Development and Evaluation of Clinical practice Guideline for Nurse Anesthetists on Conscious Sedation for Patients Undergoing Anesthesia Care at Maharaj Nakorn Chiang Mai Hospital
Keywords:
Development, Evaluation, Clinical Practice Guideline, Conscious Sedation, Nurse AnesthetistsAbstract
Objective: To develop and evaluate a clinical practice guideline (CPG) for nurse anesthetists to provide anesthetic care for sedated patients at Maharaj Nakorn Chiang Mai Hospital.
Method: A Research and development study was conducted in 2 phases. Phase 1 was clinical practice guideline (CPG) development, and phase 2 was CPG evaluation. The subjects were 20 nurse anesthetists and 155 patients who received conscious sedation during surgery. The participants were divided in to 2 groups; before implementing CPG (n=74) and after implementing CPG (n=81). Data were collected during March-May 2017. Three instruments were used for data collection: (i) CPG for nurse anesthetists to provide anesthetic care for sedated patients; (ii) a form to evaluate completeness and correction of nursing process following the CPG and a record of patient’s outcomes, including occurrences of abnormal respiratory and cardiovascular events, before and after implementation of CPG; (iii) a questionnaire to evaluate the nurse anesthetists on a possibility to implement the CPG. The draft of the CPG was developed based on the evidence-based practice (EBP). Data analysis was conducted using descriptive statistics and independent t-test.
Result: The developed CPG was divided into 3 parts for nurse anesthetists to provide anesthetic care for sedated patients (1) pre, (2) intra, and (3) post sedation periods. From training workshops, supervision, follow-up made nurse anesthetists (95 %) were able to comply in part 1 and 2 of the CPG. All nurse anesthetists (100%) were able to comply part 3. The opinions of the nurse anesthetists on appropriateness of the CPG usage were in the highest level (mean 4.66±0.481). In the evaluation on patient outcome, no respiratory complications occurred in CPG used group and incidence of oxygen saturation < 95% was significantly lower in the CPG used group (p=0.006).
Conclusion: The developed CPG was practical and beneficial for an early detection of perioperative respiratory adverse events. Therefore, it should be implemented in all patients under conscious sedation. Before using it, should study more.
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