To make your case start with a picot question

Please do not use any of the Nurse Daniel information for your own topic, nursing intervention, or change project. Nurse Daniel serves as an example only to illustrate the change process.

Nurse Daniel Story:

Daniel has been an RN for 12 years and works on a Medical-Surgical unit at a community hospital. He is completing his BSN program in a few weeks and is being mentored by his supervisor, the current Unit Manager, who will soon be retiring. Daniel will be promoted to that leadership position shortly after graduating. Daniel is aware of challenges that are impacting patient outcome measures. Daniel is also cognizant of his own strengths and limitations and is currently developing a plan to address the unit patient issues, communicate effectively, and stay engaged with his peers, as well as maintaining his own positive health status.
Daniel has identified a practice issue on his unit that he would like to address for better patient outcomes. The number of health-associated infections (HAI's) have been increasing for patients with central lines on his unit. The current Unit Manager has alerted Daniel to the fact that infection rates of patients on the unit have increased by 35% in the past year. Daniel is unsure of the exact nature and cause of this increase but suspects there may be non-adherence to policies and/or procedural errors. As he reflects on this, he also becomes aware that when his role changes to the new Unit Manager, this issue will take on renewed importance and accountability. Deciding to be proactive, Daniel begins to search for a systematic review that could be used as part of an evidence summary for quality improvement with the HAI issue. He also plans to inquire about the unit data and other in-house information that might be pertinent. After discussing his plan with the Unit Manager, Daniel decides to use the Cochrane Database of Systematic Reviews to find an appropriate systematic review. His manager suggests he also use the ACE Star Model as a strategy for looking at the evidence and planning a possible change of practice.

After searching the Cochrane Database, Daniel located a systematic review that aligned with his topic issue. He has decided to use a PICOT format to further clarify what he is wanting to summarize and plan. As far as the scope of this practice issue, Daniel also found slight increases in the numbers of HAI on other units within the facility for patients with central lines. His thinking is that the nurses may be missing the signs of infection through irregular assessment and monitoring. Therefore, his PICOT contains the following:

P=Patients over the age of 25 years with central lines
I=Develop and implement an early detection system on his unit to compare with another unit
C=The comparison of the 2 units related to the number of infections (HAI) on each unit
O=The targeted outcome would be a decrease in central line infections
T=The timeframe would be for a 6 month period of trial time
Daniel knows it will be important to justify his rationale for this type of trial, so he is preparing to summarize the discovered evidence. His Unit Manager has informed him that any trial involving a possible change of practice requires submission of evidence from the literature and presentation of the practice issue and evidence summary to the Unit Council for consideration. Daniel plans to recommend a Modified Early Warning Scoring (MEWS) system and emphasize the dangers of HAIs, patient safety concerns, unsatisfactory patient outcomes, and the variances in nursing practice from unit to unit in caring for patients with central lines.