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Nursing Evidence-Based Practice Question Development Tool

1. What is the problem? A significant proportion of patients who attend the emergency department have a respiratory problem either with acute condition or exacerbation of chronic respiratory disease, that lead to respiratory failure if immediate treatment not received. In developing countries 10% of emergency department visits were due to respiratory conditions (Desalu, Ojo, Busari & Fadeyi, 2011). The prevalence should be increased in the resent years because of covid19 pandemic. The most common conditions seen are pneumothorax, hemothorax, pulmonary contusion, pleural effusion, pulmonary edema, pulmonary embolism, COPD exacerbation, ARDS, viral and bacterial pneumonia. Early diagnosis and intervention for these conditions is critical and need differential diagnosis rapidly to prevent deterioration and reduce in hospital mortality (Zieleskiewicz et al., 2021). Usually in ER chest x-ray is done to diagnose these conditions, but it has been proved to be insensitive and inaccurate method to diagnose lung pathologies. Sensitivity of chest x-ray is 43.5% and the positive predictive value is 26.9% (Ye, Xiao, Chen & Zhang, 2015). For this low values chest CT scan considered a standard way to diagnose respiratory conditions with sensitivity from 97% to 100%, but it cannot be used in the ER because of patient’s unstable conditions which cannot tolerate transport and imaging position and time, CT device not available in all emergency departments and patient’s exposure to high radiation doses (Gibbons et al., 2021). Lung ultrasound POCUS (point of care ultrasound) devise considered an alternative to CT scan and better than chest x-ray. It has been used in triaging and diagnosing patients with respiratory and other health complains in ER (Zhou, Bartholmai, Kalra, Osborn & Zhang, 2019). POCUS proved its effectiveness in 2009 during H1N1 pandemic with 94% sensitivity, it helped in early diagnose of respiratory complications better than CXR (Testam et al., 2012). Also, the device is easy to use, available in ER, patient can be easily and continuously follow-up and no radiation exposure (Schultz, Sivakorn & Dondorp, 2020). Early diagnosis and rapid treatment initiation lead to improve outcome especially in trauma and dyspnea cases and it decreases length of stay in ER by reduce laboratory testing and CT scan time needed to diagnose the patient (Ienghong et al., 2021). Literature support its usefulness and accuracy (Gibbons et al., 2021; Mohamed et al., 2020)

2. Why is the problem important and relevant? What would happen if it were not addressed?

Nursing Evidence-Based Practice Question Development Tool 3. What is the current practice?

4. 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

5. What are the PICO components? P – (Patient, population, or problem) I – (Intervention) C – (Comparison with other interventions, if foreground question) O – (Outcomes are qualitative or quantitative measures to determine the success of change) 6. Initial EBP question ❑ Background ❑ Foreground

Nursing Evidence-Based Practice Question Development Tool 7. List possible search terms, databases to search, and search strategies.

8. What evidence must be gathered? (Check all that apply.) ❑ Publications (e.g., EBSCOHost, PubMed, CINAHL, Embase) ❑ Standards (regulatory, professional, community) ❑ Guidelines

❑ Organizational data (e.g., QI, financial data, local clinical expertise, patient/family preferences) ❑ Position statements

9. Revised EBP question (Revisions in the EBP question may not be evident until after the initial evidence review; the revision can be in the background question or a change from the background to a foreground question.)

10. Outcome measurement plan What will we How will we How often will Where will measure? measure it? we measure we obtain the (structure, (metrics are it? data? process, expressed as (frequency) outcome rate or percent) measure)

Who will collect the data?

To whom will we report the data?

Nursing Evidence-Based Practice Question Development Tool References: Desalu, O., Ojo, O., Busari, A., & Fadeyi, A. (2011). Pattern of respiratory diseases seen among adults in an emergency room in a resource-poor nation health facility. Pan Afr Med J, 9,24–24. Gibbons, R., Magee, M., Goett, H., Murrett, J., Genninger, J., Mendez, K. … Costantino, T. (2021). LUNG ULTRASOUND VS. CHEST X-RAY STUDY FOR THE RADIOGRAPHIC DIAGNOSIS OF COVID-19 PNEUMONIA IN A HIGHPREVALENCE POPULATION. The Journal of Emergency Medicine, 60(5), 615–625. Ienghong, K., Towsakul, N., Bhudhisawasdi, B., Srimookda, N., Ratanachotmanee, N., & Phungoen, P. (2021). POCUS Findings in Critically Ill Patients in Emergency Department. J Med Assoc Thai, 104, 54-8. Mohamed, M., Al-Shokri, S., Yousaf, Z., Danjuma, M., Parambil, J., Mohamed, S. … Abubeker, I. (2020). Frequency of Abnormalities Detected by Point-of-Care Lung Ultrasound in Symptomatic COVID-19 Patients: Systematic Review and Meta-Analysis. The American Journal of Tropical Medicine and Hygiene, 103(2), 815 – 821. Schultz, M., Sivakorn, C., & Dondorp, A. (2020). Challenges and opportunities for lung ultrasound in novel coronavirus disease (COVID-19). Am J Trop Med Hyg, 102(6), 1162–1163. Testam A., Soldati, G., Copetti, R., Giannuzzi, R., Portale, G., & Gentiloni-Silveri, N. (2012). Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound. Critical Care, 16, R30. Ye, X., Xiao, H., Chen, B., & Zhang, S. (2015). Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Adult Community-Acquired Pneumonia: Review of the Literature and Meta-Analysis. PLoS ONE, 10(6), 1-9. Zhou, B., Bartholmai, B., Kalra, S., Osborn, T., & Zhang, X. (2019). Lung US surface wave elastography in interstitial lung disease staging. Radiology, 291, 479–484. Zieleskiewicz, L., Lopez, A., Hraiech, S., Baumstarck, K., Pastene, B., Bisceglie, M. … Leone, M. (2021). Bedside POCUS during ward emergencies is associated with improved diagnosis and outcome: an observational, prospective, controlled study. Critical Care, 25, 34....