3 Pillars of Evidence-Based Practice
1. EVIDENCE derived from rigorous scientific research found in literature.
2. EXPERTISE derived from clinical experience and skill.
3. PATIENT PREFERENCE concerning personal health decisions.
Steps in the EBP Process
Asking for and locating evidence depends upon asking an effective clinical question.
Use the PICO mnemonic to build that question.
P = Patient Population Problem (includes demographic information)
I = Intervention Treatment Therapy Prognostic Factor Exposure
C = Comparison (could be placebo or no treatment)
O = Outcome (what you hope to accomplish; measurable)
P I C O
P -- patient, population, participant, problem (diagnosis)
I -- intervention, therapy, treatment
C -- comparison (not always required)
O -- outcome
P I C O T
P -- patient, population, participant, problem (diagnosis)
I -- intervention, therapy, treatment
C -- comparison (not always required)
O -- outcome
T -- time
P I C O (T)
P -- patient, population, participant, problem (diagnosis)
I -- intervention, therapy, treatment
C -- comparison (not always required)
O -- outcome
T -- type of studies or questions
P I C O T T
P -- patient, population, participant, problem (diagnosis)
I -- intervention, therapy, treatment
C -- comparison (not always required)
O -- outcome
T -- type of question
(therapy/treatment, diagnosis, prognosis, harm/etiology)
T -- type of study
(research method/design)
5 Types of PICO Questions
1. Diagnosis
2. Therapy (treatment / intervention)
3. Etiology (cause)
4. Prognosis (future / forecast)
5. Prevention
Diagnosis PICO:
In children with respiratory infection, is the respiratory rate as effective as chest x-ray in detecting pneumonia?
Prognosis PICO:
In premature infants (compared to full-term infants), what is the lifetime prevalence of hearing deficit?
Therapy PICO:
In patients with recurrent infection, do antibiotics, compared to no treatment, reduce recurrence rate?
Etiology PICO:
In post-menopausal women, does hormone replacement therapy increase the risk of breast cancer?