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Clinical Issues-December 2020.

Byron L Burlingame

    AORN Journal
    |November 30, 2020
    PubMed
    Summary

    This study reviews evidence-rating schemes for assessing guideline quality and discusses managing surgical patients with cardiac implanted electronic devices (CIEDs). It also examines the preoperative to intraoperative hand-over process for patient safety.

    Area of Science:

    • Medical Guidelines and Quality Assessment
    • Cardiovascular Implantable Electronic Devices (CIEDs) Management
    • Surgical Patient Safety and Communication

    Background:

    • The critical need for robust evidence-rating schemes in developing high-quality, evidence-based guidelines.
    • The unique challenges and safety considerations for surgical patients with cardiac implanted electronic devices (CIEDs), including pacemakers.
    • The importance of effective preoperative to intraoperative hand-over processes for seamless patient care transitions.

    Purpose of the Study:

    • To explore the methodologies and implications of evidence-rating schemes in medical guideline development.
    • To provide guidance on managing surgical patients with CIEDs, focusing on device interactions (e.g., magnets, electrosurgery).
    • To analyze the components and best practices of the preoperative to intraoperative hand-over process to enhance patient safety.

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    Main Methods:

    • Systematic review and synthesis of literature on evidence-rating schemes and their application in guideline quality.
    • Analysis of clinical evidence and recommendations for surgical procedures involving patients with CIEDs.
    • Evaluation of communication strategies and protocols for the preoperative to intraoperative patient hand-over.

    Main Results:

    • Evidence-rating schemes significantly impact the perceived quality and reliability of evidence-based guidelines.
    • Specific precautions, such as magnet use and careful consideration of monopolar electrosurgery, are crucial for CIED patients.
    • A structured hand-over process incorporating patient-specific information improves continuity of care and reduces errors.

    Conclusions:

    • Standardized evidence-rating schemes are essential for developing trustworthy medical guidelines.
    • Adherence to specific protocols is vital for the safe surgical management of patients with CIEDs.
    • Optimizing the preoperative to intraoperative hand-over process is a key strategy for enhancing surgical patient safety.