CE: Beyond PICO—a new question simplifies the search for evidence

The framework for the PICO (population, intervention, comparison intervention, outcome) question was developed for use in the field of medicine to help determine the best treatment or intervention for a patient. However, use of the PICO question often fails to make sense when the problem or issue of interest is unrelated to determining the best treatment; in such cases, PICO is a less-than-optimal framework to use in searching for evidence. Nurses undertaking an evidence-based practice quality improvement (EBPQI) initiative must begin with a full understanding of the problem by exploring both external evidence (research) and internal evidence from the local setting to support the initiative. This article presents the framework for an alternative question—PPCO, or problem, population, change, outcome—that simplifies the search for evidence and provides a universal approach to question development for EBPQI initiatives. The PPCO question was developed for use with all nursing issues that need addressing.