The guidelines which were presented in the CPG Recommendation address topics which are mainly concerned with surgical site infections which occur in the wounds of the individual or of the patient and created after the performance of an invasive surgical procedure. The issues which these guidelines address include recommendations which are practical enough given in clear and concise formats with immediate priority on the efforts to potentially lessen the infections which might appear in the surgical sites in acute care hospitals. The major outcomes which were considered in these guidelines include the rate or the likelihood of the surgical site infection to happen, the length or the time necessary for post-operative hospitalization, the rate of mortality, cost associated to the practice, and specificity and sensitivity of the surveillance methods.
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What population of patients is the guide intended for?
The Clinical Practice Guideline which was reviewed is intended for patients who are confined or under the shelter of acute care hospitals especially those individuals who are undergoing their respective surgeries in the United Kingdom.
What process was used to develop the guidelines?
The process which was use in order to carry out and develop a Clinical Practice Guideline include computerized searching of electronic databases in public medicine regarding those previously published guidelines and recommendations relevant to each section.
What clinical outcomes were the guidelines designed to achieve?
The Clinical Practice Guideline was designed to be able to achieve the outcomes listed below:
1. Reducing the rate of surgical site infections
2. Length of post-operative hospitalization
3. Mortality
4. Cost
5. Specificity, sensitivity of existing surveillance methods
What group or groups produced it?
The guideline was produced through a group of individuals who were commissioned by the National Institute for Health and Clinical Excellence (NICE). Such was developed in accordance with the guideline development process as outlined in the NICE Technical Manual. It was produced by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee.
What is the date on it and how recent are the research sources cited?
The date which was indicated on it was October 2008. Furthermore, the research sources which were cited include references which were made, written, or produced from 2007 up to the current year.
Credibility
Was the panel that developed the guideline made up of people with the necessary expertise? Yes _X_ No ____
Being composed of two surgeons, a tissue viability nurse, two microbiologists, a theatre nurse, surveillance coordinator, infection control specialist, and two patient representatives, it is safe to say and assume that the panel that developed the guideline was indeed composed of individuals equipped with the necessary expertise.
Was a systematic and comprehensive search for research evidence conducted?
Yes __X__ No _____
For every clinical question, the recommendations for clinical care were derived using, and linked explicitly to the evidence which actually supported them.
Are the criteria for selecting research evidence clearly described? Yes __X__ No _____
The guideline made use of relevant published evidences regarding the topic of the study and there were also evidences for consideration submitted by stakeholder organizations. Such research evidences make it clear that the criteria were indeed actually clearly described.
Is the evidence supporting each recommendation indicated and/or discussed?
Yes _____ No __X_
The evidence presented to support the recommendations is not specifically stated for each recommendation.
Is it clear when research evidence was lacking and expert opinion became the basis of the recommendation? Yes _____ No __X__
On the guidance presented, there seems to be an overriding of the individual responsibility of the healthcare professionals in making their decisions appropriate to the circumstances manifested by the individual patient in consultation with the patient’s guardian.
Was the process for formulating the recommendations systematic and free of bias?
Yes __X__ No _____
It is systematic and free of bias because of the systematic reviews of the evidences and well-conducted meta-analyses which make sure that there is no bias.
Are the guidelines current? Yes _X_ No _____
The guidelines are current because as stated they were release just on October 2008.
Was the guideline peer-reviewed or tested? Yes __X__ No _____
It can be assumed to be peer-reviewed and tested especially because the persons who developed it were experts in their own fields.
ARE THE RECOMMENDATIONS CREDIBLE? YES __X__ NO _____
As shown by the above details, it was developed by expert individuals in their respective fields; it was current, systematic, free of bias, and well-reviewed by both internal and external peers. These reasons make the recommendations credible.
Clinical Significance
Were all important decisions the nurse would have to make addressed by this guideline?
Yes __X__ No _____
The guideline clearly states all the important and vital decisions which will confront the nurse.
Were patient concerns and risks associated with the recommendations addressed?
Yes _X__ No _____
Both the potential benefits and the associated harms with the recommendations were clearly presented in ways which are balance and understandable.
Is there reasonable certainty (based on the research evidence) that the recommendations, if implemented, are likely to produce good patient outcomes? Yes __X__ No _____
It is shown by the formal consensus methods which were used to consider all the clinical care recommendations that have been previously drafted.
ARE THE RECOMMENDATIONS CLINICALLY SIGNIFICANT?
YES __X__ NO _____
The recommendations were clinically significant because the Rating Scheme for the Strength of Evidence shows that the systems reflects that the recommendations were susceptible to nay form of bias inherent in the design of the study.
Applicability
Does the guideline address the problem, situation, or decision we are redesigning in our setting? Yes __X__ No _____
It was able to assist practitioners in making decisions which were relevant to the treatment of a specific condition, it was able to provide guidance on the journey of the patient throughout the different stages of the practice of the surgery, and it was also able to compliment other existing works or studies of relevance.
Should we consider using the guideline in it’s entirely or just parts of it?
Yes __X__ No _____
To fully get the result which was shown by the guidelines, it is not enough that we consider only a part of it, rather the whole of it.
To implement the recommendations, what will we have to do differently?
To have the recommendations implemented, there is a need to offer patients and their caretakers with clear and consistent information throughout the process of the operation.
Do we have the resources and capability to implement the recommendations safely and accurately? Yes _X___ No _____
The presence of different groups and organizations such as the National Health Service and the Department of Health makes it possible to have these recommendations safely and accurately implemented.
Which departments or other providers would be affected by this change and how can we bring them into the change process?
Practitioners in the medical field directly associated to the patient will be the ones to be directly affected. Making them more cautious about the proper use of the medicines and the procedure can help them cope with the changes in the process.
How will we know if our patients are benefiting from our new protocol?
Through a personal interview with the patient or the chief officer of the hospital, we can know the benefits reaped from such protocol.
ARE THE RECOMMENDATIONS (ALL OR IN PART) APLICABLE TO OUR SETTING? YES __X_ NO _____
SHOULD WE ADOPT ALL OR SOME OF THE RECOMMENDATIONS?
YES __X__ NO _____
COMMENTS
After providing a synopsis and a critical review of the Clinical Practice Guideline, it can be assumed that the recommendations are credible, clinically significant, and also applicable to the setting. The guidelines also presented various recommendations to the patients and to the medical practitioners who are involved in the process. These recommendations include providing the patient and their caretakers with clear and concise information regarding the surgery and also on surgical site infections. And advice or recommendation on how to take care of the wounds after the operation is also necessary. They should be also be informed on whom they can contact once there have been surgical site infections manifestations. It is also recommended to inform them that they were given antibiotics and communication is very important between the patient, caretakers, and the medical practitioners especially after the procedure has been done and completed.
