Nursing Informatics: NURS 4303: 1. PICO

The first step in searching for Evidence Based material is to formulate a question that you would like answered.  This is called the PICO Question.

The following boxes will help you learn how to formulate a PICO question.

P is for who is the patient or what is the problem

• It can be the problem addressed (visiting hours in ICU or  hand hygiene) or disease (Bell Palsy).
• It can include sex, age, race, or any other characteristic that might be important to answering the question.
• Makes the statement "In a..." or "For..."

Example: A child under 2 years of age with otitis media.

In this example, is it important to note the age of the child in respect to treatment?  Yes, because treatment would vary from an infant to an adult.

Example:  A 45 year old male patient with Bell's Palsy.

In this example, is it important to note the age and sex of the patient?  Will it change treatment strategies or whatever you are trying to answer?  Probably not, but it varies depending on the situation.

 Example: All persons entering the critical care unit

In this example, do we need to be more specific as to who "all persons" is?  It is possible that it might have to be narrowed down depending on the individual situation.  Is it just employees, nurses, everyone including family?  It might even have to be divided into multiple PICO questions with one specifying employees or nurses and one for visitors.

I is for the intervention

• It can be the drug therapy, policy, test, surgical procedure, prognostic factors, age, co-existing problems
• Answers the questions "Does...?" or "Is..."

 You want to try "Watchful Waiting" for our infant with Otitis Media:

Example: Watchful Waiting

You want to see if antiviral treatment is effective for Bell's Palsy:

Example:  Valacyclovir

You want to implement a hand hygiene protocol:

Example: Hand rubbing with a waterless, alcohol based solution

C is for the comparison

• What is the standard treatment or alternative to compare with intervention?
• Placebo
• Answers the statement "Versus..."
• May not always have a comparison

Compare "watchful waiting" with standard treatment of Amoxicillin x 10 days

Example: Amoxicillin x 10 days

Compare "valacyclovir" with just steroid treatment alone.

Example: Prednisolone

Compare "Hand rubbing with a waterless, alcohol based solution" with hand washing with soap and water alone.

Example: Hand washing with soap and water

O is for the outcome.

• What do you hope to accomplish?
• Answers may begin with relieve, eliminate, reduce, improve, affect...

Otitis Media:

Example: Reducing symptoms

Bell's Palsy:

Example: Improving facial paralysis

Hand hygiene:

Example: Reducing nosocomial infections