Development of a Clinical Practice Guideline for
Acute Respiratory Distress in a Pediatric Primary
Purpose
Discuss development of a clinical
practice guideline (CPG) for acute
respiratory distress (ARD) in a
pediatric primary care setting
Identify pathophysiology of each
condition
Evidence-based practice
Impact of policy, patient
engagement & multidisciplinary
team
Background
ARD is one of the major reasons
children are seen in primary
care.
Commonly caused by a viral
illness affecting the upper and
lower airways (Fernandes et al.,
2014)
Causes inadequate ventilation,
low oxygen saturation, or
dyspnea (ICD10data.com, 2016)
The family and APRN can partner
to develop a CPG
Clinical practice guideline
Derived from systematic
review of evidence assesses
the pros and cons of treatment
option
(National Guideline
Clearinghouse [NGC],
2016)
Assist APRN in decision-making
Acknowledgements
Karen Burkett DNP, APRN, CNP
Emilee Kempf RN, BSN, MPH
Robyn Stamm DNP, APRN, CNP-AC
Peer review of capstone by fellow
graduate NP student
Care
Lauren GrantSetting
RN, BSN, CPN
University of Cincinnati College of Nursing
Pediatric Primary Care Nurse Practitioner student
Methods
This capstone examines published
literature, online resources, and
professional organizations to
investigate the following and their
impact on CPG development:
Current practice in treating
common causes of ARD: asthma,
bronchiolitis & croup
General requirements for CPG &
implications on reimbursement
Advanced practice nurse (ANP)
professional goals
National policy
Patient engagement
Behavior modification related to
CPG implementation
Summary of
findings
Systemic corticosteroids can be
used for the management of
ARD.
According to Fernandes et al.
(2014), pediatric patients
receiving this spent 8 hours less
in the ED
Those with croup spent 13 hours
less in the ED (Fernandes et al,
2014)
The treatment for asthma,
bronchiolitis, and croup are
individualized.
Asthma: Short-acting beta
agonists reduce airway blockage
(National Heart, Lung, and Blood
Institute [NHLBI], 2007)
Bronchiolitis: Nebulized
hypertropic saline can decrease
symptoms (NGC, 2016a)
Croup: Intramuscular
dexamethasone can be dosed
depending on severity
(Petrocheilou et al., 2014)
Policy and Engagement
CMS
Sets requirements for APNs
serving Medicare population to
obtain value-based payments
CPGs are linked to outcome
measures which affects
reimbursement
Patient engagement
AANP & NAPNAP
acknowledges the
importance of patient
& family engagement
Impacts care experience and thus
outcome measures
Section Heading
Conclusion
Behavior Contributing to CPGs
Improving use of CPG as
discussed by McDonnell Norms
Group (2006)
Understanding how to change
human behavior and what
motivates an APN to change
Understanding heuristics (rule of
thumb), which is based on
experience
Convenient decision-making
Non-physician driven CPGs tend
to be more successful
APNs can lead efforts to develop
CPGs
in conjunction with the
multidisciplinary team.
McDonnell Norms Group
(2006) states patients and
families are beginning to
challenge current protocols
Thus, their perspective should
be taken into account
Literature supports that
APNs would benefit from a
standardized pediatric
primary care outpatient
CPG for ARD, a common
condition.
The APN should review the
literature for current
evidence.
Educate patients about
modifications in care
practices
NGC (2014) recommends
that a CPG is reviewed on a
regular basis
Clinical knowledge is not
the sole driver for
developing a CPG
Policy, patient engagement,
and understanding behavior
contributing to CPG
utilization is important