LEARNING OBJECTIVE The learner will be able to formulate a searchable question for the clinical problem: PICO problem.
OVERVIEW The PICO question is a way to take a clinical problem that has been on your mind and begin to search for evidence about that problem area. The PICO question differs from a research question because in the process of evidence-based practice, you are not conducting a research study. That’s another separate activity. As you recall in Lessons 1 and 3, the first step in the process of evidence-based practice is to identify the practice problem. In this lesson, you formulate the problem into a searchable, answerable question that enables you to find evidence.
Let’s take the PICO acronym and break it down.
“P” stands for Population.
“I” stands for Intervention.
“C” stands for Comparison Intervention.
“O” stands for Outcome.
Since you have identified the problem, let’s start there. Perhaps the problem is falls in the clinical area. Now identify your patient population of interest. Perhaps you find this is a frequent occurrence with your elderly patients or with your post-operative patients. Next think about the end result. What would you like to see as an improvement? Reduction in fall rate could become the outcome in this PICO question. You’ll learn more about outcomes in Lesson 8.
Next consider the interventionsyou might use with patients to achieve the outcome, in this case, to reduce the occurrence of falls. Maybe you’ve read about some interesting interventions being used in another similar facility or on another unit within your own institution. Or, you’ve attended a conference and heard a presentation about a particularly successful strategy. OR, you’ve come up with a creative intervention that might work. Then, consider what you know about your patients’ experiences and preferences. Think about whether the strategy might work with your own patient population. The intervention you choose as a comparison interventionmight bewhat you are currently doing around the area of fall prevention. But maybe what you’ve discovered is “the current way is just not working!” Falls are still occurring. Or, maybe you want to compare two interventions or variations of interventions.
The terms underlined form the PICO question that will guide you as you search the literature for the evidence. An example of the PICO question related to falls is, “In elderly hospitalized patients, what is the effect of hourly nursing rounds on reducing falls compared with bedside call light and low bed positioning?”