Opioid Use Disorder and Death: Evidence Appraisal

NR 439 PICOT Worksheet

Purpose: To identify a problem or concern that nursing can change and develop a PICOT question to guide the change project.

Directions: Use the required form below to complete the Week 3 Assignment PICOT Evidence Worksheet. This includes filling in the table with information about your research question and your PICOT elements and the second part is filling in the Evidence Worksheet.

Step 1: Select the key PICO terms for searching the evidence. Clearly define your PICOT question. List each element P (problem, population, or problem), I (intervention), C (Comparison with other treatment/current practice), and O (Desired outcome), T (Time Frame). Is the potential solution something for which you (as nurse or student) can find a solution through evidence research? Look in your book for guidelines to developing your PICOT questionand also read the required articles.
Step 2: Identify the problem. What have you noticed in your work or school environment that isnt achieving the desired patient or learning outcomes? What needs to change in nursing, what can you change with the support of evidence in the literature? Describe the problem or practice issue that you want to research. What is your practice area; clinical, education, or administration? (This is NOT where you will list your PICOT question)
Step 3: How was the practice issues identified? How did you come to know this was a problem in your clinical practice? Review the listed concerns and check all that apply.
Step 4: Identifies and documents four sources of evidence. What evidence must be gathered? What sources of reliable information will be helpful for your particular question?Describes rationale for all checked types of evidence
Step 5: What terms will you use in order to make sure that your search is wide enough to obtain required information but narrow enough to keep it focused? How will you narrow your search if needed?

PICOT Question
What is the PICOT question? Define each element of the question below: P (Patient, population, or problem): I (Intervention): C (Comparison with other treatment/current practice): O (Desired outcome): T-(Time Frame): In all clients diagnosed with Opioid Use Disorder (P), does naloxone education for clients (and family) (I), compared to naloxone education only for clients prescribed with suboxone (C), lead to reduced opioid overdose deaths (O) in 12 months (T).
What is the practice issue/problem? What is the scope of the issue? What is the need for change? Overdose is now one of the leading causes of mortality by injury in the United States. According to Lott and Rhodes (2016), it results in ten thousands of preventable deaths every year. The situation is particularly dim in the case of individuals with opioid use disorder (OUD) because they are more prone to relapse and overdose. Thus, there is a need to find an effective intervention to target the population at risk. It may be suggested that overdose education can help achieve significant improvements in the given area and, for this reason, the formulated question aims to explore factors that could affect the intervention efficacy.
What is the practice area? (check all that apply) Clinical Education			Administration Other
How was the practice issue identified?(check all that apply) Safety/risk management concerns Unsatisfactory patient outcomes Wide variations in practice Significant financial concerns		Difference between hospital and community practice Clinical practice issue is a concern Procedure or process is a time waster Clinical practice issue has no scientific base Other
What evidence must be gathered? (Identifies and documents four sources of evidence. Describes rationale for all checked types of evidence) To answer the PICOT question, recent research evidence and practice guidelines must be utilized. The first type of evidence is provided in the quantitative study by Lott and Rhodes (2016) who assessed the links between naloxone education and opioid overdose outcomes. Empirical studies like this one serve to rationalize the choice of a specific intervention by providing first-hand data to support/reject a certain solution. It is particularly important to use evidence obtained from systematic reviews or randomized controlled trials (RCTs) as they are characterized by the highest quality of evidence. For instance, in their RCT, Dunn et al. (2017) compared various education interventions and demonstrated which modalities are most effective. Additionally, qualitative studies and literature reviews allow developing a comprehensive picture of the problem and getting in-depth insight into its background and significance. The review by Knipper, Banta, Jimenez, and Thomas (2017) who discuss epidemiology, historical development, and multiple clinical implications of OUD is one of them. Practice guidelines for the use of naloxone/suboxone for the prevention of opioid overdose are pivotal as well because the familiarity with them is needed for the design of high-quality, standard interventions. For instance, Farmer et al. (2015) summarize the main guidelines for the prescription of those medications in the United States and describe such problems as treatment monitoring, patient eligibility, and so forth.
Literature search Guidelines Expert Opinion Patient Preferences	Clinical Expertise Financial Analysis Standards (Regulatory, professional, community) Other
Search terms/How to narrow the search? To narrow the search, the following terms will be used: naloxone education, opioid overdose prevention, and substance use disorder treatment. The search will target the populations identified in the PICOT question separately.

References

Dunn, K. E., Yepez-Laubach, C., Nuzzo, P. A., Fingerhood, M., Kelly, A., Berman, S., & Bigelow, G. E. (2017). Randomized controlled trial of a computerized opioid overdose education intervention. Drug and Alcohol Dependence, 173 Suppl 1(Suppl 1), S39-S47.

Farmer, C. M., Lindsay, D., Williams, J., Ayers, A., Schuster, J., Cilia, A., Flaherty, M. T., Mandell, T., Gordon, A. J., & Stein, B. D. (2015). Practice guidance for buprenorphine for the treatment of opioid use disorders: Results of an expert panel process. Substance Abuse, 36(2), 209-216.

Knipper, E., Banta, G. C. J., Jimenez, N., & Thomas, M. (2017). Opioid use disorder and misuse: A review of the epidemiology and medical implications for pediatric anesthesiologists. Pediatric Anesthesia, 27(11), 1070-1076.

Lott, D. C., & Rhodes, J. (2016). Opioid overdose and naloxone education in a substance use disorder treatment program. American Journal on Addictions, 25(3), 221-226.

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