NURS FPX4030 Assessment 3 Using a PICO(T) Framework and Evidence to Develop Care Practices

Introduction

The PICO(T) framework provides a practical tool for formulating clinical research questions. This method comprises five components: Population/Problem, Intervention, Comparison, Outcome, and time frame (Research Guides: Nursing 2023).

Evidence-based practice requires precise answers when precise clinical questions need to be answered. Given this nursing background, where Heparin drips are often administered as blood clot treatment solutions, this study investigates whether their use outweighs potential risks related to Heparin-Induced Thrombocytopenia (HIT). To tackle this clinical challenge, comprehensive queries are presented alongside relevant research evidence supporting this clinical challenge.

Applying PICO(T) to Patients Receiving Heparin

Heparin is an anticoagulant that reduces and prevents blood clot formation (Mayo Clinic, 2023). This study focused on adult patients in surgical intermediate care units after bypass surgery who received Heparin to avoid blood clot formation during bed rest; patients without significant platelet count reduction after Heparin administration served as the comparison group, while platelet counts after Heparin drip were measured to evaluate outcomes; although timeframe was not explicitly addressed here; nonetheless it remains an integral component of PICO(T).

Finding Reliable Evidence

Accessing reliable sources is of utmost importance in research, so databases such as “Summon,” “CINAHL” and “PubMed” were utilized to collect peer-reviewed studies related to this topic. Filtering for recent publications (i.e., within five years) ensured findings aligned with current best practices. To verify our selections (Research Guides: Evaluating Sources, 2017), the CRAAP test (which assesses sources on Currency Relevance Authority Accuracy Accuracy Purpose was used (Research Guides: Evaluating Sources 2017).

Findings and Their Relevance

Studies offer essential insight into the effects of Heparin administration. One such study highlighted that Type 1 HIT occurs in 10-30% of patients and is characterized by platelet normalization without increased thrombosis risk; on the other hand, antibody-mediated Type 2 HIT requires immediate discontinuation (Salter et al., 2018), which may necessitate alternative anticoagulant strategies being utilized (see SALTER ETT AUT (2018) for details).

These results suggest that alternative anticoagulant strategies may be required in certain instances (Salter et al., 2018). These results also indicate that an alternative anticoagulant strategy may need to be employed (Salter et al., 2018). Another study highlighted HIT’s distinctive biological mechanisms, where ultra-large immune complexes elicit procoagulant reactions leading to thrombosis (Arepally & Padmanabhan, 2021). While Heparin-induced responses are evident, clinical and biological factors contributing to risk remain unknown.

Bleeding Risks and Heparin

Another study examined bleeding incidents across various HIT statuses and anticoagulant exposures. Findings revealed a high incidence of significant bleeding regardless of HIT status, suggesting a need for a better understanding of bleeding risks during Heparin treatment (Pishko et al., 2019). Taken together, these studies underscore the difficulty associated with balancing Heparin’s benefits against its risks.

Conclusion

The PICO(T) framework facilitates the systematic exploration of clinical questions. By employing evidence-based practices, healthcare providers can use effective criteria for diagnosing and managing HIT among Heparin users. Though Heparin use does carry an increased risk of thrombocytopenia, its many benefits in preventing thrombotic events outweigh these concerns. Rigorous evaluation of research materials ensures accurate information dissemination and supports informed clinical decision-making.

References

Arepally, G. M. & Padmanabhan, A. (2021). Heparin-Induced Thrombocytopenia: Focusing on Thrombosis. Arteriosclerosis, Thrombosis & Vascular Biology 41(1) 141-152 https://doi.org/10.1161/ATVBAHA.120.315445

Mayo Foundation for Medical Education and Research. (2023, June 1) Heparin (intravenous route and subcutaneous route) description and brand names from Mayo Clinic: http://www.mayoclinic.org/drugs-supplements/heparin-intravenous-route-subcutaneous-route/description/drg-20068726

Pishko, A. M., Lefler, D. S., Gimotty, P., Paydary K. Fardin S. Arepally G M Crowther M Rice L Vega R Cines D B Guevara JP Cuker A (2019). Assessing Risk for Major Bleeding among Patients Suspected of Heparin-Induced Thrombocytopenia Journal of Thrombosis & Haemostasis 17 11 1956 1965 https://doi.org/10.1111/jth 14587 Cuker A

Research Guides at Benedictine University Library have created the CRAAP Test to evaluate sources. Visit them today at https://researchguides.ben.edu/source-evaluation for more information!

Research Guides: Nursing: Picot. (2023, May). PICOT-Nursing Research Guides at Lansing Community College Library are here: https://libguides.lcc.edu/c.php?g=167860&p=6198388.

Salter, B. S., Weiner, M. M., Trinh, M. A., Heller, J., Evans, A. S., Adams D H & Fischer G W (2018) conducted an in-depth clinical review on Heparin-induced Thrombocytopenia: An Analysis for Journal of American College of Cardiology 67 21 2519-2532 with https://doi.org/10.1016/j.jacc.2016.02.073 for their full-text article.