PICOT

[russianbear]

I am doing RN to BSN. I need help with PICOT. I've never done this. I have to do one and a PowerPoint with it. I'm not asking you to do my homework for me, I just need a little help. I'm thinking something along the lines of "In older adults does taking multiple medications at low doses vs fewer medications at higher doses improve outcomes?" The course is aging adults so it has to relate older folks and i chose polypharmacy as a topic. I'm thinking maybe multiple BP meds or multiple diabetes meds. Anyhow, thanks in advance.

[Esme12, ASN, BSN, RN]

You might find this site helpful

Asking the right question is a difficult skill to learn, yet it is fundamental to the evidence-based decision-making process. This process almost always begins with a patient question or problem. A "well-built" question should include four parts, referred to as PICO that identify the patient problem or population (P), intervention (I), comparison © and outcome(s) (O). 1 The first step in developing a well-built question is to identify the patient problem or population. Describe either the patient's chief complaint or generalize the patient's condition to a larger population.

When identifying the P in PICO it is helpful to ask:

How could you describe a group with a similar problem?

How you would describe the patient to a colleague?

What are the important characteristics of this patient?

• Primary Problem
  
  
• Patient's main concern or chief complaint
  
  
• Disease or health status
  
  
• Age, Race, Sex, Previous ailments, current medications
  
  

Should these characteristics be considered as I search for evidence?

1

The P phrase could be more detailed if the added information influences the results you expect to find.

Identifying the Intervention is the second step in the PICO process. It is important to identify what you plan to do for that patient. This may include the use of a specific diagnostic test, treatment, adjunctive therapy, medication or the recommendation to the patient to use a product or procedure. The intervention is the main consideration for that patient or client. 1

The Comparison is the third phase of the well-built question, which is the main alternative you are considering.1 It should be specific and limited to one alternative choice in order to facilitate an effective computerized search.

The Comparison is the only optional component in the PICO question. One may only look at the Intervention without exploring alternatives, and in some cases, there may not be an alternative.

The Outcome is the final aspect of the PICO question. It specifies the result(s) of what you plan to accomplish, improve or affect and should be measurable. Outcomes may consist of:

relieving or eliminating specific symptoms

improving or maintaining function

or enhancing esthetics.

Specific outcomes will yield better search results and allow you to find the studies that focus on the outcomes you are searching for. When defining the outcome, more effective is not acceptable unless it describes how the intervention is more effective.

For example, more effective in preventing caries, or in decreasing probing depths.

In addition to identifying the PICO components, it is important to clarify the type of question you are asking and the related research method. The categories for types of questions are:

Therapy/Prevention

Diagnosis

Etiology

Prognosis

Based on four PICO component, a final PICO question can be stated as:

For a patient with Tetracycline staining, will chairside (ZOOM) bleaching as compared to over the counter White Stips decrease staining and increase tooth whiteness.

Once you have identified a patient problem and defined your question using PICO, you are ready to find the most current valid evidence.

The PICO Worksheet and Search Strategy provides the framework for developing this step of the process by guiding one to write each component of the PICO question and is also a guide in developing a search strategy, which aids in the retrieval of relevant clinical evidence.

Conducting a computerized search with maximum efficiency to answer the question is the second step in the EBDM process

LINKS to PICO Resources PICO

PICO

[Esme12, ASN, BSN, RN]

Medscape: Medscape Access

[russianbear]

Bump. I'm really having a tough time formulating a good question and finding articles to answer it.

[nursej22, MSN, RN]

I think your topic is overly broad, and it appears to have a medical or prescriber focus. Can you narrow in on a nursing problem that results from polypharmacy? I am thinking about compliance, risk of injury, side effects that trigger another medication, knowledge deficits, costs...

[russianbear]

I think your topic is overly broad, and it appears to have a medical or prescriber focus. Can you narrow in on a nursing problem that results from polypharmacy? I am thinking about compliance, risk of injury, side effects that trigger another medication, knowledge deficits, costs...

I settled on "In older adults does having fewer medications as opposed to more increase compliance?" Now I just hope I can find some information.

[nursej22, MSN, RN]

I settled on "In older adults does having fewer medications as opposed to more increase compliance?" Now I just hope I can find some information.

Sometimes your lit search will turn up another question that you hadn't thought of, and you may need to tweak it.

Good luck!

[russianbear]

Sometimes your lit search will turn up another question that you hadn't thought of, and you may need to tweak it.

Good luck!

Next step is I have to do a PowerPoint presentation on the topic.

[NickiLaughs, ADN, BSN, RN]

I would re title it, "medication compliance in the elderly and controlling poly pharmacy" etc something like that :)

[twozer0, NP]

google MeSH terms for pubmed or cinahl headings for your lit search, it will make your life easier.

[Lev, MSN, RN, NP]

Why don't you make it more simple?

Just focus on older adults and simplifying their medication regimen. Such as 1 dose of long acting/combination insulin in the AM vs insulin a couple times a day. For BP meds - extended release versions of meds vs taking med 2-3x a day. Also - taking out/combining all those supplements/vitamins many older adults take. Putting an older adult on a daily stool softener can be easier than them taking multiple different laxatives to try an have a bowel movement.

As a whole - taking meds 1x a day is much easier and there will be much higher compliance especially with older adults who can get confused with times.

[Lev, MSN, RN, NP]

That being said, medication management is really a provider vs a nursing role

If you want to focus on poly-pharmacy that is good, but the focus needs to be on a nursing role like safety. For example, educating diabetic patients (especially those on with beta blockers which can mask some signs) on the signs and symptoms of hypoglycemia so they know when to contact their provider and perhaps hold off on insulin. Patients who are on sedatives or narcotics or both should be educated on fall safety.