Post a clinically relevant research question using the PICOT format. How did you arrive at this topic and question? Why is it important?
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Developing PICOT Questions
The growth of evidence-based practice or EBP depends on constant clinical inquiry that questions common practice. This is the process by which scholarly peer-reviewed evidence is searched in support of the effectiveness of interventions used on patients. The search is facilitated by the formation of a question using the PICOT format (population, intervention, comparison, outcome, and timeframe). The search for evidence from published literature then takes place in research databases (Melnyk & Fineout-Overholt, 2019; Stannard, 2021; Twa, 2016). The purpose of this paper is to present a clinically relevant research question using the said PICOT format.
The PICOT Question
The process of formulating the PICOT question involves:
- Changing the information requirement into a PICOT statement.
- Searching research databases for evidence.
- Critically appraising the literature obtained to find the highest level of evidence (LoE) possible using the hierarchy of evidence.
- Applying the selected literature providing the best evidence to practice.
- Evaluating the results of the translation into practice (LHS, n.d.).
The development of ventilator-associated pneumonia (VAP) in mechanically ventilated critically sick patients who have been hospitalized and ventilated for more than 48 hours has been identified as the clinical concern to be addressed in this case. I came to this conclusion after reviewing the dashboard indicators in the hospital’s electronic health record (EHR). VAP is a quality improvement (QI) issue that may be used as a quality benchmark or indicator to assess the quality of intensive care unit healthcare services. It is a hospital-acquired infection (HAI), which means it may be avoided. In today’s critically ill patients, VAP is the most prevalent HAI. VAP is known to affect up to 28 percent of all patients on mechanical ventilation. VAP:
- Increases the patient’s length of stay in the intensive care unit and hospital (ICU).
- It also increases the cost of treatment for the patient, and
- Contributes to a rise in the mortality rate.
The suggested evidence-based intervention to reduce VAP is a double bundle consisting of daily oral care with chlorhexidine rinsing mixture and semi-recumbent patient positioning (Hassankhani et al., 2017; Villar et al., 2016). This is compared to common care, which does not include the use of chlorhexidine or any specific positioning requirements. Within six months, it is estimated that this approach will result in a statistically meaningful decrease in the incidence of VAP in the indicated population of patients. The PICOT statement is therefore as follows:
PICOT: In critically-ill patients who have been mechanically ventilated for more than 48 hours (P), does the use of semi-recumbent position and daily chlorhexidine oral care (I) compared to the usual care (C) result in a reduction of VAP rates (O) within a time period of 6 months (T)?
Table: PICOT elements for VAP
|P||Population (targeted patients)||Patients across the lifespan who are critically ill on mechanical ventilation for 48 hours or more.|
|I||Intervention (solution)||Semi-recumbent patient positioning and daily oral care with chlorhexidine solution.|
|C||Comparison (alternative)||Usual care with neither chlorhexidine nor patient positioning.|
|O||Outcome||A lowering of the incidence of VAP post intervention implementation.|
|T||Time||6 months or 24 weeks.|
This PICOT question is important because the problem of VAP increases the cost of care and mortality.
Ghezeljeh, T.N., Kalhor, L., Moghadam, O.M., Lahiji, M.N., & Haghani, H. (2017). The comparison of the effect of the head of bed elevation to 30 and 45 degrees on the incidence of ventilator associated pneumonia and the risk for pressure ulcers: A controlled randomized clinical trial. Iranian Red Crescent Medical Journal, 19(7), 1-10. http://dx.doi.org/10.5812/ircmj.14224
Hassankhani, H., Akbarzadeh, S., Lakdizaji, S., Najafi, A., & Mamaghani, E.A. (2017). Effects of 60° semi-recumbent position on preventing ventilator-associated pneumonia: A single-blind prospective randomised clinical trial. Journal of Clinical and Diagnostic Research, 11(12), 36-39. http://dx.doi.org/10.7860/JCDR/2017/27443.11007
Library of the Health Sciences [LHS] (n.d.). Steps in the EBP process [YouTube video]. https://www.youtube.com/watch?v=0bGJoN2NHc8
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.
Stannard, D. (2021). Problem identification: The first step in evidence‐based practice. AORN Journal, 113(4), 377–378. https://doi.org/10.1002/aorn.13359
Twa, M.D. (2016). Evidence-based clinical practice: Asking focused questions (PICOT). Optometry and Vision Science, 93(10), 1187–1188. https://doi.org/10.1097/OPX.0000000000001006
Villar, C.C., Pannuti, C.M., Nery, D.M., Morillo, C.M., Carmona, M.J.C., & Romito, G.A. (2016). Effectiveness of intraoral chlorhexidine protocols in the prevention of ventilator-associated pneumonia: A meta-analysis and systematic review. Respiratory Care, 61(9), 1245-1259. https://doi.org/10.4187/respcare.04610