Browsing Doctor of Nursing Practice (DNP) Projects by Subject "Diagnostic Techniques and Procedures"
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Development of a Guideline Using Procalcitonin as a Guide for Antibiotic TherapyBackground: Antimicrobial resistance (AMR) is a global issue that jeopardizes the health of people worldwide. Antibiotics are overused in the community and in hospitals; there is a blind usage of antibiotics, by treating suspected bacterial infections, viral illnesses or noninfective causes of inflammation which contribute to AMR, increasing costs and is ineffective. There is a need for a rapid blood test to aid in the diagnosis of bacterial infections. The current practice is to use blood cultures, which take 72 hours to result, wasting precious time. Procalcitonin (PCT) is a 116-amino acid that is secreted primarily by the Ccells of the thyroid gland. There is an association between systemic bacterial infections and rapid release of PCT levels. PCT has a sensitivity of 89%, specificity of 94%, a negative predictive value of 90% and a positive predictive value of 94% in the diagnosis of sepsis, and is a more reliable biomarker when compared to C-reactive protein, Interleukin-6 and lactate . Purpose: The Doctorate of Nursing Practice (DNP) scholarly project is a Quality Improvement Project (QIP) used to develop a clinical practice guideline (CPG) for the use of PCT as a guide for the initiation or cessation of antibiotic therapy in clinical practice. Methods: This QIP is a non-experimental approach used in the development of a CPG in a three phase approach through the formation of an expert panel by evaluating the CPG using the AGREE II tool (AGREE Next Step Consortium, 2009) and the Provider Feedback Survey (PFS). Phase one involved forming the expert panel of subject matter experts (SMEs), reviewing the current recommendations, appraising the evidence with the AGREE II tool and providing feedback. In phase two, the revised CPG was again evaluated by using the PFS with recommendations given by the SMEs. Phase three was composed of a second set of stakeholders who were recommended by the initial SMEs , who additionally incorporated feedback of the draft of the CPG by using the PFS. The final draft of the CPG, was then presented to the facility for approval and use in clinical practice. Results: The responses and frequency distributions of the AGREE II tool (N=4) were presented. Scope and Purpose (100%) and Clarity of Presentation (98.6%) scored the highest, with Stakeholder Involvement (58.3%) scoring the lowest. The responses and frequency distributions of the Provider Feedback Survey (N=8) were also collected and scored per percentage of agreement. Both frequency distributions were illustrated with histograms. Respondents overall feedback was favorable with 87.5% stating that they would adopt the CPG if approved, into their clinical practice. Implications: The CPG for the use of PCT as a guide for antibiotic therapy will provide clinicians with an aid in the decision making process for the initiation and cessation of antibiotic therapy for those patients with a suspected bacterial infection. This will enhance clinical practice by decreasing the inappropriate use of antibiotics, reducing unnecessary hospital admissions, decrease length of stay, minimize the treatment of antibiotic induced side effects, improve costs savings and the reallocation of resources.