Using Appraisal of Guidelines for Research & Evaluation II (AGREE II) Tool to Evaluate the Sepsis Resuscitation Bundle Practice Guideline

Pinelle, Michelle A.

Tuesday, 23 July 2013: 11:25 AM

Michelle A. Pinelle, BSN, RN, CCRN
Critical Care Unit, Vail Valley Medical Center, Vail, CO
Jamie K. Roney, BSN, RN, CCRN
Nursing Administration, Covenant Health, Lubbock, TX

Learning Objective 1: The learner will be able to discuss use of the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool to evaluate practice guidelines

Learning Objective 2: The learner will be able to evaluate practice guidelines to treat septic patients using Appraisal of Guidelines for Research & Evaluation II (AGREE II) Tool

Purpose: Nurses should detail clinical significance of practice guidelines, identify research criteria considered for clinical guideline development, synthesize literature used for the practice guideline’s recommendation for use, and summarize results of clinical guideline evaluation including recommendations for clinical implementation and appropriateness for use in practice.The purpose of this research was to appraise guidelines developed by the Surviving Sepsis Campaign (SSC) Sepsis Resuscitation Bundle (SRB) to treat patients with severe sepsis/septic shock using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool.

Methods: The AGREE II tool was used to evaluate development of the SRB clinical guidelines and effectiveness in application to practice by four clinicians. The AGREE II tool contained 23 items organized under six domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence. Furthermore, the instrument included two final assessment questions to allow the rater to judge the practice guideline as a whole. The AGREE II instrument allowed for the scoring of the SSC SRB by four clinicians using a 7-point likert scale for statistical comparison/inter-rater reliability.

Results: The AGREE II tool evaluation results demonstrated that the Sepsis Resuscitation Bundle was developed from sound research, expert collaboration, and with rigour. The SRB interventions recommended for the treatment of severe sepsis/septic shock found in the practice guidelines increase survival, improve outcomes, lower costs to treat, and decrease length of hospital stay are supported from solid research methodologies.

Conclusions: After reviewing the evidence produced by research and using the AGREE II tool to analyze the guideline development methodology, the SRB remains an appropriate practice guideline that addresses the increased incidence of severe sepsis and septic shock in the clinical setting. The AGREE II tool was a simple tool for use in evaluating current sepsis practice guidelines by clinicians.

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