Example Of Essay On Clinical Practice Guideline
The Prevention of ventilator-associated pneumonia guideline was developed by the Institute for Clinical Systems Improvement which is a nonprofit Organization. The sources of funding for the venture included Blue Cross and Blue Shield of Minnesota, HealthPartners, Medical, Security Health Plan of Wisconsin, and UCare. The conditions under focus in developing the guideline were Ventilator-associated pneumonia and other complications such as stress ulcer and venous thromboembolism that affect patients on ventilators. The guidelines major facets were ventilator-associated pneumonia management, prevention and risk assessment. The possible areas of clinical specialism considered to benefit from the guideline included critical care, internal medicine, emergency medicine, nursing, pulmonary medicine and preventive medicine (Institute for Clinical Systems Improvement, 2011). The guideline was formulated with users such as allied health personnel, advanced practice nurses, emergency medical paramedics, nurses, physicians and respiratory care practitioners in mind (Institute for Clinical Systems Improvement, 2011). The target population in the development of the guidelines was adult patients on ventilators in the intensive care unit.
The guidelines objectives were to eliminate ventilator-associated pneumonia in adult patients in an intensive care unit and to increase the use of ventilator-associated pneumonia bundle in all ventilated patients in an intensive care unit. These objectives achieved by the guideline are consistent with my goals as a clinician since I strive to achieve efficiency and proper patient service to patients in my clinical service. The major outcome Considered was the level of effectiveness of ventilator bundle interventions in preventing ventilator-associated pneumonia and deaths from ventilator-associated pneumonia.
The Institute for Clinical Systems Improvement settled on doing searches of electronic databases as the method to select the evidence. The organization employed a consistent and defined process in the literature search and review in order to come up with the evidence. This was done over a period of 16 months stretching from January 2009 to June 2010. The main databases used were those of PubMed and Cochrane where the major terms searched included VAP, ventilator-associated pneumonia and probiotics (Institute for Clinical Systems Improvement, 2011). The number of documents used however was not disclosed.
The results from which the guideline came from are valid. The guidelines were further subjected to internal peer review in order to validate the guideline. The validation process was basically a review and comment approach. Here, a chance was given to professionals in the involved organization to review the recommendations critically and evaluate the guideline. The validation process also gave an opportunity for the said clinicians in different organizations affiliated with the Institute for Clinical Systems Improvement to come to a common ground on the kind of response they would give to the developing team in terms of changes they wanted made to the final document.
After validation, the document approval was done by the steering committee. The committee involved in this case was the steering committee for Respiratory, Cardiovascular, Women's Health, and Preventive Services, that went through reviewing and approving each guideline based on protocols the committee formulated.
The institute for clinical systems improvement was of the idea that application of the said guidelines had the benefits of increased use of ventilator-associated pneumonia bundle in all ventilated patients in an intensive care unit and the ultimate elimination of ventilator-associated pneumonia in adult patients in an intensive care unit. The potential harm came in chlorhexidine, which in big amounts may result in irritation of the oral mucus thus calling for a dosage reduction.
Several important and practical recommendations were made. These included elevating the head of the bed at an angle of 30-45 degrees for a patient at high risk for aspiration, maintaining cuff pressure 20-25 cm h2o and avoidance of minimal leak technique. In circuit change, it was recommended for them to occur when visibly soiled rather than routinely since less frequent changes do not lead to increased incidence of ventilator-associated pneumonia.
In the issue of heated humidifiers, and heat and moisture exchangers no evidence was found to make a conclusion that the ventilator-associated pneumonia rates actually differs in those patients who have been ventilated with heated humidifiers in comparison to the moisture and heat exchangers.
In oral care, the recommendation was that use of chlorhexidine led to a reduction in the rate of ventilator-associated pneumonia. Further recommendations were made in medications involving Stress Ulcer Prophylaxis and Venous Thromboembolism Prophylaxis,.
The developers of the guideline did not indicate the strength of their recommendations. The guideline authors had a set of evidence they used to come up with their recommendations. According to Institute for Clinical Systems Improvement (2011), these were:
Elevation of the head of the bed,
Maintaining cuff pressure in the endotracheal tube between 20-25 mmHg,
Use of heated humidifiers and heat and moisture exchangers,
Providing oral care with chlorhexidine and water-soluble mouth moisturizer,
Secretion removal with specially designed endotracheal tubes,
Closed, in-line suctioning
Evaluation for kinetic bed therapy,
Stress ulcer disease prophylaxis,
Deep vein thrombosis prophylaxis
(Retrieved from: http://www.guideline.gov/content.aspx?id=36063/)
I would use these recommendations in my patient care since it has been proved that they improve the processes of care. The recommendations are practical and applicable to some of my patients and would help greatly in Prevention of ventilator-associated pneumonia
Ibrahim, E. H., Ward, S., Sherman, G., Schaiff, R., Fraser, V. J., & Kollef, M. H. (2001). Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Critical care medicine, 29(6), 1109-1115.
Pingleton, S. K., Fagon, J. Y., & Leeper, K. V. (1992). Patient selection for clinical investigation of ventilator-associated pneumonia criteria for evaluating diagnostic techniques. CHEST Journal, 102(5_Supplement_1), 553S-556S.
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