Evidence based practice module3

Discussion: Searching Databases

When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.

The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.

In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.

To Prepare:

• Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.


• Review the Resources for guidance and develop a PICO(T) question of interest to you for further study.

By Day 3 of Week 4 USE THE TOPIC MEDICATION ERRORS

Post your PICO(T) question, the search terms used, and the names of at least two databases used for your PICO(T) question. Then, describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.

Required Readings

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 2, “Asking Compelling Clinical Questions” (pp. 33–54)

Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 55–92)

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80. https://doi.org/10.18438/B8WS5N

Note: You will access this article from the Walden Library databases.

Library of Congress. (n.d.). Search/browse help - Boolean operators and nesting. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010a). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61. doi:10.1097/01.NAJ.0000368959.11129.79

Note: You will access this article from the Walden Library databases.

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-based practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58

Note: You will access this article from the Walden Library databases.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Searching for the evidence. American Journal of Nursing, 110(5), 41–47. doi:10.1097/01.NAJ.0000372071.24134.7e

Note: You will access this article from the Walden Library databases.

Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981

Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp

Walden University Library. (n.d.-d). Evidence-based practice research: Joanna Briggs Institute search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/jbisearchhelp

Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp

Walden University Library. (n.d.-h). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing? Retrieved September 6, 2019, from https://academicanswers.waldenu.edu/faq/72670

Walden University Library. (n.d.-i). Systematic review. Retrieved January 22, 2020, from https://academicguides.waldenu.edu/library/healthevidence/types#s-lg-box-1520654

THIS IS AN EXAMPLE

A Clinical Question

            The best way to form clinical question is in the form of PICO(T)  (Ask: Write a focused clinical question, 2020). I have done such a thing and have found that the question formulation and changes to it were not as challenging as finding research related to the question.

The Question:

            (P) In the hospital or clinical acute care setting, (I) is a 2 person double-check of insulin, (C) compared to a single person double-check of 5 rights, (O) more effective in the improvement of (01) insulin medication errors, (02) nurse satisfaction during a (T) 30-day term of observation?

Databases Used

            The Walden University database was used to search databases for nursing. Of those available Science Direct, CINAHL, and Cochrane, and PubMed were used. Background questions were first asked to get a sense of what has been studied in this area. It was important to understand when and why this practice first started to determine the relevance of data acquired and to determine how recently we needed to search. Then, foreground questions began to form until finally the PICO(T) question.

            During the background question period, the terms ‘double-check’ became the preferred terminology for the practice I wished to study. So using this ‘double-check’ in the PubMed database, 244 articles were found but not all pertained to my topic. Changing the text to be included only in the title or abstract, the same result achieved. Adding ‘medication errors’ reduced the yield to 21 results. At this level, the evidence is available on the basic topic of using the double-check to prevent all medication errors and relates often to high-risk medications. However, I want to know about the labor-intensive practice of using a 2 nurse double-check for subcutaneous injection of insulin. Adding a level of inquiry which includes insulin, this yielded 2 studies. One from 1983, and one from 2009. Neither of which addresses the current question other than provides background for why the practice may exist in the first place. Changing terms to highlight ‘insulin double-check” yielded two results, both relevant, and one is the most current and referred to peer-reviewed study on this topic.

Affecting Rigor and Effectiveness

            To improve the effectiveness and rigor of a database search one much identify proper and strong keywords in the question or relating to the question. Use filters to find peer-reviewed data first. Use filters for the type of study if possible, including systematic studies, and work your way down the pyramid for strength of research available. If the question is somewhat original, there may not be much evidence. This is the case here. Other filters and Boolean operator's include dates of publication, with the last 5 years preferred as ‘current’, using ‘and’ and ‘or’ and ‘not’ to include or exclude words in the title, abstract, text, or any part of the article or work.

References

Ask: Write a focused clinical question. (2020). Retrieved from Northern Arizona University: https://libraryguides.nau.edu/c.php?g=665927&p=4682772

Berdot, S., & Sabatier, B. (2018). Medication errors may be reduced by double-checking method. Evidence Based Nursing, 18(21), 67. doi:10.1136/eb-2018-102901

Chua, G., Lee, K., Peralta, G., & Heng Chi Lim, J. (2019). Medication Safety: A Need to Relook at Double-Checking Medicines? Asia-Pacific Journal of Oncology Medicine, 6(3), 246-252. doi:10.4103/apjon.apjon_2_19

Modic, B., Alber, N., Bena, J., Yager, C., Cary, T., Zhiyuan, S., . . . Kissinger, B. (2016). Does an Insulin Double-Checking Procedure Improve Patient Safety? JONA: The Journal of Nursing Administration, 46(3), 154-160. doi:10.1097/NNA.0000000000000314

Sentinel event alert: High-alert medications and patient safety. (1999, November). The Joint Commission: https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/topics-library/sea_11pdf.pdf?db=web&hash=CA29CB641C8749521733A05716852A1F

Westbrook, J., Ling, L., Raban, M., Woods, A., Koyama, A., Baysari, M., . . . White, L. (2020, August). Associations between double-checking and medication administration errors: a direct observational study of pediatric inpatients. BMJ Quality and Safety. doi:10.1136/bmjqs-2020-011473