Implementing Clinical Guidelines
Type: Essay
Subject: Evidence based Nursing
Subject area: Nursing
Education Level: Masters Program
Length: 1 pages
Referencing style: APA
Preferred English: US English
Spacing Option: Double
Title: implementing clinical guidelines
Instructions: discussion: implementing clinical guidelines go to one of the evidence based practice guideline databases that are listed in chapter 8 of your melnyk text, and choose a guideline that relates to your current or planned practice. use melnyk's tools or the agree ii instrument for evaluating the guidelines. post a short description of the practice first and then share your evaluation with your classmates. you can access the book at yuzu sign in [removed] pw gunner09$ pick any guideline related to icu
Focus: discussion question please use the agree reporting checklist i uploaded and follow the above directions please
Implementing Clinical Guidelines
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Implementing Clinical Guidelines
A 36-year-old female is admitted to the Medical ICU in acute respiratory distress with upper and lower GI bleeding. Her past medical history is significant for end-stage liver disease due to alcohol abuse. The patient is intubated in response to worsening respiratory distress, aggressively resuscitated, and given blood transfusion and vasopressor drugs. Multiple consultation services are involved in the patient’s care. All recommend that the patient’s DNR status be addressed. Eight hours into her stay, a member of the GI consultation team places a call to the patient’s mother, who lives out of state. Her mother is aware that her daughter has end-stage liver disease and states that her daughter would “not want all these things done and they should be stopped.” Over the next 6 hours, however, despite this information, the patient continues to be aggressively resuscitated. At 16 hours into her stay, the patient’s blood pressure begins to drop. The MICU physician comes to the patient’s bedside and pronounces her dead
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CHECKLIST ITEM AND DESCRIPTION |
REPORTING CRITERIA |
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DOMAIN 1: SCOPE AND PURPOSE |
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1. OBJECTIVES Report the overall objective(s) of the guideline. The expected health benefits from the guideline are to be specific to the clinical problem or health topic. |
¨ Health intent(s): screening, diagnosis and treatment, ¨ Expected benefit(s) or outcome(s)- reduce the rate of acute respiratory distress and GI bleeding ¨ Target(s)-young adults between 24-45 years |
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2. QUESTIONS Report the health question(s) covered by the guideline, particularly for the key recommendations. |
¨ Target population- young female adults ¨ Intervention(s) or exposure(s)- incubation and GI consultation ¨ Comparisons- young male adults ¨ Outcome(s)- reduce the rate of acute respiratory distress and GI bleeding ¨ Health care setting or context- patients in ICU setting |
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3. POPULATION Describe the population (i.e., patients, public, etc.) to whom the guideline is meant to apply. |
¨ Target population, sex and age- young female adults ¨ Clinical condition- acute respiratory distress with upper and lower GI bleeding. ¨ Severity/stage of disease- end-stage liver disease ¨ Comorbidities- acute respiratory distress and GI bleeding ¨ Excluded population-older adults |
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DOMAIN 2: STAKEHOLDER INVOLVEME NT |
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4. GROUP MEMBERSHIP Report all individuals who were involved in the development process. This may include members of the steering group, the research team involved in selecting and reviewing/rating the evidence and individuals involved in formulating the final recommendations. |
¨ Name of participant- Dr. GM, patient, GI team ¨ Discipline/content expertise- GI health professional ¨ Institution- ICU facility ¨ diagnosing, screening and treating patients suspected to have acute gastroenterological (GI) complications |
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5. TARGET POPULATION PREFERENCES AND VIEWS Report how the views and preferences of the target population were sought/considered and what the resulting outcomes were. |
¨ Statement of type of strategy used to capture patients’/publics’ views and preferences- Do-Not-Resuscitate (DNR) orders ¨ Methods by which preferences and views were sought- literature review from clinical databases and patient’s history ¨ Outcomes/information gathered on patient/public information- past medical history is significant for end-stage liver disease due to alcohol abuse. ¨ How the information gathered was used to inform the guideline development process and/or formation of the recommendations- The patient is intubated in response to worsening respiratory distress, aggressively resuscitated, and given blood transfusion and vasopressor drugs. Multiple consultation services are involved in the patient’s care |
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6. TARGET USERS Report the target (or intended) users of the guideline. |
¨ The intended guideline audience- GI specialists, family physicians, patients, clinical or institutional leaders/administrators ¨ How the guideline may be used by its target audience - Upon the determination of DNR, the team briefs or huddles regarding the appropriate plan of care, and everyone has a shared mental model |
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