The Agency for Healthcare Research and Quality (AHRQ) provides various clinical practice guidelines (CPGs) for physicians, nurses, and other parties involved in patient care. For this paper, safe medication use in intensive care units (ICUs) the CPG was selected due to its relevance to the current needs of inpatient care. The identified guideline aims at presenting safe medication practice recommendations for critically ill patients.
Such data sources as PubMed, CINAHL, Cochrane systematic reviews and trials, and ISI Web of Science were utilized by Kane-Gill et al. (2017), the authors of the article. While discussing recommendations, they paid attention to the medication use process, patients in a specific environment, and patient safety surveillance. In order to evaluate their assumptions, the authors applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system (Alonso-Coello et al., 2016). The conclusions are associated with improving ICU environment through reporting, assessment, and identification of risk factors.
One of the recommendations states that it is preferable to conduct ICU specific data surveillance over non-ICU analysis. The rationale for the mentioned intervention refers to the fact that it allows detecting adverse drug events (ADEs) and medication errors (MEs) and exploring them in an in-depth manner. However, it is also clarified that the differentiation between ICU and non-ICU surveillance and assessment is not likely to affect either quantity or quality of reporting (Kane-Gill et al., 2017).
The explanations of the given recommendation are based on one survey and two observational studies, which allows assuming that level III evidence was used. As noted by Brown (2014), level III evidence implies that data was obtained from multiple case controls, cohort studies, and observational studies. The rationale of the recommendation also illustrates that data received from surgical ICUs (SICUs) and adult medical ICUs (MICUs) is different with a greater risk of ADEs in the latter. The evidence that was collected and analyzed for this guideline is useful for clinicians who are expected to apply ICU-specific surveillance to timely identify and prevent potential ADEs and MEs.
In general, the recommendations provided in the selected CPG seem to be relevant and evidence-based. Kane-Gill et al. (2017) properly structured their paper, including hypotheses, questions, answers, and rationales for their practice guidelines. More to the point, the recommendations have divided into topics, such as patient surveillance and environment. This structure is rather beneficial for finding the required guideline and understanding its evidence-based explanation.
The majority of suggested comments look professional and important for the ICU settings since critically ill patients are especially vulnerable to MEs and ADEs. For instance, the authors consider that it is essential to use chart reviews in order to detect and address potential errors.
The level of evidence analyzed in this CPG varies depending on a particular recommendation. Some of them are substantiated by controlled-randomized trials (RCTs), which mean the level I evidence, known as the highest level, while others are based on level II, III, and IV. It should be noted that the authors clearly identify the sources they accessed to formulate one or another assumption, thus following such research principles as transparency and consistency (Manchikanti et al., 2014; Sarkis-Onofre et al., 2015).
In particular, they stress that there was no evidence to make the recommendation or that evidence was insufficient, and further studies must be conducted to enhance evidence rigor. Therefore, one may conclude that the CPG describing safe medication use in intensive care units is a significant, reliable, and beneficial tool for clinicians working with critically ill patients and striving to improve care quality.
References
Alonso-Coello, P., Oxman, A. D., Moberg, J., Brignardello-Petersen, R., Akl, E. A., Davoli, M.,… Guyatt, G. H. (2016). GRADE Evidence to Decision (EtD) frameworks: A systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ, 353, 1-9.
Brown, S. J. (2014). Evidence-based nursing: The research-practice connection (4th ed.). Burlington, MA: Jones & Bartlett Publishers.
Kane-Gill, S. L., Dasta, J. F., Buckley, M. S., Devabhakthuni, S., Liu, M., Cohen, H.,… Bejian, S. M. (2017). Clinical practice guideline: Safe medication use in the ICU. Critical Care Medicine, 45(9), 877-915.
Manchikanti, L., Falco, F. J., Benyamin, R. M., Kaye, A. D., Boswell, M. V., & Hirsch, J. A. (2014). A modified approach to grading of evidence. Pain Physician, 17(3), 319-325.
Sarkis-Onofre, R., Cenci, M. S., Demarco, F. F., Lynch, C. D., Fleming, P. S., Pereira-Cenci, T., & Moher, D. (2015). Use of guidelines to improve the quality and transparency of reporting oral health research. Journal of Dentistry, 43(4), 397-404.