PICOT Question Evidence-Based Practice Research Paper: Versed (Midazolam) Essay
Abstract
This paper entails into the nursing knowledge applied in the development of a PICOT question, researched using various health databases. The PICOT question investigates whether administering pre-operative Versed (midazolam) in pediatric patients results in better post-operative pain control compared to not using midazolam. The paper provides a detailed review of the research methodology, levels of evidence, and literature findings. Based on these results, the significance to nursing practice and future research is outlined, along with recommendations for changes to current practices.
Introduction
Nursing care is driven by Evidence-Based Practice (EBP), which relies on research to guide decision-making. New research findings must be effectively communicated within the healthcare setting, enabling collaboration between nurses and other healthcare professionals to incorporate EBP into daily practice. As noted by Ursuy (2014), “the purpose of this assignment is to reflect how nursing knowledge is disseminated for use in personal and professional practice.” This paper aims to explore whether administering preoperative Versed (midazolam) in pediatric patients provides improved post-operative pain control compared to those who do not receive midazolam.
Clinical Question
As a nurse working in a Surgery, Prep, and Recovery Unit, I often encounter pediatric patients undergoing various surgical procedures. In my experience, children under the age of 10 have their IV started under general anesthesia in the operating room, while those over the age of 10 have it done in the preoperative area. Both age groups can be given oral midazolam preoperatively, but IV midazolam is typically not administered due to limited IV access. The anesthesiologist evaluates the patients and decides on midazolam administration, though there is no standardized policy in place.
I noticed an inconsistency in preoperative medication with midazolam and observed that those who received it tended to have better post-operative pain control. This prompted the creation of the following PICOT question: Does administering oral Versed (midazolam) preoperatively reduce post-operative pain in pediatric patients compared to those who do not receive preoperative Versed (midazolam)?
The PICOT framework consists of:
- P: Pediatric patients
- I: Administration of oral Versed
- C: Comparison with patients not medicated preoperatively
- O: Post-operative pain management
- T: During the post-operative period
Consistent preoperative medication policies could improve the quality and safety of pediatric surgical care, enhance post-operative pain control, and potentially increase patient and parent satisfaction.
Methodology
To address the PICOT question, I searched three healthcare databases: CINAHL, Cochrane Reviews, and PubMed. Advanced search techniques, including specific key terms like “versed,” “oral midazolam,” “pediatric,” “children,” and “post-operative pain,” were used. Initially, the term “Versed” yielded limited results, but expanding the search to include “midazolam” produced more relevant articles.
The selection process was refined by reviewing abstracts, focusing on articles published within the last 12 years. Each article was categorized by levels of evidence, following a hierarchical system (Melnyk & Fineout-Overholt, 2011):
- Level 1: Systematic review and meta-analysis of randomized controlled trials
- Level 2: Randomized controlled trials
- Level 3: Controlled trials without randomization
- Level 4: Case-control or cohort studies
- Level 5: Systematic review of descriptive and qualitative studies
- Level 6: Single descriptive or qualitative studies
- Level 7: Expert opinions
Although the level of evidence was a key factor in selecting studies, relevance to the PICOT question and nursing content was equally important.
Conclusion
Resource utilization in healthcare, especially in the context of nursing research, plays a vital role in improving patient outcomes. Nurses should actively engage with research, even when changes are difficult to implement. At the registered nurse level, it is essential to evaluate evidence to guide patient care decisions and enhance overall healthcare delivery.
PICOT Question Evidence-Based Practice Research Paper: Versed (Midazolam) Essay
Discussion of Literature
Article One
The first article reviewed is “Premedicating children for painful invasive procedures” by Elizabeth R. Klein. This study utilized a descriptive survey/questionnaire to assess premedication practices and post-procedure pain in pediatric patients. The research included 108 participants: 55 physicians and 53 nurses. The physicians consisted of pediatric professors and staff oncologists, while the nurses were clinical nurses or clinical nurse specialists (Klein, 1992, p. 172). The questionnaire gathered information on premedication strategies and assessed post-procedure pain using a Likert Scale, with 1 representing no pain and 5 representing excruciating pain (Klein, 1992).
Various drug combinations, including oral and intravenous midazolam, were examined for their effectiveness in managing pain prior to invasive procedures such as lumbar punctures. Although the article holds an evidence level of six (Melnyk & Fineout-Overholt, 2011), its findings are valuable for pediatric nursing practice. The results indicated a significant reduction in pain when premedication, such as midazolam, was administered. This suggests the need for standardized premedication protocols for pediatric patients undergoing painful procedures (Klein, 1992, p. 177).
Article Two
The second article, “Pre-anesthetic medication with intranasal dexmedetomidine and oral midazolam as an anxiolytic: A clinical trial” (Linares et al., 2014), is a prospective, randomized, double-blind, controlled trial comparing two medications for preoperative anxiety in children aged 2-12 years. The trial involved 108 pediatric participants, with anxiety levels assessed using a modified Yale scale. Anxiety is closely linked to pain and its perception, making this study relevant to pain management.
With an evidence level of four (Melnyk & Fineout-Overholt, 2011), the study supports the PICOT question by showing that dexmedetomidine was superior to midazolam in reducing anxiety, which in turn could lower pain perception in pediatric patients. While the results are significant, they also highlight the need for further research and the development of standardized premedication practices to improve post-procedure outcomes.
Article Three
The third article, “A comparison of oral clonidine and oral midazolam as preanesthetic medications in the pediatric tonsillectomy patient” by Fazi et al. (2001), is a randomized, controlled comparative study. It involved children aged 4-12 years who were administered either midazolam or clonidine prior to anesthesia. The study is listed in The Cochrane Central Register of Controlled Trials.
With an evidence level of two (Melnyk & Fineout-Overholt, 2011), this trial’s findings are significant for the PICOT question and nursing practice. The results indicated that children in the midazolam group required less postoperative analgesia, suggesting that midazolam was superior to clonidine as a preanesthetic medication for pediatric patients undergoing tonsillectomy. This study emphasizes the need for future research to establish standardized care practices in pediatric preoperative medication to manage post-operative pain effectively.
Significance to Nursing
Research plays a crucial role in evidence-based practice (EBP), which can lead to improved nursing care by enhancing safety and efficacy. Interprofessional collaboration strengthens research and increases the likelihood of implementing successful practice changes (White & O’Sullivan, 2012, p. 137). Nurses are equipped to address various health issues (Black, 2014, p. 114), but they must operate within their defined Scope of Practice as outlined by the American Nurses Association (White & O’Sullivan, 2012). This is why nursing involvement in research is essential.
Quality and Safety Education for Nurses (QSEN) emphasizes the importance of quality education in healthcare. QSEN outlines six core competencies for nurses: Patient-Centered Care, Teamwork and Collaboration, Evidence-Based Practice, Quality Improvement, Safety, and Informatics (QSEN, 2013). Through the exploration of the PICOT question, several of these competencies—particularly patient-centered care, EBP, and quality improvement—were addressed. The insights gained from this inquiry are not only valuable to my nursing practice but could also positively impact others in the field.
Conclusion
The PICOT question explored yielded both supportive and non-supportive findings. However, the evidence overwhelmingly supports the importance of premedicating pediatric patients before painful procedures or surgeries to reduce anxiety and pain, both preoperatively and postoperatively. While midazolam may not always be the best choice, the findings underscore the need for further research to develop standardized preoperative care practices for pediatric patients. These practices are critical for ensuring optimal care and improving patient outcomes in pediatric nursing.
References
- Black, B. P. (2014). Professional Nursing Concepts & Challenges (7th ed.). St. Louis, Missouri: Elsevier Saunders.
- Fazi, L., Jantzen, E. C., Rose, J. B., Kurth, C. D., & Watcha, M. F. (2001). A comparison of oral clonidine and oral midazolam as preanesthetic medications in pediatric tonsillectomy patients. Anesthesia and Analgesia, 92.
- Klein, E. R. (1992). Premedicating children for painful invasive procedures. Journal of Pediatric Oncology Nursing, 9(4).
- Linares, S. B., Garcia, C. M., Ramirez, C. I., Guerrero, R. J., Botello, B., Monroy, T. R., & Ramirez, G. X. (2014). Pre-anesthetic medication with intranasal dexmedetomidine and oral midazolam as an anxiolytic: A clinical trial. An Pediatr (Barc). http://dx.doi.org/10.1016/j.anpedi.2013.12.006.
- Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott Williams & Wilkins.
- QSEN. (2013). Retrieved from www.qsen.org.
- White, K. M., & O’Sullivan, A. (2012). The essential guide to nursing practice. Washington D.C.: American Nurses Association.
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