Discuss the difference between external and internal evidence as it relates to your PICOT search strategy.

Discuss the difference between external and internal evidence as it relates to your PICOT search strategy.

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               Internal Evidences regarding Universal Protocol or “Surgical Time out” or “Surgical Pause” are embedded in the organization’s policies and procedures as mandated by the Joint Commission. The Quality Improvement Department or Risk Management have written directives on the implementation of the 3 components of the Universal Protocol which include 1) Pre-op or pre-procedure verification, 2) Site marking and 3) Surgical time out or pause before the incision (Dixon et al, 2017). Noncompliance to the policies and procedures that result to minor or lethal consequences are compiled in incident reports, near misses and sentinel event records.  Wrong Site Surgery (WSS), wrong patient and wrong procedure are the common errors tackled during root cause analysis sessions to eliminate surgical errors and improve the safety process. These are substantial internal evidences that are available for use in my PICOT research.

               External evidences of the Universal Protocol are systematic investigations which are the byproducts of rigorous studies that are typically conducted by the federal, national and local organizations to use across clinical settings. The Joint Commission mandated the Universal Protocol in partnership with the Association of Operating Room Nurses to eliminate surgical errors (Conrardy et al, 2010). The American Association of Orthopedic Surgeons and other private sectors like the insurance companies joined them in their quest for “never events” that are preventable. One example of external evidence on Universal Protocol are the researches by clinician-investigators such as intensivist Peter Pronovost and surgeons Atul Gawande and Martin Makary. Their clinical studies and investigations have been instrumental in clarifying that communication issues among the patient care teams result in errors during medical and surgical interventions. They introduced the idea of checklists to eliminate errors and eventually save lives. They were the biggest proponents of “speaking up” when there is a discrepancy in patient care (Berlinger,2016). These result to quality indicators which are used by the insurance companies to “pay for performance” as an incentive to continually improve patient outcomes.

2.  Address the strengths and weaknesses of searching in a databank versus a web-based search engine. You must use two databanks mentioned in the text.

Web based e………………………