the electronic medical record
contain a current and reviewed medication history as part of the Meaningful Use legislation.
9)Discrepencies: A Synonym for error that can widen the search for relevant material
10) Evidence Based Practice: The goal of answering this question is to develop EBP that
will positivily impact the patient care experience.
Summary
The development of a PICOT question is only possible after basic questions related to the
problem are answered. Additonally, search terms must be compiled that will lead the researcher
to the most current and relevant information. The PICOT question will be revised and and
manipulated throughout the process to identify a researchable problem.

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References

Davies, K. S. (2011). Formulating the evidence based practice question: a review of the
frameworks. Evidence Based Library and Information Practice, 6(2), 7580.
Gimnez Manzorro, ., Zoni, A. C., Rodrguez Rieiro, C., Durn-Garca, E., Trovato Lpez, A.
N., Prez Sanz, C., Jimnez Muoz, A. B. (2011). Developing a programme for
medication reconciliation at the time of admission into hospital. International Journal of
Clinical Pharmacy, 33(4), 603609. http://doi.org/10.1007/s11096-011-9530-1
Michalik, C., Matusik, P., Nowak, J., Chmielowska, K., Tomaszewski, K. A., Parnicka, A.,
Grodzicki, T. (2013). Heart failure, comorbidities, and polypharmacy among elderly
nursing home residents. Pol. Arch. Med. Wewn, 123(4), 170175.
Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for
nursing practice (Laureate Education, Inc., custom ed.). Philadelphia, PA: Lippincott
Williams & Wilkins.
van den Bemt, P. M. L. A., van der Schrieck-de Loos, E. M., van der Linden, C., Theeuwes, A.
M. L. J., Pol, A. G., & The Dutch CBO WHO High 5s Study Group. (2013). Effect of
Medication Reconciliation on Unintentional Medication Discrepancies in Acute Hospital
Admissions of Elderly Adults: A Multicenter Study. Journal of the American Geriatrics
Society, 61(8), 12621268. http://doi.org/10.1111/jgs.12380
Wimmer, B. C., Dent, E., Visvanathan, R., Wiese, M. D., Johnell, K., Chapman, I., & Bell, J. S.
(2014). Polypharmacy and Medication Regimen Complexity as Factors Associated with
Hospital Discharge Destination Among Older People: A Prospective Cohort Study. Drugs
& Aging, 31(8), 623630. http://doi.org/10.1007/s40266-014-0185-1