Implementation Guidelines for Emergency and Critical Services in Emergency and  Intensive Care Departments, Research Proposal Example

Introduction

The medical division is obliged with the responsibility of ensuring that the emergency guidelines   are promptly implemented so as to improve health care effectiveness (Lofti, 2020).  The implementation of the guidelines is critical as it determines whether contingency and emergency health service are easily accessed.(Akam, 2020). The department has developed implementation guidelines that provide a framework within which the implementations are conducted for the purposes of credibility and quality assurance (Lofti, 2020). The overall guidelines emphasize on the need to offer the emergency service with the urgency they require but in strict adherence to the stipulated rules and rules. In the guiding principles, the patients should get registered so allow for verification so as to ensure that the citizenship of the patient is determined (Alhamad, 2019).   This recommendation is not only promoting patriotism but also upholds to a greater extent the level of professionalism and accountability in the medical department (Shekar, 2017)

The process is almost similar to the adopted policy guidelines in Saudi Arabia, though, in Saudi, the process more efficient   and effective as opposed to other states that have beaurocratic process (Amer, 2020). The strategies for assessing and examining  an emergency service in Saudi Arabia is more efficient since the sector enjoys the support of the top management and uphold high ethical standards. Moreover, the experts are more competent and professional in their interactions with clients.

A 2020 study of 166 respondents in KSA identified that females have more burn prevalence rates than men. The study also recognized that 88% of burn injuries happen at home, and 36.1% of the burns were flame injuries (Almutlaq et al., 2020). Currently, paediatric burns are among the leading causes of morbidity and mortality in KSA (Akkam et al., 2020). Implementation in healthcare ensures that practitioners deliver patient care as per algorithms and recommendations stipulated in the respective clinical practice guidelines (CPGs).  For instance, the research conducted by Harvard Regents on a patient with burns in Saudi Arabia emulated that the extreme damage   covered (88%) of the body that therefore called for emergency measure (Akkam,2020). This led to the need for critical attention and concern for the patient. The mainstream of the burns was distributed all over the body with the lower body 46.4% whereas the upper body taking up the 36.1%. The patient, however, recovered from the heinous burns that ranged from 0-10% TBSA, which translates to about 62.0% giving an average mean of DLQI scores that ranges. Most skin burns occur at home and the most causative agent is hot water predominantly affecting hands. The majority of burns are treated using topical creams, and only some of them undergo skin grafting. There is a relatively higher degree of acceptance of skin burns treatment outcomes among the Saudi population (Amultlaq, 2020). Treatment of such essential and urgent services is provided for by the Systematic Advisory Board that regulates the implementations of the guidelines. The board has a good number of members who represents the interest of the researchers and technician. The EBI Literature Services Advisory Board convenes Annual General meetings to advise the EMBL-EBI on all features of the Literature Files and Service area, thus setting the expansion and progress of the resources in the background of the systematic communal within Europe and beyond.

The implementation of CPGs in the Kingdom of Saudi Arabia (KSA) is dependent on its network of primary healthcare facilities and hospitals (Almutlaq et al., 2020). CPGs in burn care, and their successful implementation, are vital to the successful delivery of burn care. There is a gap in the current studies regarding the implementation of clinical policy in burn care in Saudi Arabia. Consequently, this research seeks to address the research gap by conducting a readings on the barriers to CPG adherence in Saudi Arabia.

Background

The emergency and critical implementation guiding principle stamps very strong  statements that  seek to optimize patient care through systematic evidence-based recommendations, as well as the potential harms and benefits of implementation (Amer, 2020). According to (Ament S. 2015), the implementation of medical practice guidelines is vital in ensuring that the emergency service are promptly provided. The level of implementation of  the emergency guideline  practice  tend to decline among healthcare professionals after the first year of the guideline implementation , a case that is experienced in countries which failed to fully implement the recommendations (Ament, 2015). The scope of the research is a perfect fit to Saudi Arabia because with the implementation of the guidelines the health sector experienced upsurge in provision of medical services. They formulated Saudi Critical Care Unit that outlined the regulations that were to be enacted and implanted. The formulated guidelines played a key role in facilitating examination and psychological sustenance to the victims who required emergency medical attention (Seker,2019). The policy also  emphasized  on the need to cancel pre planned leave during a pandemic  to  prevent problems related to inadequacy in  personnel required to carry out the emergency operations  (Keenan, 2020) . Importantly is improving the morale of the staff and health workers safety. With high morale the staff who are the implementers of the guidelines would double up their effort to ensure that the emergency practises recommendations are enacted and adequately implemented. Improving staff morale is very imperative in the implementation process. This can be easily done by supporting the staff by introducing and increasing risk allowance to motivate the workers, providing necessary equipment to offer protection to the health workers (Joey, 2015).  Failure to provide the required support for healthcare workers would to discontent and even take the worst turn of events which is   industrial actions such as boycotts that negatively impacts to the health care system, an evident case in Kenya where Nurses and other doctors went on strike citing the cause negligence of healthcare practitioners by the health ministry (Amer,2020)).  The study has developed rationale of determining the greatest extent how implementation   of recommendations can impact on the economy (Batais, 2020). The analysis is keen on the metrics that would facilitate prompt implementation of the guidelines. Among those identified metrics to succefull emergency guidelines success include:

Staff supportive measures such as providing meals and drinks for frontline workers as an implementation guideline provide motivation to the staff who gain the zeal of working to save lives even if the emergency requires risking of live like for the case of the novel Corona Virus that ravaged many economies (Shekar, 2017)

Additionally, integration of the existing health care system with the top performing recommendations such as the American Association of Respiratory Care (AARC) that recommends using the highest technology equipment is a better strategy to implementation of the recommendations (Burks, 2020)

Another implementation recommendation is that ventilators with built-in air compressors, if available, should be placed on standby and only used when clinical areas lack compressed medical air outlets or when all other available ventilators are used. (Keenan, 2020).  It is also imperative to mention that many countries imitated Saudi Arabia in implementing the policies but dii not succeed since there were no elements of commitment and support from the top management (Almutlaq et al., 2020).

Cases of burn injuries that require emergency medical attention in Saudi Arabia is estimated to be 18000 cases which translates to 12 % of the total critical emergency services. Overall death toll averagely 600 is reported annually, this is only 3% of the total reported cases.  These statics are positive as they insinuates that the country is doing well in managing the situations hence keeping low death toll. (Almutlaq et al., 2020).

Revisions have shown that the main guideline implementation barriers are also associated with the process of formulating or implementing a guideline (Joy, Bielby, & Searle, 2015; Wilson et al., 2017). Specifically, the evidence and applicability of recommendations are essential factors that determine the development case’s success. In regard to burn care, the rules may be a useful tool in translating medical research about burn care and offer expert recommendations that inform nurses and professionals’ practical work in burn care departments (Searl, 2015). Despite the growing field of rules and medical recommendations, research indicates that recommended general healthcare procedures are often implemented among the professionals to help solve all emergency cares, including injuries sustained in burns or accidents. (Wilson et al., 2017). Saudi Arabia is registered with the international Scientific Advisory Board that is key in providing guidance on matters relating to systematic research and innovations thereby ensuring that the guidelines are promptly implemented. The board has a decent amount of acquaintances whose interest are represents by the selected few all over the globe. (Bielby, 2015)

Current research  conducted in third world countries and war-prone nations as Afghanistan and Vietnam about thirty to forty percent of patients receiving such services without scientific backing since most of them are taught first Aid techniques which can help reduce pain but not very efficient for healing purposes. (Buksh et al. 2019). Despite the available literature, comprehensive studies on the execution of burn care CPGs in Saudi Arabia are yet to be conducted or released (Joey, 2015). This paper seeks to address that gap by assessing the barriers to enactment of burn care CPGs in KSA.

The enactment of CPGs in the Kingdom of Saudi Arabia (KSA) is reliant on on its vast reach of primary healthcare facilities and hospitals (Almutlaq et al., 2020). CPGs in life-threatening and emergency care, and their effective execution, are vital to positive conveyance of serious care. The implementation of the guide og principles to be followed  fills the gap that existed in  the current studies regarding the implementation of clinical commendation in burn care and other emergency services that require critical attentions  (Almahamad ,2020).

Aim of the Study

The study aims at establishing the benefits that could be realised if the guidelines for implementing clinical services is properly initiated and achieved by the emergency and critical care departments.

Objectives of the study

This study aims to achieve the to explore the Implementation Guidelines for Emergency and Critical Services in Emergency and Intensive Care departments. Findings from this study will inform the process of making recommendations to enhance its implementation to improve patient care and safety.

Methodology

Design

The research is based on a systematic literature review, qualitative research, and a quantitative study (Almutlaq et al., 2020). What are the barriers to proper implementation guidelines in emergency? The quantitative study will measure the awareness of the nurses to implementation CPGs. The quantitative study will be questionnaires distributed to nurses to explore the awareness of nurses to implementation CPGs. The qualitative research study will explore the barriers to implementation CPGs. The qualitative research study will include one-to-one interviews. Interviews will be scheduled with nurse professionals working in the emergency department and critical unit. Interviews will also entail the hospital administration. The rationale to involve the hospital administration is to seek information on the possible causes of barriers to implementing guidelines at the management level.

Sample 

The sample will be select from two significant healthcare facilities in Saudi Arabia the facilities played critical roles in the fight against COVID 19 Pandemic, the menace that ravaged many health systems like for the cases of Italy and Spain where the health system was overwhelmed due to the hard-hit of the pandemic in the area.  The inclusion criteria for the selection of samples that every participant should be a registered nurse with experience at least three years and work in emergency or ICU departments. The rationale for the three years threshold is that previous studies have found out that the adherence of professionals to healthcare guidelines decrease after more than a year of the guideline implementation (Ament et al., 2015).

Data Collection

Data collection denotes the techniques used in data gathering in the research   study. (Snyder, 2019) .Surveys are very important so as to ensure that the right critique is researched. The research should be able to have a strong thesis and with analytical approach. Additionally,   I shall use a structured type of questionnaire where all the statements and questions are predetermined and pre planned. The respondents would be required to tick whether they agree or disagree with the statements in the questionnaires. A questionnaire has several queries in a precise and detailed order on a form (s). Selection and assortment of the tool is done according to the size of the target population, time and study aims that focuses on critical data on employee experience (Amer, 2020). Data collection process and procedure is synchronized and chronologically gathered, measured and analysed if they meet the main facts on the study objectives. (Almutlaq et al., 2020).

The study will be based on a mixed-methods approach. The study will use qualitative and quantitative studies that will be preceded by an analytic literature review. A systematic appraisal and review of the literature provides information about previous findings, and the different methods used to arrive at different conclusions (Snyder, 2019). A well-conducted literature review can also help the researcher identify existing gaps in the current area of study. Therefore, analysis of the available literature is a vital step before starting on primary research. This qualitative study uses data collection methods individual interview. (Searl, 2015).

In this study, data collection will entail individual interviews, which will be used to record the feelings, insights and experiences of the participants towards the barriers of implementing CPGs. One-on-one interviews will also present the participants with a confidential and private setting to reflect on their experiences and encourage them to raise any sensitive issues. The quantitative aspect will be achieved by issuing an online questionnaire designed to explore the awareness of nurses to implementation

References

Akkam, A. Y., Joarder, A., Cruz-Marcelino, N., Mitra, B., Alshehri, S., & Almazroua, F. (2020). Epidemiology of pediatric patients admitted to a burns ICU in Saudi Arabia. Burns Open, 4(3), 90-93.

Almutlaq, B. A., Jarman, A., Alfraihi, R., Albasher, G., Alotaibi, R. M., Alqahtani, A. S., & Ahmed, H. G. (2020). Skin burns in Saudi Arabia: causes, management, outcomes, and quality of life after skin burns. International journal of burns and trauma, 10(2), 28.

Alazmy, W., Samarkandi, O., & Williams, B. (2020). The history of emergency medical services response to mass casualty incidents in disasters, Saudi Arabia. Journal of Emergency Medicine, Trauma and Acute Care, 2020(1), 3.

Alshamrani, A., Alshammari, T., Sawyer, S., & Williams, B. (2020). Current state of trauma services in Saudi Arabia. Journal of Emergency Medicine, Trauma and Acute Care, 2020(1), 6.

Ament, S. M., de Groot, J. J., Maessen, J. M., Dirksen, C. D., van der Weijden, T., & Kleijnen, J. (2015). Sustainability of professionals’ adherence to clinical practice guidelines in medical care: a systematic review. BMJ open, 5(12), e008073. https://europepmc.org/article/med/28681446

Buksh, N. A., Ghani, M., Amir, S., Asmat, K., & Ashraf, S. (2019). Assessment of Nurses’ Knowledge and Practice for Prevention of Infection in Burn Patients.

Batais, M. A., Alzahrani, S. A., Alzahrani, N. A., Alsolimi, A. F., Khan, A. A., Aldossari, K. K., … & Almigbal, T. H. (2020). Knowledge and Practice of Burn First Aid Among Saudi Arabian Medical and Non-Medical University Students. International Quarterly of Community Health Education, 0272684X20972644.

Lotfi, M., Mirza Aghazadeh, A., Davami, B., Khajehgoodari, M., Aziz karkan, H., & Khalilzad, M. A. (2020). Development of nursing care guideline for burned hands. Nursing Open, 7(4), 907-927.

Shekar, K., Badulak, J., Peek, G., Boeken, U., Dalton, H. J., Arora, L., … & Pellegrino, V. (2020). Extracorporeal life support organization coronavirus disease 2019 interim guidelines: a consensus document from an international group of interdisciplinary extracorporeal membrane oxygenation providers. Asian Journal.

Keenan, S. P., Snuff, T., Burns, K. E., Muscedere, J., Kutsogiannis, J., Mehta, S., … & Canadian Critical Care Trials Group/Canadian Critical Care Society Noninvasive Ventilation Guidelines Group. (2011). Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. Cmaj, 183(3), E195-E214.

Joy, H., Bielby, A., & Searle, R. (2015). A collaborative project to enhance efficiency through dressing change practice. Journal of wound care, 24(7), 312-317.

Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333-339.

Wilson, P. M., Sales, A., Wensing, M., Aarons, G. A., Flottorp, S., Glidewell, L., & Straus, S. (2017). Enhancing the reporting of implementation research.

Perkins, G. D., Jacobs, I. G., Nadkarni, V. M., Berg, R. A., Bhanji, F., Biarent, D., … & Zideman, D. A. (2015). Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on resuscitation (American heart association, European resuscitation Council, Australian and New Zealand Council on resuscitation, heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of southern Africa …. Circulation, 132(13), 1286-1300.

Ibrahim, N., Almeziny, M., Alhamad, A., & Farrag, A. Local Experience for Managing Oncology Services during COVID-19 Pandemic in a Tertiary Care Hospital in Saudi Arabia.

Amer, H. A., Alowidah, I. A., Bugtai, C., Soule, B. M., & Memish, Z. A. (2021). Challenges to Infection Control Team during COVID-19 Pandemic in a Quaternary Medical Center in Saudi Arabia. Infection Control & Hospital Epidemiology, 1-20.

A., Alzahrani, S. A., Alzahrani, N. A., Alsolimi, A. F., Khan, A. A., Aldossari, K. K., … & Almigbal, T. H. (2020). Knowledge and Practice of Burn First Aid Among Saudi Arabian Medical and Non-Medical University Students. International Quarterly of Community Health Education, 0272684X20972644.

Alhamad, A., & Farrag, A. Local Experience for Managing Oncology Services during COVID-19 Pandemic in a Tertiary Care Hospital in Saudi Arabia.