11 Lessons from Practice: Using the JHNEBP Tools 241
Appendix B: Question Development Tool
A successful EBP project depends on accurate problem identification and appro-
priate question selection. Teams should plan to spend substantial time completing
Appendix B, and they may revisit it many times during the course of the project.
Figure 11.2 shows segments of a completed Appendix B.
- What is the problem?
Hospital continues to see an increase in CAUTI rates despite efforts to reduce rates; after-event reviews show more
infections associated with catheter care than insertion; best methods for catheter maintenance are unknown.
- Why is the problem important and relevant? What would happen if not addressed?
CAUTI is a preventable hospital acquired infection that brings patient t
addressed patient satisfaction will continue to decline and reimbursement
- What is the current practice?
There are no standard practices on the unit for catheter care or bathing
each nurse’s or technician’s experience, many use basins for bathing.
- How was the problem identified? (Check all that apply.)
✘ Safety and risk-management concerns
✘ Quality concerns (efficiency,
effectiveness, timeliness, equity, patient-
centeredness)
✘ Unsatisfactory patient, staff, or
organizational outcomes
✘ Variations in practice within the setting
✘ Variations in practice compared to community standard
❑ Current practice that has not been validated
❑ Financial concerns
- What are the PICO components?
P – (Patient, population, or problem) Adult inpatients on Med/Surg units with indwelling urinary catheters
I – (Intervention) Identify standardized method for bathing and catheter care
C – (Comparison with other interventions, if foreground question) N/A
O – (Outcomes are qualitative and/or quantitative measures to determine the success of change) Decreased
incidence of CAUTI among patients with indwelling catheters
It is important to clearly identify the
problem you are trying to solve. Spending
time looking at the issue from different
angles and perspectives will help the team
focus on the actual problem of interest.
Often, teams start an EBP project with a
solution in mind. Make sure your problem
statement does not reflect solutions.
PICO format provides a useful structure for
developing the EBP question. A background question
usually does not include a comparison (C) because it
seeks to find all best practices.
