Question:

Consider a common health issue you may see at a primary care nurse practitioner’s practice.

Describe the health problem, and suggest a treatment plan.

Review published clinical guidelines. Evaluate the chosen practice guideline based upon the components of the Clinical Practice Guideline Template.

Prompts from the Clinical Practice Guideline:

Healthcare problem identified (acute kidney disease, UTI) Please briefly describe the health problem you have identified.

Please discuss the causes, consequences, morbidity, mortality, epidemiology, and pathophysiology of this particular health problem.

Practice Guideline – Describe the clinical guideline that was used to address this problem.

Refrain from answering the questions.

Add evidence support to your answer.

Is the medical practice guideline adequate in addressing the health problem? Describe.

Is this guideline based on current evidence?

What is the strength and reliability of this evidence?

This guideline does it adequately direct the healthcare provider to manage the patient with this problem as a clinical practice?

How effective is this clinical guidance in the management patients with this healthcare issue?

Imagine how you would evaluate the effectiveness in patient management.

Analyse: What are the future healthcare requirements of patients facing this problem? How will they change with changing demographics? And what healthcare policies should be changed?

These are your questions.

Does this clinical guideline require revisions?

Please provide detailed answers.

What would be the most significant change if you were to update this clinical practice guideline?

Which evidence would you use as a basis for your revisions?

How could changes in US demographics or healthcare reform impact this clinical practice guidanceline?

What strategies would work to increase the probability that a new or revised clinical practice guideline would become a clinical standard?

Evaluation How do you assess the effectiveness of this new clinical practice guideline when directing care for patients suffering from the identified health problem.

These are some of the possible steps.

Answer to Question: NURS 460 Advanced Concepts In Clinical Nursing Informatics

Introduction

Urinary Tract Infection

UTI is the 2nd most severe serious health problem. This infection causes increasing rates of morbidity in women and increases mortality.

These microbial diseases also affect young boys. Globally, approximately 150 million cases have been reported. Ten million are in America.

National Institute for Health Care and Excellence (NICE), defines urinary tract infections as bacterial infections that can manifest as a complicated form, with variable clinical signs and treatment.

There are a number of clinical guidelines that have been created to help clinicians in secondary and primary care.

These guidelines are updated regularly to keep up with the changing evidence and new requirements for patient handling.

UTI Epidemiology

Gram negative and gram positive bacteria are both responsible for urological tract infections. Escherichiacoli is the most widespread uropathogenic bacteria.

Enterococcus pneomoniae and Klebsiella pseudomonae have been associated with significant infections.

Candida albicans can cause urinary tract infections at a very high rate (Flores, Mireles et.al., 2015).

Complications of complicated UTI include infected catheters and abnormalities structural to the tract.Pathophysiology Of UTI

UTI can affect the upper as well as lower tracts.

Bcaterial colonization reaches its peak through the ureters and limits the flow of urine. It then reaches the urinary bladder, where they reproduce and produce a biofilm (Walsh & Collyns 2017).

Mortality and Morbidity

UTIs are the major cause of infant mortality and morbidity.

United States have been shown to have an increase in societal burden. In fact, millions of UTIs were reported in the United States over the last five years (Schaeffer&Nicolle 2016).

Untreated or undiagnosed, bacterial infections can recur and cause renal damage and septichock.

Discussion

Guidelines for Clinical Practice

Treatment guidelines must be created to address the heterogeneity among symptoms of urinary system infection.

These guidelines are designed to improve patient handling and have been implemented in primary care.

These guidelines have a major impact on all sectors in the health care industry.

These guidelines are designed to promote and improve patient care.

These guidelines are based upon the symptomatic interpretation and management of clinical manifestations.

Based on the results of previous trials and applications, clinical practice guides are subject to modifications.

These guidelines help to reduce the cost of healthcare.

Guidelines are regularly updated and revised to reflect the latest evidence.

Guidelines include technological applications designed to provide efficient patient care.

Realistic clinical guides provide better ways of measuring the efficacy and quality of primary healthcare.

National Institute for Health and Care Excellence, NICE provides guidelines for treating urinary tract infection. This guideline is intended to ensure that health professionals can provide quality patient care.

This algorithm shows how to treat bacterial infection of the urinary tract.

Figure 1: NICE47 guideline

(Source: Created by Author)

Figure 2: NICE47 guideline

(Source: Created by Author)

NICE guidelines are designed to diagnose and manage urinary tract infections.

UTIs often occur in children and women younger than 50.

These guidelines can be used to guide patients in the management of recurrent infections.

NICE guidelines offer a detailed treatment approach that addresses a broad range of risk factors involved in the pathogenesis and progression of urinary tract infection (Simpson (2017)).

These clinical guidelines have been developed using a specific range of diagnostic signs.

These treatment strategies are categorised for infants, young children, and adults.

The strength of these guidelines lies in their reliance on the current evidences of clinical trials involving patients with urinary tract infection.

The algorithm, as well the guidelines, provide a guideline for primary care staff.

The algorithm has specific inclusion criteria. Also, the details of how to focus diagnostic criteria on assessment are included.

Guidelines include recommendations for urine testing strategies to be used as the primary treatment for children who are reported with unexplained symptomatic criteria.

The guideline makes important recommendations to prevent the recurrence or recurrences among young children.

NICE guidelines have demonstrated significant efficacy in the treatment of recurring infections in young children.

The NICE guidelines have resulted in a decrease in the number of recurring infections in young men.

NICE targeted self care practice strategies to decrease antibiotic prescribing to UTI patients. This strategy is effective in preventing the development of drug-resistant bacteria. Drummond, 2016.

A revision to guidelines has revealed that the severity of the symptoms must be considered by patients prior to prescribing antibiotics (Yue, et al. 2014).

This approach has been shown to have a positive impact on patient care and treatment.

Analyse of Guideline

NICE guidelines have significant implications and represent a promising trend in primary patient care.

The guidelines are designed to focus on young children and infants. Older adults are not included in the development and regulation of these guidelines.

UTI have been reported among elderly people in both their complicated and less-complicated forms.

It is important to revise the guidelines and take into consideration evidence from clinical trials for older adults (Montini-Herwitt, 2015).

This guideline may be used as a reference for the treatment of infants or young children at a high efficacy level.

This guideline is not designed to address the specific needs of women. However, UTI is a serious problem that affects a high number of candidates for female positions (Brubaker et.al., 2014).

Revision is needed to include clinical guidelines that support the older population and the women population.

This bacteria can be caused by lifestyle and insanitary sanitation.

While revising or modifying guidelines, the focus should be on insanitation.

United States has previous records of hospitalizations of children and females with urinary tract infections.

Annually, 50000 hospitalizations have been reported. Most of the cases were infants and women, while a smaller number of patients belonged to children under five years old (Chaudhari Monuteaux und Bachur, 2018).

Due to the use of high-throughput technologies such as imaging for treatment, hospitalization charges in the United States is very high.

Over the last five year, the hospitalization and diagnostic charges have gone up significantly.

Statistical analysis of economic burden has been done on UTI patients admitted to UTI-related hospitals in the United States. The rise in treatment and hospital costs is not related to the growing number of hospital admissions.

In the United States, hospital costs have increased by approximately $1200 per annual per patient admitted (Spencer et. al. 2013, 2013).

The UTI rates in the USA are increasing with continuous immigration.

It is essential to reduce the economic burden as well as the incidence of infection. The guidelines should also be adjusted to accommodate the needs for those who have lower incomes.

In order to provide high-quality primary treatment, there are many studies that must be conducted and the evidence should be reviewed (Wu et.al., 2013).

Evaluation Of The Revised Guideline

Guidelines for clinical practice are designed to improve the patient’s care.

The guidelines provide guidance for nurses and health professionals in providing high-quality care.

The strategies of nurses and health care professionals to reach out and provide quality medical care have changed.

The health service programs are improved by the revision and updating of clinical guidance.

It is up to the individual to decide if these guidelines are appropriate.

Evaluation strategies are crucial to the success and sustainability of clinical practice guidance.

After being revised and updated, clinical practice guidelines can be disseminated for primary benefit.

These evaluation plans aim to evaluate the effectiveness of the guideline (Chua, et al. 2017).

The development and implementation of strategies is necessary to assess whether the guidelines are being followed by clinical practice.

Evaluations are possible in many ways. One way is to evaluate the development guidelines. Another way is to target treatment methods and check the follow-up scheme for patients after receiving medical attention.

The following steps can be used to assess whether or not the updated guidelines have a positive effect on the patients’ health.

To monitor the infection status of UTI patients monthly

To suggest a change in the dosage of antibiotics to patients receiving treatment.

To keep track of disease progression by offering telephonic interactions on a weekly basis

To schedule a home visit to verify if there are any side-effects from the treatment options.

To partner with patients’ families for routine checkups, and further medication consultations

Learning Points

For patients with urinary tract infections, nursing and health care personnel are trained to provide primary care.

Infections of the bacterial type are more common in children and pregnant women.

For primary care that is high quality, clinical guidelines are essential.

In order to improve treatment management, it is worth considering the effects of research and evidences.

Conclusion

Most people are affected by a urinary tract infection, which is the leading cause of death in children and women.

The incidence of urinary tract infection in infants is also moderate.

Clinical practice guidelines have been developed to help improve patient care quality and treatment procedures.

Health care professionals and nurses are adapting to the many improvement strategies that can be offered to patients.

To ensure that the guidelines are followed and patients receive high quality care, solid evidence is needed.

For the revisions to be successful, evaluation programs should be created.

Revision and updating guidelines should focus on reducing the economic burden.

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