Friday, June 2, 2017

EBP Project Part I: Using PICO

This last semester I had the opportunity to write the first draft of my evidence-based practice (EBP) scholarly project proposal for my Doctor of Nursing Practice (DNP) program. This experience has given me new insights into the processes of EBP and proposal writing. Using a conceptual framework is important to guide the EBP process because it helps guide the EBP process by providing an outline for the steps that need to be taken (Hall & Roussel, 2014; Moran, Burson, & Conrad, 2014). While many models exist, I will be using the Iowa Model of EBP since it has been noted to be a useful in nursing EBP projects and is the model endorsed by my DNP program (Everett & Titler, 2006; Hall & Roussel, 2014).  
In the Iowa Model, the EBP project is stimulated by triggers that can be knowledge or problem focused (Everett & Titler, 2006). An example of a knowledge focused trigger would be new research that shows a need for change in clinical practice (Everett & Titler, 2006). In this day and age, every hospital is stacked up against other facilities of comparable size who offer similar services; quality metrics from an institution are compared to metrics of other facilities in a process called benchmarking (U.S. Centers for Medicare & Medicaid Services [CMS], n.d.). A quality indicator, such as surgical site infection rates, would be an example of benchmarking data that could be a problem focused trigger for an EBP project (Everett & Titler, 2006).
Developing a Patient Population, Intervention, Comparison, and Outcome (PICO) question is really helpful when completing a literature review because it narrows the focus to a particular issue (Hall & Roussel, 2014). In the Iowa Model, the problem portion of the PICO question is derived from the knowledge and problem focused triggers (Everett & Titler, 2006; Hall & Roussel, 2014). After identifying a trigger, one must consider the organization’s priorities; this is the second step in the Iowa Model and shows the necessity to weigh the potential benefits that can be gained from an EBP project against competing issues and needs (Everett & Titler, 2006). If the knowledge or problem focused trigger is an organizational priority, an interdisciplinary EBP team can be formed of key stakeholders and those with EBP expertise (Everett & Titler, 2006; Hall & Roussel, 2014).
Developing a succinct and focused PICO question helps to generate a search that is neither too broad nor too narrow (Hall & Roussel, 2014). After identifying a problem, the next step is to consider potential solutions. The “I” in PICO stands for “Intervention” (Hall & Roussel, 2014, p. 256). In the example of surgical site infection as the problem focused trigger, using chlorhexidine soap for baths pre-operatively could be the intervention the team chooses to investigate in the literature (Everett & Titler, 2006; Hall & Roussel, 2014). The PICO question could be, “Do preoperative chlorhexidine baths lower surgical site infections compared to standard antimicrobial soaps?”. In this question, surgical site infection rates are the outcome of interest, and bathing with the standard bar or liquid soap used in the hospital is the comparison intervention (Hall & Roussel, 2014). 
Everett, L. Q., & Titler, M. G. (2006). Making EBP part of clinical practice: The Iowa Model. In Teaching Evidence-Based Practice in Nursing (pp. 295-324). New York: Springer Publishing Company.
Hall, H. R., & Roussel, L. (2014). Evidence-based practice: An integrative approach to research, administration, and practice. Burlington, MA: Jones & Bartlett Learning.
Moran, K. J., Burson, R., & Conrad, D. (2014). The Doctor of Nursing Practice scholarly project: A framework for success. Burlington, Mass: Jones & Bartlett Learning.
U.S. Centers for Medicare & Medicaid Services. (n.d.). What is hospital compare? Retrieved from

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