Evidence-Based Practice Question in Clinical Practice - Paper Example

Evidence-based practice has been the cornerstone of clinical practice whereby old procedures have been disqualified through the application of sound evidence (Howarth, 2012). In evidence-based practice, the medical practitioners have managed to study medical interventions that have the best patient outcome through the use of examples in practice thus yielding more confidence in improving the clinical procedures (Davies, 2011). Through the application of sound evidence, patients have benefited, unlike the past clinical practice where theoretical based clinical approaches were being applied in most of the clinical practices. In the nursing practice, evidence-based practice has been fueled to develop more and more professional guidelines to improve patient outcome. Additionally, the search strategy of using PICO question is another improved approach in clinical issues whereby a PICO question is the backbone of the research (Davies, 2011). After developing the PICO question, the search strategy is then carried out to answer the question with the aim of developing answers to the challenging issue (Davies, 2011). In the current practice, the preoperative guidelines have been experiencing a lot of contradictions regarding the recommendable practice. With the modern practice, there is a need to develop a standardized practice through the use of the evidenced-based practice in healthcare. The purpose of this paper is to develop and answer a PICO question regarding the EBP on the preoperative recommendations of a total knee replacement or total hip replacement patient.

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Identification of a researchable problem

Concerning the fasting guidelines provided by the doctors and the anesthesiologists, there exist some contradictions regarding the most appropriate procedure. After midnight order is the oldest and common norm applied in the patient guidelines before a surgical procedure (HealthCommunities.com, 2017). Taking an example of a patient who will have the procedure in the afternoon, this recommendation will be unsuitable for them having gone without food for more than twelve hours. The clinical practice should develop strategies to accommodate such exceptions. With the modern anesthesia techniques and current research on the prolonged research, pulmonary aspiration has been found to have no significant relation with long fasting hours. Following the long fasting hours some up to eighteen hours, some studies have identified some clear fluids that don't affect the surgical procedure through facilitating pulmonary aspirations.

During a total knee replacement or total hip replacement procedure, a whole body anesthetic is applied, unlike other local surgical procedures that don't affect the body physiological functioning. The above surgical procedures also take long hours to complete making thus calling for additional research on the most appropriate procedure to ensure patient safety and better outcome (Mhealth.org, 2017). The significance of this research procedure is to develop an evidence-based procedure operation procedure that will accommodate all surgical patients.

Questions related to the issue

Concerning the feasibility of the questions related to this issue, some of the aspects that have been considered include the available information regarding the issue, what has been done so far towards solving this problem, and the research experience needed to solve the problem. The first question is what are the preoperative fasting guidelines? This question arises following the available preoperative guidelines which are now regarded as old guidelines. These guidelines need some review to ensure all patients have an equal outcome following a surgical operation in total knee replacement or total hip replacement. The second question is why should one not eat or drink anything before a surgical procedure? This question is very important to advise the patient to achieve the best outcomes. Fasting affects the post-operation events and therefore researching the question above will contribute a lot in caring for post-operative complications. What is the recommendable fasting duration before surgery is the third question? This question is very beneficial regarding the old guidelines where the patients were recommended to fast from midnight subjecting patients to more than 12 hours fasting. The fourth question state, is clear fluids recommended before surgery? For this question, some patients may get a wrong implication of what the doctors mean by clear fluids. Researching on this question will help patients experiencing long waiting hours with supplementary nutrients that will not affect the surgery procedure. The fifth question concerning this issue what are the risks of total knee replacement surgery? Through this question, the research will help patients with knowledge concerning the advantages of fasting and more so, the precautions required behind the recommended fasting hours. The five questions will also be applied to doctors and anesthesiologist concerning the new change in practice.

PICO Question

The PICO question is: When a patient is preoperative for a total knee replacement (TKR) OR total hip replacement (THR), should they be told to be NPO after midnight before surgery or are clear liquids up to two hours before the surgery acceptable? In Population, patients for preoperative for total knee replacement (TKR) or (THR) are advised to fast before undergoing the procedure. For the Comparison, NPO after midnight before surgery is being compared to the use of clear liquids up to two hours before surgery. In the comparison above, the two approaches are acceptable, but they have a different patient outcome. For a better patient outcome, the outcomes of the two approaches need to be compared for a better practice change. Concerning the outcome of the PICO question, the outcome variable is acceptability.

Keywords

The significance of keywords is to help in the literature review. Some of the keywords have been applied in various studies thus helping in gathering data. Evidence-based practice is a core word concerning this issue because the goal of this research is to implement a practice change in healthcare. For the two terms Total knee replacement and Total hip replacement, they are the basic search terms to answer the PICO question. To link the surgical replacement procedures with the fasting requirements another essential search is the risks during a replacement surgery procedure. NPO after midnight and its advantages are also essential search terms for this evidence-based practice project. Preoperative fasting guidelines as a search term are also useful for gathering the old guidelines that are currently in practice. The significance of clear fluids taken before surgery and the recommended food with clear liquid as search terms offer adequate information regarding the required food stuff when a patient is faced with prolonged fasting. Effect of food during operation is another search term essential to address the dilemma between effects of fasting and having a successful operation procedure. The keywords above will be very useful in gathering the essential facts and therefore developing an evidence-based practice on preoperative guidelines before total knee replacement and hip replacement procedures (HealthCommunities.com, 2017).

References

Davies, K. S. (December 01, 2011). Formulating the evidence based practice question: A review

of the frameworks. Evidence Based Library and Information Practice, 6, 2, 75-80.

HealthCommunities.com, (2017). Fasting Before Surgery - Before and After Surgery

HealthCommunities.com. (2017). Healthcommunities.com. Retrieved 11 March 2017, from http://www.healthcommunities.com/before-after-surgery/fasting-before-surgery.shtmlHowarth, M. L. (March 01, 2012). Research for Evidence-Based Practice in Healthcare. Nurse

Education in Practice, 12, 2.)Mhealth.org, (2017). No food or drink after midnight before surgery? Not so fast, experts say |

MHealth.org. (2017). Mhealth.org. Retrieved 11 March 2017, from https://www.mhealth.org/blog/2015/august-2015/no-food-or-drink-after-midnight-before-surgery-not-so-fast-experts-say