Posted: March 22nd, 2023

Evaluating Organizational Change

Clinical practice guidelines are important in healthcare settings because they determine the level of success in decision-making regarding patient care. They are systematically developed statements that guide patient and practitioner decision-making about suitable care for particular medical situations (Murad, 2017). Clinical guidelines play an important role in improving the quality of services provided by supporting interventions based on adequate evidence of effectiveness. Therefore, they discourage the use of ineffective interventions or those that are likely to affect the patient. They create uniformity in clinical practice to reduce inequality and disparities in health care. The guidelines empower patients to take an informed part in decision-making and in creating public policy. Many healthcare organizations have developed clinical guidelines over the last three decades that are improving performance outcomes and increasing the value of care. I have worked in a healthcare organization with clinical practice guidelines for the proper use of carotid endarterectomy.

Introduction to the Healthcare System Practice Guideline

The clinical practice guideline at the hospital involves the proper use of carotid endarterectomy. The procedure is one of those developed by the RAND Corporation in the mid-1980s. Various factors inform the reason for this clinical practice guideline. For instance, carotid endarterectomy is a frequently performed procedure. It uses a considerable amount of healthcare resources and varies in the way it is used, especially in hospitals and geographical locations across the U.S. (Examples of Clinical Practice Guidelines and Related Materials, 2019). Therefore, it is essential that practitioners understand the most effective way to apply the procedure to achieve positive results. The guideline is a comprehensive analysis as well as categorization of indication for the utilization of carotid endarterectomy. It is a tool for shared decisions between the physician and patient regarding the use of the procedure in the hospital. The practice engages the patient when a decision is being made to use carotid endarterectomy as a treatment procedure.

The clinical practice guideline for the use of carotid endarterectomy involves critical analytic and logistical guidance to ensure that the practitioners understand how to implement the procedure in practice. The development of the guideline includes detailed analysis of literature to identify what works on the use of the procedure. It was a rigorous process to determine the best evidence to use in practice depending on the special conditions of the hospital, such as the number of people seeking the procedure and the complexity of their medical conditions (Murad, 2017). For example, the guidelines include the implementation of the intervention depending on the number of episodes of carotid TIA or amaurosis fugax. The information helps decision making about the necessary treatment, such as the need for a surgical procedure. Furthermore, the guideline includes a cost-effectiveness analysis of the use of medical resources to determine whether the hospital has adequate facilities to support carotid endarterectomy.

Implications of the Guideline for Different Professionals in the Healthcare System

The clinical practice guideline has implications on the role of various professionals in the health care organization. It affects the role of nurses, pharmacists, technicians, practitioners, nurse educators, health researchers, and policy analysts because of their responsibility in providing quality care to the patients at the hospital. The guidelines reveal the best practice in the use of the procedure, including the analysis to determine its necessity during treatment. Nurses are one of the most significant service provider group that offers the initial point of care whenever a patient visits the hospital. Therefore, they should generate factual and reliable information based on the patient condition and in line with the clinical practice guideline (Examples of Clinical Practice Guidelines and Related Materials, 2019). The guideline requires nurses to collect adequate information in collaboration with the patient to enhance safety and quality care. Nurse educators and researchers at the hospital should perform ongoing collection and analysis of information to provide evidence in line with the procedure (Engelke & Marshburn, 2006). They should also use the evidence collected to train nurses and other healthcare providers on the best practice in relation to the clinical practice guideline.

The guideline has an impact on nurse practitioners because they provide primary care to patients, including evaluation, diagnosis, and treatment. Therefore, they should follow specific instructions when working with patients who require carotid endarterectomy. Since practitioners play an important role in the diagnosis and treatment procedure (working closely with the surgeon), they should understand how the guideline affects their work. For example, they should recognize the extent of the carotid artery disease to recommend to the patient the best treatment procedure that will have an effective outcome (Kuliha et al., 2015). Technicians are affected by the guidelines because of the role they play in preparing patients for carotid endarterectomy. They should understand the essential tools and resources necessary for a successful procedure. Besides, pharmacists work closely with the surgeon and nurse practitioners to provide the correct medication in the course of the treatment. Therefore, they are affected by the guideline regarding the type of medicine to prescribe before and after the surgery. Therefore, all the healthcare providers involved in the treatment of the carotid artery disease should understand how the guideline affects their work.

Evidence Used to Define the Clinical Practice Guideline

The hospital used evidence provided by the RAND Corporation study in developing the clinical practice guideline. The organization proposed clinical practice guidelines used at the hospital regarding how carotid endarterectomy rate. The need for the guidelines was based on the controversial nature of the procedure regardless the fact that it is commonly performed in many health care settings (Winslow, Solomon, Chassin, & Kosecoff, J., Robert, 1991). The organization realized the need to create the guidelines to ensure effective use of the procedure and to protect patients from flawed decisions. The guidelines include the possible reasons for the performance of carotid endarterectomy, as well as the scenarios in which it should be avoided, such as if it endangers the life of the patient (Naylor et al., 2018). Therefore, healthcare providers at the hospital should conduct a comprehensive evaluation of the patient before settling for the carotid endarterectomy. Some of the sources of evidence relating to the guideline and the use of carotid endarterectomy in the treatment of carotid artery disease are obtained from clinical trials that provide evidence of its efficacy (Kuliha et al., 2015; Naylor et al., 2018). However, other sources of evidence are available in the development of the guideline and proof of its effectiveness when appropriately used in the treatment of the condition.

Another course of evidence to support the development of the clinical practice guidelines was recommendations from a panel of experts. The medical professionals converged to define and establish the efficacy and appropriateness of carotid endarterectomy using the Delphi and other technical and analytical methods. Their input would prove without a doubt that the procedure is the most effective and safe for the treatment of carotid artery disease. Besides, it is important to establish that the hospital has the necessary resources to support the procedure (Abbott et al., 2015). For example, the clinical practice guideline was developed for the hospital because of the presence of qualified surgeons and practitioners with the competence to perform it.  The procedure has been proven appropriate based on the rating of a panel of medical experts. A study by Winslow, Solomon, Chassin, Kosecoff, and Robert (1991) proved the efficacy in a sample of 1,302 Medicare patients in three different parts of the United States. They affirmed that as long as the procedure is conducted for the right reason and by qualified medical personnel, it is effective as a treatment for the carotid artery disease.

However, experts have proven the need for comprehensive and adequate evaluation of the patient before considering the treatment procedure. Kuliha et al. (2015) suggested the need for safe and quality care in hospitals across the country. Their study revealed negative indications if carotid endarterectomy was performed in undeserving patients. Therefore, the clinical practice guideline was developed as a best practice tool to ascertain the need for the procedure. Besides, experts recommend the need to engage the patient throughout the treatment process to ensure informed decision-making. For example, medical personnel should not perform a procedure without the consent of the patient. Hence, the patient should understand all the information regarding the procedure to give their consent. It is part of the implementation of evidence-based patient-based care at the hospital (Spence & Naylor, 2016). Medical professionals should always strive to achieve this kind of care when working with their patients.

The Level of Evidence used in the EBP

Clinical practice should be based on adequate evidence to support the efficacy of treatment procedures. Levels of evidence are used to determine the quality of proof available for a clinical process or procedure. The level is assigned to research based on the quality of the method used to collect and analyze the data. It also depends on the quality of the research design, validity, and applicability to practice (Young, Rohwer, Volmink, & Clarke, 2014). The quality of the study supports the strength of the recommendations. The clinical practice guideline used systematic review of evidence-based clinical practice procedures to determine the efficacy of the medical practice. Evidence from a systematic review of relevant randomized controlled trials entails level I evidence due to their quality in informing clinical practice (Winslow, Solomon, Chassin, Kosecoff, & Robert, 1991). Such sources of evidence ensure objective and verifiable data that can inform clinical decisions.

From the review of clinical trials with information about the use of carotid endarterectomy, practitioners determine the efficacy and best practice in the application of the evidence in practice. Review of literature allows comparison of various findings to recommend action. For example, a review of two to five studies can provide the necessary evidence to inform the efficacy of recommendations in practice. For instance, in a study commissioned by RAND Corporation to determine the effectiveness of carotid endarterectomy and related clinical guideline, a high percentage of reviewed studies revealed the appropriateness of the procedure on patients with the uneven carotid distribution. The evidence not only considers the efficiency of the process but also offers possible complications relating to the procedure such a stroke (Young, Rohwer, Volmink, & Clarke, 2014). Evidence suggests the need to ensure that all processes are completely safe for application depending on the individual patient’s characteristics and risk factors.

Personal Opinion Regarding the Use of the Guideline

From a review of the hospital’s use of the guideline, it is evident that the approach has been used for the past two decades to inform the treatment of the carotid artery disease. As a result, most of the healthcare professionals are aware of the clinical practice guideline, which means that they understand what should be done in case a patient exhibits relevant symptoms. The clinical guideline is a part of the necessary training at the hospital because of the high number of patients who seek treatment for the carotid artery disease. Therefore, healthcare providers should understand the best decision to make when treating such patients. I have observed an ongoing use of the guideline by professionals in the hospital treating the carotid artery disease. For example, treatment involves a comprehensive evaluation of the symptoms and patient history before deciding on the course of treatment. Notably, not all cases of problematic carotid arteries warrant the procedure. Therefore, practitioners should determine with a high level of accuracy the need for the procedure.

Another use of the guideline at the hospital involves the active engagement of the patient in the care process. Evidence-based practice dictates the need to place the patient at the center of the medical care process (Young, Rohwer, Volmink, & Clarke, 2014). The guideline also dictates that the procedure should not be performed on the patient without adequate discussion. I have witnessed practitioners at the hospital engaging patients in comprehensive consultations before performing the procedure. They discuss the pros and cons of the process based on the unique patient’s characteristics. They also evaluate other possible treatments, such as stenting (Kuliha et al., 2015). Notably, they only perform the procedure upon complete agreement and cooperation of the patient and engage other professionals to decide and implement the treatment collaboratively. Consequently, the treatment for the carotid artery disease has been highly effective in the hospital with minimal cases of adverse effects.

Conclusion

Clinical practice guidelines play a significant role in the provision of safe and quality care to patients. They include best practice and evidence-based process in the treatment and management of various medical conditions.  Hospitals have diverse guidelines that healthcare professionals should follow whenever they have patients suffering from different conditions. An example of clinical practice guideline involves the use of carotid endarterectomy in the treatment of carotid artery disease. The guidelines inform health care providers about the need to perform the procedure, depending on the medical history and signs presented by the patient. They also evaluate the efficacy of the procedure in comparison with other possible treatments for the condition. Besides, the practitioners work with the patient to make the critical decision regarding their care. They provide the necessary information for the patient to make an informed choice. They also engage the patient through the treatment process. As a result, the hospital has posted positive results in the treatment of the carotid artery disease over the last two decades.