Evidence-Based Gynecologic Surgery Best Practices: The AHRQ Safety Program
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the elements that are evidence-based and should be incorporated in to pre-, intra- and postoperative gynecologic care 2. Describe the recommendations for prevention of venous thromboembolism for women undergoing gynecologic surgery
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Aug 14 2018 through Aug 14 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Pharmacy Education
Postgraduate Institute for Medicine designates this continuing education activity for 0.25 contact hour(s) (0.25 CEUs) of the Accreditation Council for Pharmacy Education. (Universal Activity Number – JA4008162-9999-18-351-H05-P)
Type of Activity: Knowledge
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
The AHRQ, American College of Surgeons and Armstrong Institute at Johns Hopkins have developed a safety program to assess and help incorporate evidence-based practices into surgical care. An evidence review of gynecologic surgery was conducted, supporting the protocol elements in the AHRQ Safety Program that include the following best practices
‘Potential’ association between preoperative patient education and improved outcomes (low level evidence)
Minimally invasive gyn surgery
Oral mechanical bowel prep should be abandoned (strong level evidence)
When bowel prep is desired (patients at high risk such as colorectal resection)
Based on colorectal surgery evidence, oral mechanical bowel prep alone is not effective
Use one of the following regimens (moderate level evidence)
Oral mechanical bowel prep and oral antibiotic
Oral antibiotic alone
Note: The review states “Data from non-randomized studies suggest that bowel preparation may be omitted within a well-developed ERP (enhanced recovery pathways) that incorporates a SSI reduction bundle even when bowel resection is anticipated”
Routine nasogastric tube
Associated patient discomfort with no known benefit (high level evidence)
Routine peritoneal drains
Prophylactic use is not beneficial following lympadenectomy for gyn surgery
Avoid unless there is a rectal anastomosis within 6 cm of the anal verge and no diversion or patient at high risk for pelvic collections (moderate level evidence)
Intermittent pneumatic compression alone for (moderate level evidence)
Minimally invasive surgery for any indication or
Laparotomy for benign disease
Add preoperative pharmacologic prophylaxis for patients undergoing laparotomy for gynecologic malignancies
Weak level evidence from observational studies but consideration given to high rate of VTE in this population
Supported by multiple societies
Use mechanical prophylaxis for the duration of hospitalization in all gynecologic surgical patients and mechanical and/or pharmacologic prophylaxis for gynecologic oncology surgical patients (high level of evidence)
Gyn oncology: Extend VTE chemoprophylaxis for 4 weeks following surgery
Supported by multiple guidelines, but further research required on long-term benefits
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
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