Clinical Practice Guideline for Management of Pulmonary Hypertension Patients Undergoing Non-Cardiac Surgery
Other TitlesPulmonary Hypertension Guideline
Abstractthat can eventually lead to heart failure and death (Strumpher & Jacobson, 2011). Due to the medical advancements made in the diagnosis and treatment of PH, not only has the incidence of PH been steadily increasing (1.1 - 2.4 new cases per million residents each year), the patient population is living longer despite the severity of their condition (Ling et al., 2012). As a result, older and sicker patients with PH have been presenting for surgery which is an area of concern for anesthesia providers. PH is a significant risk factor for perioperative adverse complications and poor outcomes with a mortality rate of 1-7% and a morbidity rate ranging from 6-42% (Kaw et al., 2010; Meyer et al., 2013; Price et al., 2010; Ramakrishna et al., 2005). Anesthesia providers have noticed an increase in patient with pulmonary hypertension requiring surgery at a mid-sized community hospital, where standardize practices are currently not in place to guide the care of this vulnerable patient population. The purpose of this scholarly project is to develop and evaluate a clinical practice guideline (CPG) that anesthesia providers can use in the perioperative management of all adult PH patients undergoing surgery. Three separate phases were utilized in the developed of the CPG. During the initial phase, a clinical practice guideline team was established and guideline revisions were made based on the AGREE II Tool quality appraisal. In the second phase, the facility’s anesthesia staff provided feedback by completing the Practitioner Feedback Questionnaire (PFQ) survey after the CPG was presented by DNP student leaders. The project’s third phase involved presenting the finalized CPG to the facility’s Chief Anesthesiologist to review and provide feedback on the site’s usability. All data was collected blindly and tabulated in Excel, where the statistical analysis was performed. The AGREE tool informed guideline revisions by identifying domains with low quality ratings, thus enhancing the quality of the guideline. The PFQ offered insight to the sample’s demographics and facilitated the CPG’s 82% approval rating among anesthesia staff. These results indicate that the CPG’s intended users support its utilization in practice, as well as the clinical setting’s need for standardize care to assist with the perioperative management of this patient population. The DNP student leaders were able to effectively collaborate with clinical experts to translate applicable evidence into the practice setting and utilize valid instruments to develop a site-specific CPG that can help facilitate management strategies that can improve perioperative outcomes for patients with pulmonary hypertension.
Intraoperative Care--Practice Guideline
Intraoperative Complications--prevention & control
Postoperative Complications--prevention & control
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/6381
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