Analysis and Application of Clinical Practice Guidelines, Research Paper Example

Introduction

Surgical infection is a very sensitive issue among surgeons and surgery practitioners. According to the center for disease controlsurgical infections can occur either at the incision after surgery or systemic due to surgical intervention (Center for Disease Control, 2014). Therefore, monitoring of surgical infections through clinical practice guideline is imperative. In the following paragraphs a study relating clinical practice guidelines for antimicrobial prophylaxis in surgery would be evaluated using the appropriate summary sheet.

Scope and purpose of the clinical practice guidelines

This encompasses full understanding of prophylaxis and its implementation in surgical settings. For these clinicians prophylaxis means infection prevention characterized as primary and secondary criteria. Also, prophylaxis from a broader perspective could be described as removing incidences of infection form surgical sites as well as systems sometimes referred to as eradication. Importantly, primary prophylaxis is indicative of preventing the occurrence of initial infections whereas secondary infection is in reference to eliminating incidences of recurring or reactivating pre-existing infections. A more precise description of eradication as pertains to these guidelines relates to removing form the systemic environment colonized organisms. The guidelines established in this protocol provide scope of practice in perioperative surgical interventions(Bratzler, Dellinger & Olsen, 2013).

The specific purpose of these guidelines is mainly intended for practitioners to implement standardized approaches towards ‘rational, safe, and effective use of antimicrobial agents’ (Bratzler et.al, 2013, p. 195)  as a prophylactic measure in limiting surgical-site infections (SSIs).Importantly, these guidelines were designed after analysis of clinical evidence basedstudies integrating current emerging issues. Further, these guidelines represent an update,which was published previously as ASHP Therapeutic Guidelines pertaining to Antimicrobial Prophylaxis in Surgery, 1. It was also adapted from expert IDSA and SIS published protocols (Bratzler et.al, 2013).

Stakeholder involvement

The stakeholder involvement in creating of these guidelines is accredited to the American Society of Health-System Pharmacists (ASHP). This is anationalprofessional of about 40,000 pharmacists, students and pharmacy technicians dedicated to providing distinguished pharmacological needs for persons hospitalized in hospitals; health systems as well as ambulatory clinics. The Society is 70 years old executing professional expertise towards enhancing patient safety through pharmacological interventions across the nation (American Society of Health-System Pharmacists, 2014).

Another Stakeholder is the Infectious Diseases Society (IDSA) of America, which is an professional association consisting of scientists; physicians, and other health care infectious diseases experts. IDSA is focused on improved quality of health for communities,individuals and thesociety through health education promotion programs, research, public health interventions and applying specific infectious diseases strategies (Infectious Diseases Society of America, 2014).

The Surgical Infection Society (SIS) expertise was recruited in creating these guidelines also. This organization is concerned with educating both the public and health care providers about surgical infections. A second focus relates to conducting research adding knowledgein the science to enhance an awareness of surgical, infections and how prophylaxismanagement should be executed. The organization functions by applying specific bylaws regarding membership and stakeholder involvement in projects such as creating guidelines (Surgical Infection Society, 2014).

Society for Healthcare Epidemiology of America (SHEA) was included a stakeholder due to its dedicationtowards healthcare epidemiology practice advancement. The organization focuses on limiting and preventing morbidity, mortality. It is acknowledged that surgical infections are associated with a very high health care cost. As such, the organizationuses its expert in making recommendations for clinical practice guidelines. Therefore, partnershipswith infectious disease experts, epidemiologists, public health specialists, policy makers, consumers, scientists are encouraged by the (SHEA) (Society for Healthcare Epidemiology of America, 2014).

Rigor of development

To begin this project,memberswere recruited from stakeholder organizations ASHP, IDSA, SIS, andSHEA. They served as anexpert panel designed to analyse ‘validity, reliability, and utility’ (Bratzler et.al, 2013, p. 195) of guidelines, which were to be revised. Essentially,further collaboration with University of Pittsburgh School of Pharmacy;University of Pittsburgh Medical Center Drug Use and Disease State Management Program  were  the additional experts assigned to the panel in supporting articulation of expert ideas during revision of  former guidelines’ protocol and creating the  new ‘Clinical practice guidelines for Antimicrobial prophylaxis in surgery’ (Bratzler et.al, 2013).

Disclosures related to conflict of interest in the venture were required from both members of the panel and assigned contractors. This procedure was conducted prior to beginning phases and appointment and was updated during the developmental stages of the guidelines. A sample of documents was selected for analysis by the panel. They were related to specific aspects of the selected surgical procedural section. After the analytic revision the revised document was placed for scrutiny on the American Society of Health-System Pharmacists (ASHP). Reviewers’ comments were addressed through further revisions by the panel. Finally, an approved document was produced by the expert panel, which was later sent to the Stakeholder organizations board of directors (Bratzler et.al, 2013).

However, formal rigors included selection of appropriate evidence in preparing the guidelines. Experts on the panel graded evidence by applying a seven (V11) level criteria ranging from level 1 being well controlled randomized studies and meta analyses; level 11, evidence from small randomized trials; level 111, literature providing data from well controlled cohort studies; level 1V, well conducted case control studies; level V, well conducted uncontrolled studies; level V1, conflicting evidence that supports a recommendation and level V11 expert opinion evidence (Bratzler et.al, 2013).

The mainliterature was retrieved fromAmerican Society of Health-System Pharmacists (ASHP) Therapeutic Guidelines on AntimicrobialProphylaxis in Surgery. This was supported by data retrieved from primary studies published during the date the time of previous guidelines, which is 1999, andJune 2010. Literature search was conducted using the internetto access MEDLINE, Cochrane Database and EMBASE. Experts were mindful of study designs giving the highest value to double-blind studies and randomized controlled trials(Bratzler et.al, 2013).

One rigor experienced in preparing these guidelines, experts explained was embodied a limitation found in establishing valid randomized controlled trials to meet the for selection criteria. Precisely, it encompassed evidence supportive of antimicrobial prophylaxis in surgical procedures. As such, guidelineswere designed to highlight characteristics inclusive of ‘validity, reliability, clinical applicability, flexibility, clarity’ (Bratzler et.al, 2013, P 196).   These research features were consistent with those espoused by American Society of Health-System Pharmacists’ (ASHP) therapuetic guideline philosophy, which encompassed a multidisciplinary approach (Bratzler et.al, 2013).

Recommendations

Recommendations were perceived in the categories of preoperative dose timing, which was discovered to be most effective within 60 minutes before the incision; selection and dosing, weight based dose changes in obese pateints/ clients; duration of prophylaxis being revised from post-operative routine of a single dose antibiotics for 24 hours to clarifying the necessity of antimicrobial therapy in the post-operative pateints. The need should be assessed based on a presence of indwelling catheters, drains, intravascular catheters all which may contribute to infections. In the absence of these devices it should be further evaluated if prophylaxis antibiotics are mandatory (Bratzler et.al, 2013).

Recommendations regarding expansion of common principles were also given to reflect revisions in using mupirocin and vancomycin in surgical prophylaxis intervention. Importantly, new recommendations pertaining to thoracic procedures and implantable insertion devices were set forth in the new guidelines. These recommendations are specifically applied to adults 19 years of age and older along with pediatric pateints from one to 18 months of age. They do not pertain to infants and newborns (Bratzler et.al, 2013).

The nurse’ role in carrying out these recommendation has to coincide with organizational polices. If the organization does not think the guidelines are applicable then it is wise not to be a whistleblower, but coincide until they find it useful to the organization.

Application

These guidelines did not evaluate or present surgical prophylactic infection modifications pertaining to pateints with renal or hepatic dysfunction exclusively. However, the expert panel cautioned that they may be inappropriate for certain clinical surgical settings and in depth revisions may be necessary.  Further recommendations are that clinicians use their judgment in applying recommendations to their individual/peculiar surgical environments. Importantly, these guidelines reflect current knowledge of the phenomenon based on the scientific literature that was reviewed and evidence retrieved (Bratzler et.al, 2013).

Special population considerations pertain to pediatrics, which undergo many surgeries similar to those of adults. Currently specific data is limited in addressing prophylactic antibiotics therapy in their surgical interventions. As such, selection of antimicrobials is similar to that of adults in relation to their body weight. Common principles and guideline were developed that are applicable under general circumstances (Bratzler et.al, 2013)

Conclusion

The foregoing Summary Sheet outlining Clinical practice guidelines for Antimicrobial prophylaxis in surgery encompassed an account of scope and purpose of the clinical practice guidelines; stakeholder involvement; rigor of development; recommendations and application. As a nurse it is my opinion there would be  no extra costs incurred in implementing these guidelines because prophylactic antibiotic treatment is already enforced in surgical settings even though surgical infections are increasing.  As was recommended by the experts in-depth studies into application to specific settings and surgeries need to be investigated and guidelines established. Precisely, from recommendations application of these guidelines could be reduced antimicrobial administration costs in cases which do not really need antimicrobials.

References

American Society of Health-System Pharmacists (2014). About us. Retrieved on June 10^th, 2014 from http://www.ashp.org/menu/AboutUs

Bratzler, D, Dellinger, E., & Olsen, K. (2013).Clinical practice guidelines for Antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm, 70; 195-283

Center for Disease Control (2014).Surgical Site Infection (SSI. CDC and Prevention. Retrieved on June 10^th, 2014 from http://www.cdc.gov/HAI/ssi/ssi.html

Infectious Diseases Society (IDSA) of America (2014). About IDSA. Retrieved June 10^th, 2014 From http://www.idsociety.org/About_IDSA/

Society for Healthcare Epidemiology of America (2014). About > Mission > History, Retreived on June 10^th, 2014 from http://www.shea-online.org/About/MissionHistory.aspx

Surgical Infection Society (2014). About the Society. Retrieved on June, 10^th, 2014 from http://www.sisna.org/history-of-the-society