• Clinical Practice Guideline Development, Implementation, and Evaluation in an Oncology Practice

      Mallare, Stacy S. (2017)
      Background: Forty percent of adult cancer patients suffer from at least one clinically significant episode of anxiety and/or depression during their illness. When these mental health problems are untreated, patients will adhere less to their treatment regimens and have weakened immune systems thereby leading to more disease- related complications and higher rates of morbidity and mortality. Despite the high rate of comorbid emotional distress in cancer and its negative sequelae, most patients are not receiving appropriate care. Clinical practice guidelines can direct the detection and treatment of mental health problems that can be integrated into the cancer setting. Purpose: The purpose of this quality improvement project was to develop a best-practice guideline to screen, assess and manage patients with depression and cancer and test its feasibility in an out-patient oncology practice. Procedure: A multi-disciplinary consensus group reviewed recent literature and solicited staff opinion to develop a set of eight best practice recommendations adapted from the American Society of Clinical Oncology Guidelines for Depression and Anxiety. Based on these recommendations, a stepped-care model was developed using a multidisciplinary framework and including an algorithm with a clinical pathway to guide treatment and work flow. During a five-week period all new patients were screened at their first appointments with the Patient Health Questionionnre-9, (PHQ-9) a self-administered, nine-item scale to detect presence and severity of depression. Based on their scores, they were offered psychosocial education and, if necessary, referral to community mental health specialists. Descriptive statistics were computed to calculate PHQ-9 scores, frequency of use of tool and success of the stepped care model to direct care. Results: Between the times of data collection, 308 patients were admitted to the clinic. Of these, 240 were successfully screened for depression. One-hundred and eighty-nine of these screenings were reviewed by the patient’s provider. According to the cut-off criteria for mild (5-9), moderate (10-14), and severe (>15) depression, 84 (mild), 16 (moderate) and 9 (severe) patients were identified as positive cases. Over half of the patients (55%) were negative for depression while over a third (35%) reported minimal depression. A small portion of patients had moderate (7%) and severe (3%) depression. Of the 109 positive screens (PHQ-9 score ≥5), in 61 cases, the appropriate hand-off communication to social work occurred. Of the patients successfully triaged to social work, all were provided psychoeducation and moderate and severe cases of depression were also provided with at least one community referral. Adherence to protocol was 78% and was calculated based on: the number of patients successfully screened over the five-week period (240), the number of patient screenings reviewed by the patient provider (189) and the number of patients successfully referred to social work (61). Conclusion: Strategies to increase adherence include improving handoff interdisciplinary communication particularly between the technicians responsible for the screening and the social worker completing the advanced assessment. This could be done by streamlining work flow processes such as assigning one staff member per shift to complete all screenings which would also increase accountability. Clinical guidelines and an algorithm to guide practice should be adapted by all clinical facilities. This project increased ability of providers to identify depression in cancer patients and successfully directed patients to receiving the level of care appropriate to their need.
    • Clinical Practice Guideline for Management of Pulmonary Hypertension Patients Undergoing Non-Cardiac Surgery

      Woods, Kathryn A. (2017)
      that 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.
    • Clinical Practice Guideline for Planned Cesarean Section: Intraoperative Interventions

      Gilmore, Lara E.; Amos, Veronica Y. (2020-05)
      Problem & Purpose: Thirty percent of all births in the United States are performed by cesarean delivery (CD) making it the most common surgical procedure performed. Common complications include Spinal Induced Hypotension (SIH) and Post Spinal Shivering (PSS), which can have a detrimental impact on the mother and the fetus. Another factor that contributes to infant morbidity and mortality is not practicing delayed cord clamping (DCC). Lack of guidelines to manage intraoperative complications and DCC results in a variation in practice among anesthesia providers, leading to an increase in maternal and fetal morbidity and mortality. The purpose of this quality improvement project was to develop a clinical practice guideline (CPG) incorporating evidence based best practice interventions to standardize and optimize care of women undergoing planned CD to reduce the incidence of SIH and PSS. It also included the standardization of delayed cord clamping (DCC) times to decrease morbidity and mortality among healthy infants. Methods: An extensive literature review focused on management of SIH, PSS and DCC was conducted. A CPG was drafted and presented to a team consisting of Director of Obstetrics Anesthesia and Director of Fetal and Maternal medicine who analyzed the CPG utilizing the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Modifications were made based on results and the CPG was presented to the anesthesia providers within organization who evaluated the usability of the CPG utilizing the Peer Feedback Questionnaire (PFQ). Results: Two AGREE II tools were distributed and completed representing a 100% response rate. Each of the domains on AGREE II tool received a score greater than 70% indicating good quality. The overall guideline assessment score was 91.7%. A total of 39 PFQs were distributed to anesthesia providers, 17 were completed representing a 43% response rate. Analysis of the PFQ revealed a total percentage of agreement of 87.4% with a standard deviation of 6.6. The percentage of agreement was also calculated for the five subscales. Quality and acceptance of CPG received the highest scores of 97.9% and 87.5% respectfully while the lowest score of 39% was obtained in applicability. Conclusion: Favorable results on AGREE II tool and PFQ demonstrated the CPG was of good quality and well accepted by anesthesia providers. Implementation of the CPG has the potential to improve the standardization and optimization of women undergoing planned CD as well as standardizing DCC times to improve infant morbidity and mortality.
    • A Clinical Practice Guideline for Postoperative Cognitive Impairment: Anesthetic Interventions

      Taylor, Natalie L.; Pellegrini, Joseph (2020-05)
      Problem & Purpose: Postoperative delirium and postoperative cognitive dysfunction, collectively referred to as postoperative cognitive impairment (PCI), are two neurocognitive risks that accompany anesthesia. The incidence of developing PCI can be as high as 50% and is heightened after the age of 65. Currently, the anesthesia department at a mid-sized community hospital in Baltimore City does not have a structured process for the perioperative management of these patients. A Clinical Practice Guideline (CPG) was written recommending a strategy to preoperatively assess and identify high-risk surgical patients, and includes evidence-based anesthetic interventions recommended for this population. The purpose of this scholarly project was to identify the anesthetic interventions included within this CPG: a guide which outlines the perioperative anesthetic management of patients >65 in order to decrease the incidence of PCI. Methods: CPG content was derived from a literature search identifying evidence published within the past 10 years and included five systematic reviews, two randomized control trials, and the current recommendations of the American Geriatrics Society and American College of Surgeons. The CPG was designed, analyzed by key stakeholders, and revised according to criteria found within the AGREE II tool. The CPG was presented to anesthesia staff and analyzed for applicability and acceptance using the Practitioner Feedback Questionnaire (PFQ). Results: AGREE II results by key stakeholders provided >88% positive feedback showing CPG quality in scope, content, and development. PFQ results demonstrated an overall average positive feedback and agreement of 70% (SD=19.1) among anesthesia providers (n=13). Feedback regarding the overall Quality of the CPG was both positive (88%) and neutral (12%). Applicability of Recommendations received the least encouraging feedback: 35% positive, 38% neutral, and 27% negative. Conclusion: Analysis demonstrates that the CPG’s content was regarded by anesthesia staff as high quality and that the majority of providers believe the CPG to be an improvement compared to what is currently practiced. While the majority of the polled anesthesia providers felt favorably towards the interventions, there remains reluctance towards its applicability into practice. Even so, 70% of anesthesia staff answered positively when asked if the CPG should become a guideline. Further staff education is recommended to enhance user buy-in.
    • A Clinical Practice Guideline for Staphylococcus aureus Decolonization in Select Surgical Outpatients

      Celotto, Abigale A. (2017)
      Surgical site infections (SSI) are among the most prevalent types of hospital-acquired infections, causing substantial negative consequences for patients and health care systems, including increased morbidity and mortality rates, and higher costs to hospitals and insurers. Preoperative nasal colonization with Staphylococcus aureus (S. aureus) is an independent risk factor for the development of an SSI. Decolonization bundles that include combined use of nasal S. aureus colonization screening, targeted nasal decolonization, and preoperative Chlorhexidine gluconate (CHG) bathing are an effective means of SSI prevention. The purpose of this DNP scholarly project was to develop and evaluate an institutional clinical practice guideline (CPG) for the decolonization of S. aureus in adult, non-emergent cardiac surgery and total hip and/or knee arthroplasties. This manuscript focuses on the CHG recommendations within the larger decolonization bundle. The setting for this project was an ambulatory, Patient Readiness and Evaluation Center within a tertiary, mid-Atlantic medical center. It was anticipated that the guideline would be evaluated and graded as high quality and be considered reasonable and practical for implementation. Guided by Steven’s Stevens Star Model of Knowledge Transformation, the CPG was developed and evaluated in three phases. Prior to Phase One, a thorough evidence review and first draft of the CPG were completed. Phase One involved introductory meetings with stakeholders while Phases Two and Three were evaluation and revision phases. Two samples& Evaluation (AGREE II) Tool. The second sample consisted of eight end-users who assessed the CPG for applicability and sustainability utilizing the Practitioner Feedback Questionnaire. All six domains within the AGREE II tool scored greater than the targeted 80% agreement. The highest scoring domain was Editorial Independence with 94% agreement, while the lowest scoring domain was Applicability scoring 82% agreement. The final item, Overall Assessment of the Guideline, scored 90% agreement all SMEs stating they would recommend use of the guideline. Components that scored close to 80% were revised before Phase Three commenced. Of the four factors within the Practitioner Feedback Questionnaire, quality scored the highest with 93.75% favorable responses, while applicability of recommendations scored the lowest with 35.5% positive responses. Overall the CPG was found to be of high quality and practical for implementation with all SMEs and end-users stating they would use the CPG if it were implemented at their facility. The overarching goals of the CPG to standardize practice and minimize patient morbidity aligned with the institutional missions to deliver superior health care and discover ways to improve health outcomes. If the CPG were implemented as standard institutional practice, it is anticipated that the number of SSIs, specifically S. aureus infections, would decrease, reducing the targeted medical center’s healthcare costs and improving patient outcomes.
    • Clinical Practice Guideline for the Decolonization of Staphylococcus aureus in Surgical Patients

      Moledina, Ashifa (2016)
      Background: A surgical site infection (SSI) is a post-surgical complication closely linked with increased morbidity and mortality. SSIs are preventable with appropriate care and insurers no longer reimburse for their cost. Chlorhexidine Gluconate (CHG) is an antiseptic agent that is used preoperatively, often within a decolonization bundle, as a safe and cost effective means of decreasing the risk of SSIs. Objective: The purpose of this doctorate of nursing practice (DNP) project is to develop an evidence based, standardized, pre-operative CHG bathing regimen for surgical patients to be utilized in a decolonization clinical practice guideline (CPG) for elective cardiac and hip and knee arthroplasty patients at the targeted pre-op center. Design: Three DNP students developed an evidence based CPG which was evaluated for guideline quality, methodological rigor, and transparency by a group of subject matter experts (SME) (n=7) using the AGREE II tool platform. After incorporating SME feedback, the revised CPG was distributed to a group of end users (n=8) for evaluation of guideline’s quality, applicability and acceptability utilizing the Practitioner Feedback Questionnaire (PFQ). Results: All domains of the AGREE II tool were scored above the 80% benchmark with Editorial Independence scoring the highest at 94% and Applicability scoring the lowest at 82%. The PFQ Applicability scores were also low with only 35.4% favorable responses however 100% of respondents from both groups recommended this CPG for practice at their site Implications: Earlier stakeholders and end user engagement may have increased CPG applicability while decreasing staff’s reluctance to change. The finalized CPG was distributed to the Department of Infection Prevention and Hospital Epidemiology and target site staff for future implementation.
    • Clinical Practice Guideline for Utilizing Sugammadex in Reversal of Neuromuscular Blocking Agents

      Hansen, Karissa; Pellegrini, Joseph (2019-05)
      Background: Residual paralysis is ongoing presence of muscle weakness postoperatively following the administration of a neuromuscular blocker and subsequent reversal agent during the intraoperative period. Presence of residual neuromuscular blockade postoperatively has been associated with increased mortality and morbidity, low oxygenation, and respiratory complications. Recent studies have shown incidences of residual neuromuscular blockade ranging from 16 to 60 percent. Local Problem: A medium sized hospital in Maryland reported postoperative complications associated with residual paralysis. Increased side effects such as muscle weakness, increased length of stay in Post Anesthesia Care Unit, and delay in discharge may be due to the lack of guidelines for reversal of non-depolarizing neuromuscular blockers. A meeting with institutional key stakeholders identified the need for a guideline for the use of sugammadex in prevention of residual paralysis. Development of CPG: The focus of this project was to develop a Clinical Practice Guideline for the use of sugammadex in the prevention of residual paralysis for high risk patients and in emergent situations such as cannot intubate, cannot ventilate scenarios. A literature review was conducted to support evidence for the Clinical Practice Guideline, gathered data was presented to the key stakeholders. The project proposal was then submitted to the University of Maryland, Institutional Review Board and granted a Non-Human Subjects determination. The quality of the Clinical Practice Guideline was assessed by institutional key stakeholder and analyzed using the AGREE II tool and then presented to the entire anesthesia department for further evaluation. Adjustments to the Clinical Practice Guideline were made following departmental feedback and a final Clinical Practice Guideline along with algorithms were developed for this project and were distributed throughout the perioperative arena. A further assessment was done by the department using Practitioner Feedback Questionnaires. All data collected from the AGREE II tool and the Practitioner Feedback Questionnaires were synthesized, analyzed, and evaluated. The final project manuscript was submitted to the University of Maryland School of Nursing Doctorate of Nursing Practice committee for review. Results: The results of the final AGREE II Tool were 100% across the 6 domains and for the overall assessment. Each appraiser had a total score of 161/161 points and an overall of 322/322 points. The anesthesia providers, the end users of the guideline, evaluated the Clinical Practice Guideline using the Practitioner Feedback Questionnaires. Majority of anesthesia providers felt the guideline should be approved for practice (95.5%) and felt if the guideline was approved, they would use it in their own practice (100%) and would apply the recommendations to their patients (100%). This analysis demonstrated buy-in and acceptance of the Clinical Practice Guideline by the department. Conclusion: Study results indicate sugammadex compared to current reversal, neostigmine, is safe and effective in the reversal of neuromuscular blocking agents and reduces adverse events and undesirable side effects. The approval of the Clinical Practice Guideline can change clinical practice and improve patient care. A standardized approach for reversal of neuromuscular blockade with the use of sugammadex will decrease the incidence of residual paralysis in this institution.
    • Clinical Practice Guideline on Utilizing Low-dose Ketamine Infusions for Treatment Resistant Depression

      Hunt, John H.; Amos, Veronica Y. (2021-05)
      Problem & Purpose: Standardly prescribed medications have increasingly become less effective in mitigating depression. This finding has led practitioners to explore alternative ways to treat refractory depression. Ketamine, a dissociative anesthetic, given as a low-dose infusion has become an efficacious regiment for managing the treatment resistant populations symptomology. Clinicians at an outpatient infusion center observed an increase in infusion related hemodynamic abnormalities due to non-standardized infusion therapies. The development and implementation of an evidence-based clinical practice guideline to standardize the administration of low-dose ketamine infusions aims to help alleviate the identified institutional problem. Methods: An extensive literature review was conducted to evaluate the most current evidence regarding ideal ketamine infusion rates to manage treatment resistant depression. A draft clinical practice guideline was developed with assistance from the institution’s stakeholders. The Appraisal of Guidelines for Research and Evaluation II tool was utilized by the stakeholders to appraise the draft guidelines quality. The finalized guideline was presented to the anesthesia team members and critique via provider feedback questionnaire was elicited. Results: The appraisal tools overall domain rating was an 88.9%, which represented a high-quality practice guideline. Provider feedback questionnaire results showed the developed guideline was accepted by stakeholders and anesthesia staff. Implementation of the new practice guideline was recommended without any changes. Conclusion: The anesthesia team valued the developed guideline which led to its acceptance. However, sustainability will rely on the provider success rates based on the utilization of the guidelines recommended dose range as well as periodically collecting and assessing provider feedback questionnaire data to ascertain the level of continued staff buy-in.
    • A Clinical Practice Guideline: Pre-Emptive Opioid Sparing Analgesia in Total Hip and Knee Arthroplasty

      Bob-Manuel, Bateim; Pellegrini, Joseph (2019-05)
      Background: Traditionally, postoperative pain has primarily been treated using opioids. Use of opioids as the “mainstay” of pain management can result in psychological addiction and adverse effects, such as nausea and vomiting, sedation, dizziness, constipation and respiratory depression all of which may delay patient discharge. effects. Preemptive multimodal analgesia involves the introduction of an analgesic pain regimen before the onset of noxious stimuli such as the surgical incision. Recent understandings in pre-emptive analgesia have defined it as an intervention given before incision or surgery, given that it is more effective than the same treatment administered after incision or surgery. Multimodal pain management solutions are associated with fewer opioid-related side effects, along with fewer interruptions to physical therapy. Additionally, this approach interchanges opioids pharmaceuticals with non-opioid analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDS), selective cyclooxygenase-2 (COX-2) inhibitors, and gabapentinoids. Local Problem: This Doctor of Nursing Practice project aimed to develop a clinical practice guideline to serve as a guidance for anesthesia providers in regards with the initiation of preemptive opioid sparing analgesia for total knee and hip arthroplasties at a large community hospital in Maryland. Currently there is no guidelines for the use of administration of preoperative analgesia for the TKA/THA patient at this institution. Intervention: The development of the guideline occurred in three phases. Phase one encompassed the recruitment of stakeholders and initial drafting of the clinical practice guideline. Phase two included the utilization of The Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool to assess the quality of the guideline. The finalized guideline was presented at Grand Rounds to the anesthesia department staff. A Practitioner Feedback Questionnaire (PFQ), was handed out at the beginning to all in attendance for evaluation of the CPG. Lastly, phase three encompassed the graduate students presenting final approved guideline in entirety to the anesthesia department, a performance of data analysis/evaluation, submission of finalized manuscript to the stakeholders for review, and final presentation of doctoral project in the form of a poster presentation. Results: Domain scores from the AGREE II tool ranged from 71.6 to 100%. The highest rated domain was “Editorial Independence” at 100%. Other strongly scored domains included “Scope and Purpose” at 94.4%, “Clarity of presentation” at 83.3% and “Rigour of Development” at 84.7%. The lowest rated domains included “Stakeholder Involvement” at 47% and “Applicability” at 80.4%. The students received 74% return rate of the Practitioner Feedback Questionnaires at the presentation (n=29). Most anesthesia providers felt the guideline should be approved for practice (95.5%), would use it in their own practice (100%) and would apply the recommendations to their patients (100%). Conclusions: The cumulative result of multimodal analgesia is a promising alternative that may reduce needs for high doses and dependence on opioids along with any potential associated adverse effects. The total cost of utilizing the medications mentioned in the CPG would be roughly $6,300 in one year, which can result to a 73% savings when compared to their current practice.
    • Clinical Practice Guidelines for the Anesthetic Management of Patients with Pulmonary Hyertension

      Naper, Jessica E. (2017)
      Problem: Pulmonary Hypertension (PH) is a severe, progressive, disease with limited treatment options and poor prognosis. The risk of morbidity and mortality increases significantly when patients with PH must undergo surgery. There is a reported 42% increase in morbidity of patients with PH and the rate of perioperative mortality varies between 1-18% for patients undergoing non-cardiac, non-obstetric surgery. A small, academic, secondary care hospital within Maryland has reported an increase in adverse events among patients with PH, including unexpected or prolonged ICU admissions, and respiratory failure. The hospital has identified a need to standardize the care of anesthesia providers in the areas of perioperative management of PH to maximize outcomes and reduce morbidity and mortality. Objective: The purpose of this doctor of nursing practice (DNP) project was to develop and evaluate a clinical practice guideline (CPG) for the intraoperative anesthetic management of PH patients presenting for non-cardiac, non-obstetric surgery. The anticipated outcome of implementation was a reduction in perioperative adverse events such as respiratory failure, heart failure, hemodynamic collapse, abortion of surgical procedure, and unexpected ICU admission. Methods: The project occurred in a three stage format. In the first stage, the most current literature on the intraoperative management of patients with PH was evaluated and a guideline developed using Brower’s Agree II tool. The tool consists of 23 items within 6 quality domains; each domain focuses on a specific feature of a CPG. A team of appraisers critically analyzed and scored the guideline using the Agree II tool. In the second stage, the guideline was evaluated by anesthesia providers using Brower’s practitioner feedback questionnaire (PFQ). This tool seeks and purpose (86%), stakeholder involvement (92%), clarity and presentation (85%), and editorial independence (100%). The lowest scores where in the areas of: rigour of development (80%), and applicability (60%). From the PFQ data agreement or strong agreement was indicated 88% of the time when practitioners were questioned about the need for a guideline, or agreement with the guidelines content. However, the results of the PFQ echoed weaknesses brought to light by the Agree II appraisal. Only 72% of providers agreed that the draft recommendations would make an obvious effect on patient outcomes. Implications: Based on the Agree II and PFQ results, guideline developers decided to incorporate facilitators, barriers, and implications of guideline use into the CPG. The guideline team strongly believes that it is prudent for providers to use the best evidence available to treat patients, and while PH research is limited, the sources that are available should be consulted as a guide for better outcomes. After final review, guideline recommendations were submitted to the anesthesia department as a source of quality improvement. These guidelines are not to be considered generalizable knowledge.
    • Enhanced Recovery After Surgery for Cesarean Delivery Clinical Practice Guideline: Postoperative Interventions

      Wali, Alexandra; Amos, Veronica Y. (2020-05)
      Problem & Purpose: In the United States, the cesarean delivery rate is approximately 32% of all births, with well over a million performed each year. Compared to women who performs spontaneous vaginal births, cesarean deliveries are associated with a prolonged length of stay. These women are usually young and healthy, possess the ability to achieve a rapid recovery, and have a unique incentive to return to their baseline functional capacity in order to care for their newborn. Enhanced Recovery After Surgery (ERAS) is a standardized set of perioperative interventions implemented to improve surgical outcomes, optimize patient care, and reduce hospital costs. Even though there is an enormous amount of evidence to support the improvements ERAS has made for perioperative care pathways among many surgical specialties, obstetrical surgery lacks established protocols based on such principles. The purpose of implementing the ERAS clinical practice guideline (CPG) is to standardize care throughout the perioperative period and optimize recovery for parturients undergoing elective cesarean deliveries. Methods: The CPG was created using high quality evidence and subsequently evaluated by elected stakeholders using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Dissemination took place following the incorporation of stakeholder recommendations and feedback. A Practitioner Feedback Questionnaire (PFQ) survey following the formal presentation or the CPG during grand rounds was given to anesthesia staff to assess acceptability and usability of the CPG. Results: Feedback received from the AGREE II Tool and PFQ show satisfactory results on the quality, usability, applicability, and acceptance of the CPG. Conclusion: The favorable AGREE II Tool assessment results, widespread acceptance of the interventions among staff as evidenced by the PFQ results, as well as the strength of evidenced utilized to create the recommendations included in the CPG, will facilitate the quality and safety of recovery for elective cesarean deliveries at the institution of interest.