Clinical Practice Guidelines (CPGs)

Evaluating Organizational Change
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Evaluating Organizational Change
Introduction
Clinical Practice Guidelines (CPGs) are increasingly being used in healthcare practice today. As opined by Steinberg et al., (2011), the CPGs are statements with recommendations aimed at optimizing patient care and are developed from a systematic review of the evidence as well as the evaluation of the positive and negative outcomes associated with alternative care options. Accordingly, medical practitioners use these guidelines to make decisions at the bedside or comply with rules of operation in clinics and hospitals. Moreover, spending by insurers or governments is based on CPGs to realize better results in the provision of healthcare services. This paper evaluates the organizational change in a hospital setting based on the CPG for screening as well as the management of pediatric elevated blood pressure (BP). Therefore, the paper presents an overview of the guideline, a discussion on how the guideline impacts different medical practitioners, how evidence attached to the guideline is defined, a determination of the level of evidence used in the evidence-based practice (EBP) identified, an opinion on how well medical professionals follow the guideline, and a conclusion based on the overview of the guideline as discussed in the current paper.
An overview of the CPG for the Management of Pediatric Hypertension
Pediatric hypertension (HTN) has become a serious concern for the medical field today (Flynn et al., 2017). Correspondingly, research has been conducted in this area, yielding important findings over the last decade. In the foregoing, the American Academy of Pediatrics (AAP) sought to address evidence gaps in pediatric HTN based on a systematic literature review of the subject. Consequently, changes have been made on the original recommendations regarding the screening and management of childhood BP as given by the U.S. Fourth Working Group on BP. These changes include 1) Replacing the term “elevated BP” rather than “pre-hypertension” 2) An updated normative data table, 3) A new way of classifying BP, 4) A strong endorsement of ambulatory BP measurement, 5) A reduced BP target for hypertensive children with chronic and non-chronic kidney disease, 6) Replacing the term “Prehypertension” with “elevated BP,” and 7) Simplification of BP classification for adolescents aged ≥13 years based on the BP guidelines by the American Heart Association (AHA) College of Cardiology (Sinha et al ., 2019). Therefore, the updated guideline has improved efforts by relevant medical practitioners to diagnose, evaluate, and manage HTN in children or adolescents within the outpatient setting. Moreover, the updated CPG has been endorsed by the AHA since sufficient evidence has demonstrated its invaluable utility in pediatric HTN care.
It is noteworthy that it was not possible to identify enough evidence in the process of updating the guideline. In such instances, recommendations were made based on agreements through consensus by experts in the subcommittee dealing with the management of pediatric HTN (Flynn et al., 2017). Accordingly, the experts were involved in the comprehensive review of literature, leading to the updates. Moreover, the subcommittee regularly makes changes to the CPG as soon as new evidence emerges based on implementation tools provided by the AAP (Flynn et al., 2017). The subcommittee involved in the guideline update comprised 17 members and was co-chaired by a general pediatrician and a pediatric nephrologist (Flynn et al., 2017). To ascertain their integrity, each subcommittee member had to reveal any conflicts of interest, whether financial or proprietary, that could be linked to them or their family members in the process of developing the guideline (Flynn et al., 2017). Additionally, all potential sources of conflict were promptly addressed by the AAP (Flynn et al., 2017).
Impact of the Guideline on Medical Practitioners
Directions for Blood Pressure Checks
Different medical practitioners, including nurses, nurse educators, technicians, pharmacists, CFOs, among others, are held to this guideline as they have to adhere to the changes as provided by the CPG on the management of childhood HTN. Accordingly, the guideline directs medical practitioners involved in the screening and management of pediatrician HTN to carry out annual measurement of BP for children aged ≥3 years if they fall into subgroups like the obese, those currently on medication that could increase BP, those suffering from renal diseases, and patients with a history of diabetes or coarctation (Sinha et al., 2019). Other categories of children aged ≥3 years who require more frequent checks are those who have recurrent urinary tract infections, urological malformation, congenital heart disease, malignancy, tuberous sclerosis, neurofibromatosis, sickle cell disease, or those who have undergone bone marrow transplant procedure (Sinha et al., 2019). Moreover, medical practitioners are required to conduct regular BP checks for newborns who are small for the normal gestational age, premature babies born at the age of fewer than 32 weeks, as well as those with very low birth weight, as well as children with umbilical arterial catheterization (Sinha et al., 2019).
There are also standardized procedures similar to those of the U.S. Fourth Working Group on BP that ought to be considered by medical practitioners involved in the measurement of BP in children. They include requirements such as i) Ensuring that the child patients sit for 3-5 minutes in a quiet room with their legs uncrossed, ii) Measuring BP at the heart level in the right arm, and iii) Ensuring that the bladder cuff length is between 80% to 100% of the arm circumference and not less than 40% as the position of cuff’s lower end is approximately 2 to 3 centimeters (cm) upwards of the antecubital fossa while placing the stethoscope on top of the brachial artery (Sinha et al., 2019).
Moreover, as provided for in the updated and original guidelines for measuring pediatric HTN, it is not recommended for medical professionals to use BP readings recorded in school settings (Sinha et al., 2019). Additionally, oscillometric devices are accepted for use as screening tools in various childhood age groups, albeit with the caveat that any records of elevated BP have to be confirmed through the auscultatory method, which best predicts damage to target organs (Sinha et al., 2019). Whenever there is an initial elevated BP, medical practitioners are expected to take two additional readings during the same visit before calculating their average as the final reading. In the office setting, however, the diagnosis of HTN should be based on three readings from separate occasions. Further, BP measurements on the wrist or forearm are not ...