Practice guideline for arterial blood gas measurement in the intensive care unit decreases numbers and increases appropriateness of tests

Pilon, C S; Leathley, MJ; London, Robert T.; McLean, Sydney; Phang, P. Terry; Priestley, Richard S.; Rosenberg, Fsa Marjorie A.; J, Singer; Anis, Aslam H.; Dodek, Peter

doi:10.1097/00003246-199708000-00016

Cited by 74 publications

(54 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Great personnel and financial resources are required to develop guidelines. Disappointingly, observational studies [1][2][3][4][5][6][7] and randomized controlled trials 8 conducted within the intensive care unit (ICU) have generally shown no clear benefit from the use of guidelines as measured by improvements in processes and outcomes of patient care. High quality professional society practice guidelines such as the recent guidelines for the prevention of ventilator associated pneumonia jointly developed by the Canadian Critical Care Society (CCCS) and the Canadian Critical Care Trials Group 9 may have had a different effect, but this has not been measured.…”

Section: Conclusion : De Nombreuses Institutions Canadiennes Dévelop-mentioning

confidence: 99%

Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians’ attitudes

Sinuff

Eva

Meade

et al. 2007

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: To understand clinicians' perceptions regarding practice guidelines in Canadian intensive care units (ICUs) to inform guideline development and implementation strategies. Methods:We developed a self-administered survey instrument and assessed its clinical sensibility and reliability. The survey was mailed to ICU physicians and nurses in Canada to determine local ICU guideline development and use, and to compare physicians' and nurses' attitudes and preferences towards guidelines. Results:The survey was completed by 51.6% (565/1095) of potential respondents. Although less than half reported a formal guideline development committee in their ICU, 81.0% reported that guidelines were developed at their institutions. Of clinicians who used guidelines in the ICU, 70.2% of nurses and 42.6% of physicians reported using them frequently or always. Professional society guidelines (with or without local modification) were reportedly used in most ICUs, but physicians were more confident than nurses of their validity (P < 0.001). Physicians considered endorsement of guidelines by a colleague more relevant for enhancing guideline use than did nurses (P < 0.001). Nurses considered low risk of the guideline and whether the guideline is consistent with their practice (P < 0.001) to be more relevant to guideline uptake than did physicians (P < 0.001). Lack of agreement with recommendations was a more important barrier to use of guidelines for physicians than for nurses (P < 0.001).Conclusions: Many Canadian institutions locally develop guidelines, and many ICU physicians and nurses report using them.Planning implementation strategies according to clinician preferences may increase guideline use. The nature of the differences in attitudes towards guidelines between nurses and physicians, and their impact on clinician adherence to guidelines requires further exploration.

show abstract

Section: Conclusion : De Nombreuses Institutions Canadiennes Dévelop-mentioning

confidence: 99%

Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians’ attitudes

Sinuff

Eva

Meade

et al. 2007

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…[9][10][11][12][13][14][15][16][17][18] Using protocols for sampling ABGs has shown enhanced rates of correct indwelling arterial line placement and appropriate ABG sampling. 9,10 Specifically, Browning et al 10 evaluated respiratory therapists' effectiveness in determining when to sample ABGs.…”

Section: Are Respiratory Protocols Effectivementioning

confidence: 99%

“…Subsequent studies have confirmed the value of protocols in improving the allocation of ABGs in the ICU, and in directing the placement of indwelling arterial catheters. Pilon et al 12 conducted an observational cohort study with a before-and-after design, in which the rate of appropriately drawn ABGs increased from 44% at baseline to 78% and 79% at 2 and 13 months after protocol implementation, respectively. Associated benefits with implementing the aforementioned protocol included a reduced mean number of ABGs drawn per patient per day (from 4.9 to 2.4 -3.1, P Ͻ .001), and a concomitant cost savings of $19.18 Canadian per patient per day.…”

Section: Are Respiratory Protocols Effectivementioning

confidence: 99%

The Scientific Basis for Protocol-Directed Respiratory Care

Modrykamien

Stoller

2013

Respir Care

View full text Add to dashboard Cite

SummaryAs defined by the American Association for Respiratory Care, respiratory care protocols are "guidelines, usually written in algorithmic form, for providing respiratory therapy services." The need for protocols has been framed by the frequent occurrence of misallocation of respiratory care, consisting both of over-ordering (ie, prescribing respiratory care that is unlikely to confer benefit) and under-ordering services (ie, failing to prescribe services that would be expected to offer benefit). In this context, the current paper reviews available studies regarding the effectiveness of respiratory care protocols. Such studies can be organized into those assessing respiratory care treatments in the ICU, and those addressing non-ICU respiratory care. In the ICU, studies have addressed sampling both ABGs and liberating patients from mechanical ventilation; in the latter activity, multiple concordant randomized controlled trials have shown that weaning protocols implemented by respiratory therapists and/or nurses can accelerate patients' liberation from mechanical ventilation, with shorter stay and lower cost. Outside of the ICU, studies have addressed the effectiveness of respiratory care protocols in guiding the use of supplemental oxygen, bronchopulmonary hygiene, bronchodilator use, and of assessing patient for step-down unit placement. All such studies have shown that respiratory care protocols are effective. Furthermore, 2 concordant randomized controlled trials have shown that comprehensive respiratory care protocol programs can enhance the allocation of respiratory care services, with concomitant savings and no excess adverse outcomes. Overall, while the overwhelming weight of available evidence supports the effectiveness of respiratory care protocols, gaps in current understanding remain, especially regarding settings outside the acute care hospital (eg, geriatric care, palliative care, and extended care facilities). In the same spirit that engendered the Sugarloaf Conference to assess the effectiveness of respiratory care, further assessment of the effectiveness of respiratory care protocols is encouraged and expected.

show abstract

“…Impact is generally evaluated by investigating multiple clinical and cost outcomes before and after guideline implementation or by comparing the outcomes of 2 groups of patients who have been randomized to guideline-based interventions or usual care. Two randomized control trials, 42,43 3 quasiexperimental designs, 3,44,45 and 3 observational studies 21,46,47 were identified that investigated the impact of practice guidelines on clinical and cost outcomes. These studies generally measured clinician adherence with practice guidelines and compared patient outcomes in the experimental verses control groups.…”

Section: Impact On Patient Outcomesmentioning

confidence: 99%

“…The majority was found in specialized medical journals, but several included nurses as first authors 18,19 or members of the research team and coauthors. 20,21 The authors were largely health services researchers and clinicians affiliated with major medical and research institutions. Much of the work was funded by public or private health services research grants.…”

mentioning

confidence: 99%

Practice guidelines and measurement: state-of-the-science

Dykes¹

2003

Nursing Outlook

View full text Add to dashboard Cite

show abstract

Practice guideline for arterial blood gas measurement in the intensive care unit decreases numbers and increases appropriateness of tests

Abstract: Implementation of this guideline for arterial blood gas measurement increases efficiency of test utilization without prolonging mechanical ventilation or affecting outcome.

Cited by 74 publications

References 11 publications

Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians’ attitudes

Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians’ attitudes

The Scientific Basis for Protocol-Directed Respiratory Care

Practice guidelines and measurement: state-of-the-science

Contact Info

Product

Resources

About