- The Purpose of evidence-based practice (EBP) = BEST PATIENT CARE, &
- The Definition of EBP = Best evidence + Clinical judgment + Patient/Family preferences & values
THEN…How do I get started with EBP to improve patient care?
One of the 1st steps is to identify clearly the clinical issue that needs solving. One way to do that is by using PICO.*
WHAT IS PICO? PICO is an acronym to help you clarify the clinical problem & to help you prepare to search the literature for evidence
- P = Patient population or problem
- I = Intervention or treatment that you want to try out & is based in best evidence
- C = Comparison intervention or treatment (This might be some standardized care on your unit; or un-standardized care given by individual nurses based on their individual expertise)
- O = Outcome you want to achieve.
EXAMPLE: Let’s say you work with post-op patients and want to speed up patients’ return of normal GI function. Right now on your unit, patients are NPO post-op progressing to ice chips and so on as their bowel sounds start returning. But you have 2 concerns: a) some patients’ GI function seems quite slow to return; & b) quicker return to a nutritious diet may speed healing. You read an article that gum chewing can reduce the time of postoperative ileus. With that information, here is how your PICO problem would look:
- P = Postoperative patients with ileus
- I = Gum chewing postop
- C = NPO with gradual diet progression when bowel sounds start returning
- O = Reduce time of postop ileus with sooner return to nutritious eating
CRITICAL THINKING: Now you try it. What is problem for patients (or nurses) on your unit? Try writing it out in a sentence or two and then put it into PICO format. You are now on your way with beginning an EBP project that will promote the very BEST PATIENT CARE.
Want to read more on PICO? Try out
- From CSU/Sonoma: http://www.sonoma.edu/users/k/koshar/n300/PICOs.html
- From Cochrane: http://learntech.physiol.ox.ac.uk/cochrane_tutorial/cochlibd0e84.php
*Note: Some use PICOT that includes “T”. The “T” stands for the time it will take to show an outcome. Because the timing does not seem to me relevant to all questions I typically omit it, but you may find it helpful. If so, use it!