Cardiac Surgery in an Era of Antiplatelet Therapies: Generating New Evidence

2.50
Hdl Handle:
http://hdl.handle.net/10755/149322
Type:
Presentation
Title:
Cardiac Surgery in an Era of Antiplatelet Therapies: Generating New Evidence
Abstract:
Cardiac Surgery in an Era of Antiplatelet Therapies: Generating New Evidence
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Ley, S.
P.I. Institution Name:California Pacific Medical Center
Practice Problem: In 1999 the antiplatelet agent clopidogrel (Plavix) was introduced for prevention of stroke, myocardial infarction, and stent thrombosis following percutaneous coronary interventional procedures. The cardiac surgical service soon noted a rapid increase in coronary artery bypass graft (CABG) patients with preoperative clopidogrel exposure immediately prior to surgery, and questioned the impact of this medication on postoperative bleeding complications. As part of our ongoing cardiac surgery quality improvement and research programs, the clinical nurse specialist (CNS) for cardiac surgery concurrently monitors perioperative benchmarks and surgical outcomes via a clinical database system (PATS by Axis Clinical Software, Inc.; Portland, OR). At the beginning of 1999, the CNS added clopidogrel to the list of preoperative medications monitored within the database to assess its potential impact on surgical outcomes. Lessons Learned: Ideally, large randomized controlled trials guide practice decisions for important clinical questions. Unfortunately, data is limited for many issues, contributing to the need for internal evidence-based initiatives. Despite relatively small sample sizes and lack of randomization, internal data is often viewed as strong evidence in the center in which it was obtained, as occurred here. Critical to the acceptance of such findings is use of quality controls in data collection processes and appropriate research methodologies. Through these efforts, our center has a heightened awareness of the potential for bleeding complications with both oral and intravenous antiplatelet agents, and look cautiously on new drugs and treatments that have limited patient experience. Successful quality improvement activities and evidence-based practice changes require more than technology. The active participation and contributions of CNS's are essential to the process and outcomes of quality care delivery.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleCardiac Surgery in an Era of Antiplatelet Therapies: Generating New Evidenceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/149322-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Cardiac Surgery in an Era of Antiplatelet Therapies: Generating New Evidence</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Ley, S.</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">California Pacific Medical Center</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">leyj@sutterhealth.org</td></tr><tr><td colspan="2" class="item-abstract">Practice Problem: In 1999 the antiplatelet agent clopidogrel (Plavix) was introduced for prevention of stroke, myocardial infarction, and stent thrombosis following percutaneous coronary interventional procedures. The cardiac surgical service soon noted a rapid increase in coronary artery bypass graft (CABG) patients with preoperative clopidogrel exposure immediately prior to surgery, and questioned the impact of this medication on postoperative bleeding complications. As part of our ongoing cardiac surgery quality improvement and research programs, the clinical nurse specialist (CNS) for cardiac surgery concurrently monitors perioperative benchmarks and surgical outcomes via a clinical database system (PATS by Axis Clinical Software, Inc.; Portland, OR). At the beginning of 1999, the CNS added clopidogrel to the list of preoperative medications monitored within the database to assess its potential impact on surgical outcomes. Lessons Learned: Ideally, large randomized controlled trials guide practice decisions for important clinical questions. Unfortunately, data is limited for many issues, contributing to the need for internal evidence-based initiatives. Despite relatively small sample sizes and lack of randomization, internal data is often viewed as strong evidence in the center in which it was obtained, as occurred here. Critical to the acceptance of such findings is use of quality controls in data collection processes and appropriate research methodologies. Through these efforts, our center has a heightened awareness of the potential for bleeding complications with both oral and intravenous antiplatelet agents, and look cautiously on new drugs and treatments that have limited patient experience. Successful quality improvement activities and evidence-based practice changes require more than technology. The active participation and contributions of CNS's are essential to the process and outcomes of quality care delivery.</td></tr></table>en_GB
dc.date.available2011-10-26T10:00:08Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T10:00:08Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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