PICOT For Quality Improvement Discussion

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Create a 3-5-page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question.

PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.

It stands for:

P – Patient/population/problem.
I – Intervention.
C – Comparison (of potential interventions, typically).
O – Outcome(s).
T – Time frame (if time frame is relevant).

The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs. By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search.

You are encouraged to complete the Vila Health PCI(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course.

DEMONSTRATION OF PROFICIENCY

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.
- Explain the findings from articles or other sources of evidence.
Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
- Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
- Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
Competency 3: Apply an evidence-based practice model to address a practice issue.
- Define a practice issue to be explored via a PICO(T) approach.
Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
- Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style. PICOT For Quality Improvement Discussion

Reference

Boswell, C., Cannon, S. (2015). Introduction to nursing research. Burlington, MA: Jones Bartlett Learning.

PROFESSIONAL CONTEXT

As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.

PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question.

SCENARIO

For this assessment, please use an issue of interest from your current or past nursing practice.

If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment.

INSTRUCTIONS

For this assessment, select an issue of interest an apply the PICO(T) process to define the question and research it.

Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest. After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source’s specific findings and best practices related to your issues, as well explain how the evidence would help you plan and make decisions related to your question.

If you need some structure to organize your initial thoughts and research, the PICOT Question and Research Template document (accessible from the “Create PICO(T) Questions” page in the Capella library’s Evidence Based Practice guide) might be helpful.

In your submission, make sure you address the following grading criteria:

Define a practice issue to be explored via a PICO(T) approach.
Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
Explain the findings from articles or other sources of evidence.
Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
Communicate using writing that is clear, logical, and professional with correct grammar and spelling using the current APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Assessment 3 Example [PDF].

ADDITIONAL REQUIREMENTS

Your assessment should meet the following requirements:

Length of submission: Create a 3–5-page submission focused on defining a research question and interpreting evidence relevant to answering it.
Number of references: Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
APA formatting: Format references and citations according to the current APA style.

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Vila Health: PICO(T) Process In health care and public health, evidence-based practice is quickly becoming the cornerstone of what determines high quality. Whether it’s performance, quality, or public policy improvement, evidence-based practice allows health care and public health professionals to identify trends in practice, system or process problems, or other problems, and interventions to correct or improve them. But without a good, well-thought-out PICO(T) question to guide the evidence search, you can often miss the mark. In this activity, you will experience the PICO(T) process firsthand. After completing this activity, you will be able to: Understand the basic elements of the PICO(T) process. Understand the increasingly inter-professional nature of health care and public health. Experience the elements of the PICO(T) process (the population or problem, intervention, comparison, outcome, and time). St. Anthony Medical Center Prevention and Infection Control Nurse Introduction You are a nurse at St. Anthony Medical Center, a major hospital in a metropolitan area with 500 patient care assistants (PCAs) and thousands of other professional staff members. You’re going to be tasked with an important quality improvement project. To hear more about it, you have a meeting set up with the hospital’s Prevention and Infection Control nurse. Ellen French Prevention and Infection Control Nurse Hi! It’s good to see you. I think you’re going to do some great work for us. In fact, I know you are, because there’s a QI project that’s suddenly gotten very important. So here’s the background on the project. Last week, the hospital’s board met, and they talked about a problem they want solved: flu vaccinations for our PCAs, or patient care assistants. They’re not happy about the rate of compliance last year, and they want us to get that rate up in time for this year’s flu season. Obviously, no hospital wants to be known as the one where you pick up the flu from a staff member! It’s a clinical problem, a potential public health issue, and a possible PR nightmare. And as you’ll see from the numbers, our compliance rates last year were pretty sad. So we need an intervention, and we want you to help design it for us. That’s going to mean starting with a solid PICO(T) question, so let’s start there. Let’s review what the PICO(T) process is, so that we’re on the same page. The PICO(T) process helps you design a question that guides your research. The acronym PICO(T) includes the question’s five components. PICOT For Quality Improvement Discussion

The P stands for Population or Problem, and it’s basically the “who” or “what” part of the question. You’re describing the specific population or problem that you want to research. Is it people with diabetes? People with diabetes in a given county? Middle-aged men and women who use opiates more than twice a week? Or is it a problem with low flu vaccination rates among PCAs? You get the idea. The I stands for Intervention. What are you going to do? Are you going to test out a particular therapy or evidence-based model? Try specific tests or medications? Conduct a survey? Without a Comparison, you won’t know whether your intervention worked. So, for instance, the C might be to compare one part of the population (the part that hears a presentation on condom use, let’s say) to another part that didn‘t hear the presentation. You can compare what happens with either different treatment or no treatment. Depending on your question, there may not be a true comparison. In that case, you’ll compare the current state with the desired state. The O stands for outcome. What do you hope to accomplish? Diminished symptoms might be the goal of a particular medical intervention, whereas increased behaviors might be a public health goal. Finally, there’s the Time frame. How long do you have to complete the intervention? Now, I’ve set up some interviews with a few other people, both inside and outside the hospital. I’m hoping that — with their input and the evidence-based research you’re able to do — you can design a performance improvement intervention to get our compliance rates up. Once you’ve completed your interviews, check back with m e, and we’ll go over what you’ve got so far. We’ll have to get your project approved by your course facilitator. PICOT For Quality Improvement Discussion

INTERVIEW: Peggy Truman Director of public health for Hennsey County The St. Anthony Medical Center board is not happy about their patient care assistants’ flu vaccination rates. They want those rates to improve by the time flu season comes around again. I’ve been assigned to design an intervention to improve those rates. As a public health official, what would you suggest I start with? Interesting project! Well, I’m very familiar with the evidence on what prevents people in the general population from getting their flu vaccination. Their reasons for getting — or not getting — their flu shots are probably not that different from those of your PCAs. So I’d start by thinking about the many reasons why the general population doesn’t get their flu shots. PICOT For Quality Improvement Discussion

Ordinarily, we think about barriers to access, but that doesn’t seem to apply in a hospital! I assume that any PCA who wants a flu shot can get one pretty easily and at no cost. So it’s a reasonable starting place to focus on what discourages or encourages someone to get a flu shot, and which of those factors apply to PCAs more than the general population. Still, there may be factors that apply specifically to PCAs. What makes a PCA decide to get a flu shot? Is it knowing the risks of failing to get one? Is it feeling that they ought to, in order to protect their patients? Do they want to set a good example for patients? Or do you think it’s all of the above? You’ll probably need to talk to some of your PCAs to get a better feel for this. But you’ll also want to do some preliminary research. If I were doing this project, I’d get to the library and find some articles on successful vaccine intervention programs in institutional settings like hospitals. That will give you some ideas for interventions that might improve your compliance rates. Director of public health for Hennsey County Have you done campaigns to encourage flu vaccination in the past? What interventions did you use that were successful? Were any unsuccessful? We certainly have, and I’d say they were mixed. We might do an intervention one year, and see that more people get vaccinated. But then we do the same intervention the next year, and different people get vaccinated. Some do it one year and don’t bother the next, or vice versa. The thing to keep in mind is that the flu affects different demographics differently. So you need to appeal to them differently. A 25-year-old is not going to respond to information about the risk of flu the same way as a 55-year-old. For older people, the information about risk is much more compelling and more likely to prompt a decision to vaccinate. To younger people, flu just sounds like a cold that they probably won’t get anyway. We’ve tried information campaigns in mailers, humorous campaigns on social media, and using social service agencies as ambassadors to talk up the flu shot outside of the doctor’s office. Director of public health for Hennsey County What kind of results did you get from them? Well, for the older demographic, we used presentations about influenza that educated people about the associated risks. Not everyone knows the complications that can arise from the flu. But once they do — at least this is what happened in our last county-wide campaign — they see the reason for the flu shot. We got a good response in that demographic. So you might do well with informative presentations to your PCAs about the flu — you know, what it can do to them, what it could do to their younger children or older relatives, information of that nature. It might be smart to address PCAs’ fears about vaccination, too. They probably know more than the average person about what can go wrong with a flu shot. If you give some statistical information about how likely — or unlikely — adverse events really are, it might help to allay those fears and get them out of the way. Mary Mills Nurse Manager of the Medical/Surgical Unit What do the PCAs you manage think about flu shots? It really depends on the person! The older ones just get them, or at least that’s the impression I get. They think they should, so they do it and they don’t make a big deal of it. There are a few who are actually opposed to them on principle, and you can get into an argument about whether or not vaccines cause autism if you’re not careful. And frankly, the CNAs of color sometimes aren’t big fans of it, but not for the reason you might think. People of color have been the victims of some pretty appalling medical malpractice disguised as research, so they’re not always thrilled to roll up their sleeves for the latest thing. Why should they trust that the flu shot is what they’re told it is? As a person of color myself, I understand that perspective, even if I don’t share it. I don’t mean that all of them say that, but I have heard those opinions here and there. Nurse Manager of the Medical/Surgical Unit How do you think it’s best to try and communicate with PCAs about flu shots? Emails? Calls? Other tactics? PCAs are on the move a lot. I don’t think calls would be a good idea. It’s just one more thing for them to have to deal with on top of charting and rounds and everything else! I check my email every day, but I don’t know if they do, so that might not be a good method. What about a popup message in the EHR when they log in? Nurse Manager of the Medical/Surgical Unit What kind of appeals do you think PCAs are most likely to respond to? Well, they’ve heard over and over that the shot’s effective, that it prevents infection, that it’s good for your patients, blah blah blah. I know that’s true, and so does everyone else. PICOT For Quality Improvement Discussion

But when we’ve heard it all before, I’m not sure it’s really going to help to hear it again. And when the data comes out that the shots for one year are only 50 percent effective for a particular strain of flu, that doesn’t help make the case either. Instead, if you can come at them with a more novel argument, it’s probably going to disrupt their habitual responses. Nurse Manager of the Medical/Surgical Unit What do you think about the idea of using presentations to convey information about the value of the flu vaccine? I don’t know. I mean, PCAs are inundated with information 24/7 around here. And if you pit a PowerPoint against an opinion, the opinion usually wins. I think it makes more sense to dodge the rational part altogether, and think of a way to motivate people that doesn’t relate to the flu shot itself. For example, why not set it up as a friendly competition between our PCAs and our nurses and physicians? Nurses and physicians are pretty good about getting their vaccine, from what I’ve heard. So base all of your communications on the idea that the PCAs are trying to have a better compliance rate this year than the doctors! If you do that, you might see compliant PCAs bugging the noncompliant ones to just get it done, so they can show up the doctors. And I think stressing the obligations they have to their patients and even their families might be effective. Jackie Sandoval Chief Nursing Officer What data do you have on flu vaccine compliance rates for patient care assistants at this hospital? That’s a good question, and you’ve come to the right person! Part of my job is to manage infection control at the hospital, so I’m in charge of our vaccination efforts. Here’s what we know. The CDC recommends annual vaccination, so we start our drive to get the PCAs in for their shots before early flu season — roughly late September or early October. Last year, 73 percent of our PCAs got the flu vaccine by October 15, which is good compared to PCAs nationally (about 64 percent). But it’s not good according to the board, and I agree with them. We’d like to see 85 to 90 percent compliance this year. We know we’d probably get higher rates if we made it mandatory, but the board has been reluctant to do that. Still, we want to do as much as we can to encourage it. We’d like to see 100 percent compliance, although we’re realistic about the odds of that! Chief Nursing Officer – Do you have any suggestions for possible tactics that might make the project more successful? Well, I’m not sure how hard to push this. But it could be useful to frame it as an ethical obligation — that it’s their duty as part of the health care team to do it, even if they have personal or political beliefs about it. It seems reasonable to expect that even PCAs who don’t like the idea will be more willing if we can associate their patients with it. Another idea is to give them some idea of what the flu does to their patients when they get it. So maybe some statistics, specific to your hospital, about patient morbidity and mortality related to the flu? One thing I would try to hit hard: a lot of PCAs just don’t see the point . PICOT For Quality Improvement Discussion

They’ll talk about how the shot doesn’t even necessarily have the right flu strain in it, or that it isn’t always effective — and they’re not entirely wrong about those things. So you probably won’t have a lot of success if you don’t address those issues. You can’t convince them that it’s 100 percent effective, because of course that isn’t true. That’s where tying it back to an ethical obligation might be helpful – you know, “It may not be 100 percent effective if you get the shot, but it will be 0 percent effective for your patient if you don’t get it.” Something like that. One other possibility: You might want to frame it in terms of what they want, instead of what they’ll avoid. PCAs need and love their PTO, so maybe suggest that they’re less likely to be out sick if they get the shot! Library Guides LIBRARY GUIDES HOME CAPELLA LIBRARY HOME Library / Library Guides / General Purpose Guides / Evidence-Based Practice in Nursing & Health Sciences / Create PICO(T) Questions Evidence-Based Practice in Nursing & Health Sciences This guide covers some of the basic principles of EBP in healthcare, as well as links to EBP resources. Guide Home PICOT QUESTION AND RESEARCH TEMPLATE Create PICO(T) Questions Use this Word document to help you form your PICO(T) question and get started with your library research strategy. Find EBP Articles Refer to the other boxes on this page and the “Find EBP Articles” page for additional tips and strategies. Locate EBP Books ” PICOT Question and Library Search Review Levels of Evidence Critically Appraise the Evidence PICOT QUESTION PROCESS Learn more – Selected Websites Creating a question using the PICOT elements will provide a framework for the research you need to conduct an evidence-based study or to make an evidence-based decision. Ask a Librarian PICOT Elements: (P) – Population, Patients or Problem: The sample of subjects used in a study, or the problem being addressed. (I) – Intervention: The treatment that will be provided to subjects enrolled in your study. (C) – Comparison or Control: Identifies an alternative intervention or treatment to compare. Many study designs refer to this as the control group. If an existing treatment is considered the ‘gold standard’, then it should be the comparison group. A control group is not required for every type of study. (O) – Outcome: The clinical outcome that measures the effectiveness of the intervention. (T) – Time: Duration of the data collection. Some versions don’t include this element, and time may not be specified in cases where the question is focused on prediction or diagnoses. PICOT Question Formats: Intervention: In _______ (P), how does _______ (I) compared to _______ (C) affect _______ (O) within _______ (T)? Prognosis/Prediction: In _______ (P), how does _______ (I) compared to _______ (C) influence/predict _______ (O) over _______ (T)? Diagnosis or Diagnostic test: In _______ (P) are/is _______ (I) compared to _______ (C) more accurate in diagnosing _______ (O)? Etiology: Are _______ (P), who have _______ (I) compared to those without _______ (C) at _______ risk for/of _______ (O) over _______ (T)? Meaning: How do_______ (P) with _______ (I) perceive _______ (O) during _______ (T)? Example PICOT Questions: In acute care hospitals (P), how does having a rapid response team (I) compared with not having a response team (C) affect the number of cardiac arrests (O) during a three-month period (T)? In women with gestational diabetes (P), how does a monitored diet and exercise program over the course of pregnancy (I &T), compared to the use of metformin only (C) reduce the incidence of high birth weight babies(O)? In patients admitted for acute myocardial infarction (P), how well does the hospital’s new data model created from EMR data (I) compared to current practices (C) predict readmission rates (O) within 30 days after initial discharge (T)? For patients of a rural health clinic (P), does the use of text message reminders (I), compared with telephone calls (C) reduce the number of missed appointments (O) over a six month period (T)? References: Melnyk, B.M., Fineout-Overholt, E., Stillwell, S. & Williamson, K. M. (2010). Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice. AJN, American Journal of Nursing, 110, 51-53. Posing the research question: Not so simple To make your case, start with a PICOT question What is your research question? An introduction to the PICOT format for clinicians. Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice. (Not in library) << Previous: Guide Home Last Updated: Jun 29, 2020 2:00 PM Subjects: Nursing & Health Sciences URL: https://capellauniversity.libguides.com/EBP Next: Find EBP Articles >> ! Print Page Tags: administration, health_services, nursing, publichealth Login to LibApps Print PICO(T) Questions and an Evidence-Based Approach Scoring Guide CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED Define a practice issue to be explored via a PICO(T) approach. Does not define a practice issue. Defines a practice issue, but does not frame it within the context of a PICO(T) question or approach. Defines a practice issue to be explored via a PICO(T) approach. Defines a practice issue to be explored via a PICO(T) approach. Notes how the exploration of the practice issue will benefit from a PICO(T) approach. Identify sources of evidence that could be potentially effective in answering a PICO(T) question. Does not identify sources of evidence. PICOT For Quality Improvement Discussion

Identifies sources of evidence, but does not connect them to the PICO(T) question, or the connection is unclear. Identifies sources of evidence that could be potentially effective in answering a PICO(T) question. Identifies sources of evidence that could be potentially effective in answering a PICO(T) question. Presents criteria or rational used to determine potential to answer the PICO(T) question. Explain the findings from articles or other sources of evidence. Does not list the findings from articles or other sources of evidence. Lists the findings from articles or other sources of evidence, but does not offer a full explanation. Explains the findings from articles or other sources of evidence that are relevant to a PICO(T) question. Explains the findings from articles or other sources of evidence that are relevant to a PICO(T) question. Notes which sources are the most credible. Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question. Does not identify the relevance of the findings from chosen sources of … PICOT For Quality Improvement Discussion