PICO: Planning and Evaluation

PICO Question: For patients with sickle cell anemia (P), does the use of hydroxyurea(I) reduce the future risk of organ damage(O) compared with prophylactic penicillin use only(C)?

You are a nurse practitioner working in an office that provides care for patients with sickle cell disease. How do you get patients on board to use Hydroxyurea to decrease the incidence of organ damage? Below are few pointers. Also after implementing the plan, an evaluation should be done eg. use scales (Likert scale) to rate patient’s pain level.

Plan:

1. You should consider yourself the NP working in an office where you want to implement this.

2. You should not consider hiring any new staff. If the patient needs a referral to a social worker, then there should be one on staff, or one the office refers to on a regular basis that be consulted in these cases.

3. Is there some reason why health insurance wouldn’t pay for this treatment? Unless you know insurance won’t pay, you should assume it will pay for those who have health insurance. For those who do not have health insurance, this is a different problem (one that is difficult to fix across the board) and really can’t be fixed within the scope of this paper.

4. As you consider implementing this in the office where you work, think about who will need to be on board (the providers). Usually when we start a patient on a new medication, we explain all the risks and benefits of the new med, and the patient always has the right to refuse. So getting a patient’s “consent” is assumed. And this is not a research study, so they do not need to sign a written consent.

5. Make sure you think about what outcomes you will be measuring. Your outcome in the PICO is “future organ damage”, so it is important for you to identify an outcome that can be measured sooner rather than later.

Evaluation:

1. What specific outcomes will you look at? serum creatinine? GFR? pain?

2. How often will you measure these outcomes?

3. What will be considered a positive outcome?

4. What will be considered a complication?

. Consider asking the patients to complete a short (4-5 question) survey on their satisfaction with the new med.