Development Of Nursing Practice Guideline For Acute Heart Failure Patients Based On GRADE System

As one of the common acute critical diseases, acute heart failure is of high incidence, high mortality and high readmission rates. Nurses take fully part and play an important role in the management of acute heart failure (AHF). While the nursing practice of AHF lacks of standard currently. Clinical practice guideline helps to regulate medical practices and improve the level of medical staff, acting as a clinical-decision tool bridging the gap between the best evidences and current clinical practices. But the exsiting AHF guideline involves few recommendations related to nursing, which is also unsystematic. Moreover, the quality of guidelines should be taken into consideration and guidelines from abroad should be localized, when applied.Objetctives:To build the nursing practice guideline of AHF and appraise the quality of it.Methods:The guideline was developed based on The Grading of Recommendation Assessment, Development and Evaluation (GRADE) system. Specific procedures included:1. Guideline group was setted up firstly.2. Clinical nursing issues on AHF were produced through the retrospective analysis of nursing records of AHF patients and the interview of key informant in cardiovascular field, then truned them into PICO modle.3. Recommendations were formed relatively through evidence synthesis from AHF related high-quality guidelines, systematic reviews or original literatures, based on the issues produced.4. Nursing practice guideline for AHF patients was developed.5. Experts in cardiovascular field were organized to review the guideline. 6. The quality of final-version guideline was appraised by AGREE II.Results:1. Guideline group consisted of 12 members, including physicians, nurses and researchers in cardiovascular field.2. Totally 10 clinical nursing issues on AHF were produced, including organization of care, clinical assessment, posture guidance, rotating tourniquets, oxygen supply, pharmacological management, medical assist treatment, monitoring and education, based on the retrospective analysis of 30 nursing records of AHF patients and the interview of 7 physicians and nurses in cardiovascular field.3.26 recommendations on AHF nursing practices were formed, through the evidence synthesis from 7 high-quality AHF related guidelines, and original literatures on posture guidance, rotating tourniquets, alcohol humidifying oxygen supply.4. The developed nursing practice guideline of AHF contained 6 parts, guideline group members, introduction, research methods, synopsis of guideline, explanation of recommendations, references.5. Ten experts participated in the peer review of guideline. Scores of the importance and necessity of the issues produced were all≥4. Except the part of pharmacological management, scores of the applicability of other recommendations were all>3. Scores of the rigor of the process of evidences synthesis and recommendations formation were all>3. Totally 10 recommendations were revised,5 recommendations were deleted,6 recommendations were added, according to the advices of experts. There were 27 recommendations at last.6. Five of the six fields in AGREE Ⅱ scored above 60%, according to the results of 3 experts.Conclusions:The development of "Nursing Practice Guideline for AHF Patients" was based on the clinical status in China, evidence-based principle, and professional judgements of medical staff. This guideline was of good quality, and is recommended to be applied into the care of acute heart failure.