DNP/710 Week 2: Developing a PICOT Question, sample paper

From "Nothing After Midnight" to Five Defined Elements: A PICOT Question on a Two-Hour Carbohydrate Drink for Elective Surgery Patients, With the Reason for Each Choice

[Student Name]

University of Phoenix

DNP/710: Evidence-Based Practice Measurement and Clinical Inquiry

Week 2 Assignment

[Instructor Name]

[Date]

The hospital and scenario are composites written for a model paper.

Last week, I documented that elective patients at our same-day surgery center fast a median of 11.4 hours from liquids and 14.2 hours from solids, far longer than guidelines require, and that 44% report severe thirst. The problem is clear, but "patients fast too long" is not a question evidence can answer. This paper develops a PICOT question to guide my search.

Why a Structured Question

Stillwell et al. (2010) describe asking the clinical question in PICOT format as the first step of evidence-based practice after cultivating a spirit of inquiry. They explain that a well-formulated question identifies the population, intervention or issue of interest, comparison, outcome and time frame, and that the type of question, such as intervention, prognosis or meaning, determines the kind of evidence that best answers it. A vague question produces an unfocused search and irrelevant results.

Question Type

My question is an intervention question: does a change in practice improve outcomes compared with current practice? Intervention questions are best answered by systematic reviews of randomized controlled trials, then individual trials, which will guide where I look first and which studies I weigh most heavily when the evidence disagrees.

Population

The population is adults undergoing elective surgery under general or regional anesthesia at a same-day surgery center, excluding patients with diabetes, gastroparesis, bowel obstruction or other conditions that increase aspiration risk. I narrowed from "surgical patients" because emergency patients and those with delayed gastric emptying need different fasting rules.

Intervention

Two interventions are possible: simply allowing clear liquids until 2 hours before surgery, or giving a specific carbohydrate-containing clear drink at that time. In a three-arm trial, Hausel et al. (2001) found that patients given a carbohydrate-rich drink before surgery reported less hunger and anxiety than patients given plain flavored water or kept fasting, and less thirst than those who fasted, without any worsening of gastric contents. This suggests the drink may do more than water alone. My intervention is a 400 mL carbohydrate-containing clear drink completed 2 hours before scheduled surgery, with clear liquids allowed until then.

The problem had one word, "long"; the question needed five elements before a database could answer it.

Current Guidance on the Intervention

Joshi et al. (2023), in a modular update of the national fasting guidelines, addressed carbohydrate-containing clear liquids, chewing gum and pediatric fasting. The update supports the intervention for healthy adults undergoing elective procedures, which strengthens its feasibility in our setting and signals that anesthesia colleagues are likely to accept it.

Comparison

The comparison is current practice: nothing by mouth after midnight. Using current practice rather than water alone reflects the real choice our hospital faces.

Why Not a Broader Intervention

I considered a full enhanced recovery pathway, which includes carbohydrate loading along with many other elements. But a bundle makes it impossible to know which part helped, and implementing it would require surgeons, anesthesiologists and pharmacy to change many practices at once. A focused question about fasting and a carbohydrate drink fits the scope of a DNP project and addresses the problem I documented.

Outcomes

Primary outcomes are patient-reported thirst and hunger immediately before surgery on a 0-to-10 scale. Secondary outcomes are quality of recovery on the first postoperative day and fasting duration from liquids. Safety outcomes are aspiration events and cases delayed or canceled because of intake. Hausel et al. (2001) used visual analog scales for thirst, hunger and anxiety, which supports their use.

Time

The time frame covers the preoperative period on the day of surgery and the first 24 hours after surgery for recovery outcomes. Most of our patients go home the same day, so the recovery measure will be collected by a follow-up phone call the next morning, which our nurses already make.

The PICOT Question

In adults without diabetes undergoing elective surgery at a same-day surgery center (P), does drinking a carbohydrate-containing clear drink 2 hours before surgery, with clear liquids allowed until then (I), compared with fasting from midnight (C), reduce preoperative thirst and hunger and improve quality of recovery (O) from the morning of surgery through the first postoperative day (T)?

Defining the Drink Precisely

A question must define its intervention precisely enough to search and to implement. "Carbohydrate drink" could mean juice, sports drinks or a commercial preoperative product. Clear liquids must be free of particles, fat and protein to empty quickly from the stomach. For the question, I define the intervention as a clear, carbohydrate-containing drink without protein or fat, in a fixed volume at a fixed time, so that evidence can be matched and the practice standardized.

Testing the Question

Is it answerable? Yes: trials and reviews of preoperative carbohydrate drinks exist. Is it relevant? It addresses our documented problem. Is it feasible? The intervention costs little, and outcomes can be measured by nurses already in contact with patients. Is it ethical? National guidelines support the intervention for healthy adults.

Alternative Questions Considered

I also drafted a meaning question, "How do elective surgery patients experience prolonged preoperative fasting?" and a prognosis question about whether prolonged fasting predicts postoperative nausea. Both are worth asking, but neither directly guides a practice change. The intervention question does, which is why I chose it. The meaning question may inform patient education later.

Stakeholder Review

I shared the draft question with the chief anesthesiologist, a surgeon and two preoperative nurses. The anesthesiologist asked that the population exclude patients with body mass index over 40 and those on GLP-1 receptor agonists, which delay gastric emptying. I added both exclusions. Early review by stakeholders makes the question more realistic and builds support for the eventual change.

Measuring What Patients Feel

The outcomes are deliberately patient-centered. Length of stay and insulin resistance are common in the literature, but our patients go home the same day and our problem was their discomfort. Choosing thirst, hunger and recovery keeps the question tied to what the audit found and what patients told us.

Search Terms From the Question

The PICOT elements supply search concepts: elective surgery, preoperative carbohydrate loading or drink, preoperative fasting, thirst, hunger, patient comfort and quality of recovery. Each will be expanded with synonyms and subject headings next week.

What the Question Leaves Out

The question excludes patients with diabetes, who may benefit but need separate evaluation for glucose effects, and it does not address solid food timing, which remains at 6 hours. These are deliberate limits, not oversights.

Conclusion

A PICOT question turned the problem of prolonged fasting into a focused intervention question about a carbohydrate-containing clear drink 2 hours before surgery. An early trial suggests the drink reduces thirst, hunger and anxiety beyond water, and a recent national guideline update supports its use in healthy adults. Each element was chosen deliberately, and the question now directs the search for evidence.

References

Hausel, J., Nygren, J., Lagerkranser, M., Hellström, P. M., Hammarqvist, F., Almström, C., Lindh, A., Thorell, A., & Ljungqvist, O. (2001). A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesthesia and Analgesia, 93(5), 1344-1350. https://doi.org/10.1097/00000539-200111000-00063

Joshi, G. P., Abdelmalak, B. B., Weigel, W. A., Harbell, M. W., Kuo, C. I., Soriano, S. G., Stricker, P. A., Tipton, T., Grant, M. D., Marbella, A. M., Agarkar, M., Blanck, J. F., & Domino, K. B. (2023). 2023 American Society of Anesthesiologists practice guidelines for preoperative fasting: Carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration: A modular update of the 2017 American Society of Anesthesiologists practice guidelines for preoperative fasting. Anesthesiology, 138(2), 132-151. https://doi.org/10.1097/ALN.0000000000004381

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question. American Journal of Nursing, 110(3), 58-61. https://doi.org/10.1097/01.NAJ.0000368959.11129.79