Assignment: Standard Albuterol Care

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Assignment: Standard Albuterol Care

Assignment: Standard Albuterol Care

ORDER NOW FOR AN ORIGINAL PAPER:Assignment: Science Methodology

Selection of a clinical topic can be determined by both importance of outcomes (as defined by high prevalence, high rate of morbidity and mortality, resource intensiveness, or wide variation in care) and organizational readiness for improvement. Internal data can help identify importance quantitatively, especially when including cost of care for each disease process being considered for clinical standards. Simply defined, organizational readiness is the institutional member’s commitment to the complex change that might ensue from development and implementation of the clinical standard;25 they must value the development process as well as the potential in order to assure ongoing engagement for development, implementation, and sustainability.

Guideline development teams should be created with a multidisciplinary, “bottom up” approach to allow front line content experts rather than authoritative leaders to voice all opinions. Patient and family participation and feedback should be incorporated into the guideline development process in order to ensure that important clinical questions and outcomes to the patients and their families are considered.

Determining the scope of the clinical standard, along with patient inclusion criteria and exclusion criteria, is a prerequisite to identifying the important clinical questions to be addressed. Focused clinical questions should be brainstormed based on areas of variation in care, new research availability, areas with performance outcomes below benchmark, and/or identified patient care concerns. Clinical questions should be presented in Patient Intervention Comparison Outcome (PICO) format in order to ensure searchable keywords and specific recommendations (eg, in children with acute asthma in the ED [P], do anticholinergic agents [I] versus standard albuterol care [C] reduce admission rates [O]).26 Patient-centered outcomes are preferred and should be rated on their degree of importance to the patient. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology currently utilizes 3 categories for outcome rating (critical, important but not critical, and limited importance). Outcomes of limited importance are not included in the development of the clinical standard as they should not have an effect on decision-making related to patient care.27

A systematic search for existing national guidelines and pertinent clinical research for each question should be completed using research databases, evidence-based practice websites, and professional organization websites (eg, American Academy of Pediatrics, Agency for Healthcare Research and Quality National Guideline Clearinghouse, or specialty specific professional societies pertinent to the guideline topic).

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