PICOT Evidence Review

PICOT Evidence Review

Nursing practice strives and demands improvement in quality care and enhance patient safety outcomes. The Joint Commission predicts that two – thirds of sentinel adverse errors are associated with miscommunication between the caregivers during hand-off among the patients (The Joint Commission, 2018). The implication of the handoff is the transfer and acceptance of the responsibility for the care of the critical ill or injured adult. Effective communication enhances this transfer (Halms, 2013). In most cases, crucial information about the care of the patient is lost during changes in shifts (Jukkala, 2012). Thus, we need strategies to enhance the safety and quality of the hand-off process. PICOT Evidence Review

Most hospitals lack information standardization that is essential during handoff in intensive care units that translates to inaccuracy in information exchange (Halms, 2013). The situation leads to inconsistent patient care with a high degree of dissatisfaction among the patients as well as the patient safety associated with medical errors. The family members of the patients can also be affected and it can be catastrophic to the patients. Confirming that hand-off occurs at the bedside with patient participation and not at the nurses’ station is an opportunity to promote patient gratification and safety by involving patients and family members to be participants where they can clarify and correct inaccuracies (McMurray, 2011). Therefore, The Joint Commissions and the National Patient Safety Goals suggests the need for improvements in communication effectiveness among the caregivers (The Joint Commission, 2018). PICOT Evidence Review

Among the adults in the critical care unit (P), does the handoff among the clinician that incorporate the patients with the family members (I), relative to the handoff that involves the clinician only (C), improve patient safety (O) during the length of stay in the ICU (T).

In the above PICO(T) question, the population, P includes the adult patients in the ICU. The intervention, I is the clinician handoff at the end of the shift that involves the patient and the family members. The standard practice –comparison is the clinician handoff report. The outcomes, O entails the patient safety. Time, T is the length of stay in the ICU. PICOT Evidence Review


Description of Search

I have utilized Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases and PubMed at the Health Sciences and Human Services Library of the University of Maryland, to complete the advanced search. The search terms “acute care” or “inpatient” AND “hand-off” or “shift report” AND “patient safety” or “patient satisfaction” were applied during the research. The original search resulted in 229 articles. The result then was limited by peer review and narrowed to the article year range from 2011to 2018 with English language only, which left 107 articles for review. Tile and abstract was reviewed in the 107 articles. A total of 85 articles were excluded due to various reasons cited in PRISMA diagram. The full-text review applied to the remaining 22 articles, there were 17 articles eliminated due to various reasons but not limited to: lack of controlled trial, insufficient result and irrelevant experiment towards PICO question. Conclusively, five articles were eligible and included in the evidence review process.

The current research focuses on particular departments and institutions with much of their emphasis on the convenience use of designs, samples as well as outcome measures. The starting point in the future research in handoff must be the development of the conceptual framework that places the PICOT questions within the theoretical framework on the basis of the previous evidence search. It is also suitable to isolate the articles identified through evidence search that are not particular to the items of the PICOT questions. Only the articles that address all issues as suggested in the PICOT questions can be considered for use in the research. PICOT Evidence Review


Ford, Y., Heyman, A., & Chapman, Y. (2014). Patients’ perceptions of bedside handoff: The need for a culture of always. Journal of Nursing Care Quality, 29(4), 371-378.

Halms, M. A. (2013): Nursing handoffs: Ensuring safe passage for patients. American Journal of Critical Care, 22(2), 158-161

Jukkala, A., James, D., Autrey, P., & Azuero, A. (2012). Developing a standardized tool to

improve nurse communication during shift report. Journal of Nursing Care Quality,

27(3), 240-246. PICOT Evidence Review

McMurray, A., Chaboyer, W., Wallis, M., Johnson, J., & Gehrke, T. (2011). Patients’

perspectives of bedside nursing handover. Collegian, 18, 19-26.

The Joint Commission. (2018): The National Patient Safety Goals. Retrieved February 06, 2018 from http://www.jointcommission.org/standards_information/npsgs.aspx

Sand, K., & Sherman, J. (2014). A quantitative assessment of patient and nurse outcomes of

nursing bedside report implementation. Journal of Clinical Nursing, 23, 2854-2863 PICOT Evidence Review