Clinical area and clinical question
The proposed clinical area for best practice promotion is the improvement of care of older persons with acute conditions. According to Gardiner, et al., (2011) older persons with acute problems are often neglected in most health institutions dealing with acute conditions.
The observed neglect is on the rise despite the fact that older persons constitute the largest consumers of acute care in healthcare institutions (Reuben & Tinetti, 2012). Not only are older persons the largest consumers of healthcare services, documented evidence points to the fact that they face numerous physical and psychological issues. Among other risks, older persons are at an increased risk of falls, delirium, loss of function and mobility and the risk of having adverse drug side effects. As Farhat, et al., (2012) documents, older persons equally have an increased risk of cognitive impairment.
With the increased number of older persons in the society, there is need to ensure proper care is given in order to improve their quality of life and wellness. In this regard, this manuscript proposes a person centered care in managing acute patients such as older persons.
The proposed clinical question that needs to be addressed in this regard is, what are the impacts of advanced care planning in older patients with acute conditions?
Searching for practice guidelines
The methodology employed in the literature search of materials that address the topical issue will include a structured review of articles that talk about improving care among older persons who have acute conditions. In order to maintain relevance of data, articles that address the topical issue will be selected based on their publication dates. In this regard, articles published within the last five years (2011-2016) will be considered. Several relevant electronic databases will be used in this literature such and they include google scholar, PubMed, Medline, Academia research complete and other relevant websites including the Physician's Orders for Life-Sustaining Treatment (POLST) website. These databases are considered due to their publication of peer reviewed sources. The search criteria in these websites will include terms such as ‘older persons’, ‘quality of care’, ‘older persons with acute conditions and care’ and ‘care for older persons’ among others in order to capture all the relevant articles on the topical issue. So as to obtain literature addressing older persons with acute conditions and their care, the search criteria will filter the search by including an age bracket. Studies on older persons above 60 years will thus be the only ones considered for review. Adoption strategy
Practice guidelines will be adopted by first enlightening the support staff in my clinical area of practice on the available evidence. This move will guide the promotion of evidence based practice. Trainings will then be offered to the healthcare practitioners in the practice area in order to be acquainted with the best practice of care of older patients will acute conditions. Appropriate policy recommendations at the institutional level will also be done in order to ensure that the adopted practice guidelines are adhered to. In this regard, a reward system may be considered in order to encourage the adoption of the proposed practice guideline.
Guideline appraisal using the Appraisal of Guidelines, Research and Evaluation in Europe (AGREE) instrument.
GUIDE: Strongly Agree 4 3 2 1 Strongly Disagree
Clarity and presentation: 4
The recommendations are specific and unambiguous: 3
Scope and Purpose: 4
Stakeholder Involvement: 4
Rigor of Development: 2
Clarity and Presentation: 4
Applicability: 4
Editorial Independence: 3
References
Farhat, J. S., Velanovich, V., Falvo, A. J., Horst, H. M., Swartz, A., Patton Jr, J. H., & Rubinfeld, I. S. (2012). Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly. Journal of Trauma and Acute Care Surgery, 72(6), 1526- 1531.
Gardiner, C., Cobb, M., Gott, M., & Ingleton, C. (2011). Barriers to providing palliative care for older people in acute hospitals. Age and ageing, 40(2), 233-238.
Reuben, D. B., & Tinetti, M. E. (2012). Goal-oriented patient care—an alternative health outcomes paradigm. New England Journal of Medicine, 366(9), 777-779.
