PICO(T) Questions and an Evidence-Based Approach in healthcare
Evidence-based practice (EBP) has developed into an essentially crucial component of nursing practice in recent times. One of its key aspects is the use of a PICO(T) framework to come up with solutions to clinical problems. The PICO(T) framework is an acronym that represents Patient population, Intervention, Comparison, Outcome, and Time. It has been known to help clinicians, nurses, researchers and many other health practitioners achieve relevant and credible results in terms of care practices. With the aid of the PICO(T) framework, we take a look at a practice issue that relates to patient falls in the hospitalized geriatric population. We also take a look at sources of evidence that could be potentially effective in answering a PICO(T) question with regards to geriatric patient falls. An explanation of the findings from articles or other sources of evidence is also provided, along with the relevance of the findings from selected sources of evidence in making decision related to a PICO(T) question.
The PICO(T) Approach in Geriatric Patient Falls
Patient falls is a major safety issue not only in the United States but the entire world. This safety issue is one that is yet to be fully solved, despite the emergence of evidence-based practice interventions. In the U.S. alone, rates of patient falls range from about 3.3 to 11.5 falls per 1000 patient days. Annually, it is estimated that 700,000 to 1 million patient falls occur in United States hospitals (Lelaurin & Shor, 2019). Geriatrics are one of the patient populations affected more by hospital falls. Nearly 45% of geriatric patient falls result in some sort of injury, while 10% of these falls lead to serious trauma that results in mortality (Khalifa, 2019). These numbers only serve to highlight the plight of geriatric patients with regards to falls, as well as the fact that hospital falls are still a major patient safety issue that needs to be addressed. The PICO(T) approach would be significantly useful in solving this safety issue as it would bring in an aspect of evidence-based practice interventions. This might be what has been missing in attempts to solve the issue of hospital falls.
In attempting to solve the issue of geriatric patient falls using the PICO(T) approach, it is imperative that we come up with a feasible PICO(T) question that will guide these attempts. Our question will therefore be: “For hospitalized geriatric patients, does restriction using bedside rails reduce the risk of patient falls, as compared to no use of bedside rails?”
Answering a PICO(T) practice question requires the use of credible and relevant sources. One of the core competencies that nurses graduate with from nursing school is the skill of researching and identifying credible, evidence-based, scholarly sources that are required for EBP. Sources of such information include websites and databases such as the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database by EBSCO publishing, the American Cancer Society (ACS), the PubMed website (https://pubmed.ncbi.nlm.nih.gov/), the Journal of Pain by the American Pain Society (APS), and lastly the International Journal of Pain and Relief. It is important as well to verify that information from these sources is recent, credible and relevant to the topic, which in this case is geriatric patient falls.
The TAARP criterion would be a good approach in determining recency, credibility and relevance of evidence. TAARP represents timeliness, authority, audience, relevance and perspective (BYU, 2021). Evidence used in answering a PICO(T) question has to contain the most recent information and preferably not older than 5 years, hence timeliness. Journals should be peer-reviewed, and the authors have to cite their credentials in order to prove that they have authority to write on patient falls. The authors also need to ask themselves who the article should be addressed to, in order to communicate to the appropriate audience. In verifying relevance of a source, nurses have to ask themselves whether the source supports their ideas and whether their research questions have been answered (BYU, 2021). Lastly, each individual has some bias in them. It would therefore be prudent to pick a source that helps in understanding the other side of the argument as well.
The use of bedside rails in prevention of hospitalized patient falls is a concept as old as the nursing profession. This is a practice that has existed for as long as nurses can remember. Its effectiveness in ensuring that bed-ridden patients are confined to their beds is what has enabled it to withstand the test of time. However, its effectiveness in the prevention of hospital falls as compared to no use of bedside rails or any form of restraints is still largely undocumented (Marques et al., 2017). This may be partly due to the fact that hospital falls do not only occur when the patients are bed-ridden or around their beds. Patients, and more so geriatric patients, experience falls due to a number of factors that predispose them. These include advanced age, multiple comorbidities, history of falls, female gender, gait disorders, cognitive decline as well as various hospital environmental factors such as slippery or wet floors and weak beds (Timmons et al., 2019).
A number of strategies have however been developed in attempts to manage geriatric patient falls. Top among them has been enhancing the safety of the patient’s environment with interventions such as flooring, beds and rails; as well as the use of technological interventions such as wearable devices and floor and room sensors (Timmons et al., 2019). Both strategies have proven to be successful independently, with trials ongoing on merging the two into one in order to observe the resultant impact on rates of patient falls. The use of bed and bedside chair pressure sensors linked to radio pagers to prevent bedside falls in the geriatric population has already been trialed with some success (Timmons et al., 2019). The fact that articles used to gather evidence for this topic were retrieved from the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database by EBSCO publishing, only serves to emphasize how credible and relevant the database is with regards to information on health and nursing.
Relevance of Findings
From the findings of this paper, it is clear that our PICO(T) question is still an area that needs more research. Marques et al. (2017) found out that despite the magnitude and relevance of the problem, studies that specifically address the use of bedrails in the prevention of geriatric patient falls are lacking, which may be attributed to its ethical dimension. Posing this question therefore offers researchers the opportunity to carry out studies in an attempt to find answers. However, being a fairly ancient practice, it might be more prudent to invest more time and resources in the study by Timmons et al. (2019). This is because the study is the most relevant owing to the fact that it keeps up with modern technological advancements, which is the direction the entire world is taking. More studies should be conducted to determine the effectiveness of merging the modern technological advancements with ancient practices such as the use of bedside rails.
The PICO(T) framework is an effective approach in answering a problematic clinical question using EBP interventions. It is essential that in using the approach, nurses find credible and relevant sources in which to retrieve evidence; as well as using the TAARP criterion in determining the credibility of journals and articles used as evidence. The question of use of bedside rails in preventing geriatric patient falls is one that requires more research, with the option of a merger with modern forms of technology also providing another viable route.
Brigham Young University (2021). Step-by-Step Guide & Research Rescue: Evaluating Credibility. Retrieved from https://guides.lib.byu.edu/evaluating-credibility
Khalifa, M. (2019). Improving Patient Safety by Reducing Falls in Hospitals Among the Elderly: A Review of Successful Strategies. In ICIMTH (pp. 340-343). Retrieved from https://doi:10.3233/SHTI190088
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients: State of the Science. Clinics in Geriatric Medicine. May; 35(2): 273-283
Marques, P., Quieros, C., Apostolo, J., & Cardoso, D. (2017). Effectiveness of bedrails in preventing falls among hospitalized older adults: a systematic review. JBI Database of Systematic Reviews and Implementation Reports. Retrieved from https://doi:10.11124/JBISRIR-2017-003362
Timmons, S., Vezyridis, P., & Sahota, O. (2019). Trialing technologies to reduce hospital in‐patient falls: an agential realist analysis. Sociology of Health and Illness, 41(6), 1104-1119. Retrieved from https://doi.org/10.1111/1467-9566.12889
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