Published in April 2014 Issue             

An Interview with Committee Chair,
Pamela Davis, RN, CBN, CCM

Pamela Davis, RN

The mission of the IH Clinical Issues and Guidelines Committee is to create evidence-based guidelines and position statements with focus on clinical issues related to the integrated multidisciplinary team, as well as issues related to the individual Integrated Health disciplines. Its goal is to enhance the safety, quality and outcomes of bariatric and metabolic surgical patient care.

connect recently explored the work of the committee with Committee Chair and IHEC Liaison, Pamela Davis, RN, CBN, CCM, Bariatric Program Director at TriStar Centennial Medical Center in Nashville, TN.

connect: What led to the formation of the committee?

In 2007, as part of the growth and development of the Integrated Health sector of ASMBS, a strategic plan was developed. There were two additional committees formed, Integrated Health Clinical Issues and Guidelines (IHCIGC) and the Continuing Education committee. The role of the IHCIGC is to identify clinical issues pertinent to the care of the bariatric surgery patient and to establish guidelines for safe, consistent and effective care of the bariatric surgery patient to optimize long-term outcomes.

connect: How does the committee determine which issues need position statements and which ones need to be updated?

The IHCIGC receives topics for statement development from several different sources: the Executive Council may issue a directive for a specific statement to be drafted, another ASMBS committee may request IHCIGC develop a statement or guideline, members of the IHCIGC committee may generate topics and we welcome submission of suggestions from ASMBS members.

connect: What is the process for developing or updating position statements?

Once requests are received, the IHCIGC may charge a subcommittee within the IHCIGC to write the initial draft of the statement or it may be assigned to another ASMBS committee. Then a thorough review of available literature is performed and a draft statement is created.

The draft statement is submitted by the subcommittee to the full IHCIGC for review and comment, then the draft is returned to the subcommittee to incorporate recommended edits. This process may occur multiple times until the final draft is approved by the entire IHCIGC. A legal advisor also reviews the approved draft with the IHCIGC Chair.

This draft is then submitted to the Executive Committee of the Executive Council (ECEC) for review and comment. The draft may also be sent to another committee for
simultaneous review.

Once approved by the ECEC, the draft is sent to the full Executive Council (EC) for review and approval. This EC-approved statement is then sent to the entire ASMBS membership via email for comment.

Once membership comments are incorporated, the statement must go back to the ECEC and Executive Council for final approval. Then it is ready for publication!

connect: Does the IH Clinical Issues and Guidelines Committee work closely with the ASMBS Clinical Issues Committee? How do you coordinate work on the development of guidelines?

As the chair of the IHCIGC, I also sit on the ASMBS Clinical Issues Committee. As such, both committees are kept aware of each other’s projects and may seek input from each other on both the topics and the content.

connect: The committee completed its first guideline, “Gastric Band Adjustment Credentialing Guidelines for Physician Extenders" in 2012. Why was that the first guideline? What led to its development? What has been the impact?

With the increase in bariatric surgery procedures and lifelong follow-up for those patients growing in number, many practices utilize Advanced Practice Providers for gastric band adjustments. We found a pretty significant variance in practice from state to state and from program to program. The ASMBS President at the time, Dr. Robin Blackstone, tasked the IHCIGC with the development of “Gastric Band Adjustment Credentialing Guidelines for Physician Extenders,” to provide a safe and consistent approach to the care of the metabolic and bariatric surgery patient. The IHCIGC developed an ad hoc committee for completion of this task. We surveyed high volume band programs for their existing approach, reviewed the literature and developed our first guideline.

connect: What is the committee’s current focus and projects? What is the timeline for issuance of new guidelines or position statements?

We currently have several projects under way.

Revision of the original 2004 “Suggestions for the Pre-Surgical Psychological Assessment of Bariatric Surgery Candidates” has been a very arduous task, as the behavioral health subcommittee has reviewed hundreds of articles in the course of developing a new document. The draft is currently going through the various stages of review and we anticipate it being ready for the ASMBS membership over the summer.

Similarly, the revision of the “ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient” document from 2008 has taken a substantial amount of time due to the sheer volume of literature relating to the micronutrients and macronutrients in relation to the metabolic and bariatric surgery patient. The draft document is still being written. We anticipate it being ready to go through the various committee reviews within the next couple of months.

ASMBS and the American College of Sports Medicine are working collaboratively on physical activity recommendations for the individual with severe obesity. This statement is in the early formation period. Guidelines regarding sensitivity training for individuals with severe obesity are in the final draft stage. We anticipate the draft to begin the review process
very soon.

connect: What are the biggest clinical issues facing Integrated Health professionals in bariatric surgery?

I believe one of the greatest clinical issues we face is a lack of support and recognition of our contribution to the care and outcomes of the metabolic and bariatric surgery patient. A comprehensive, accredited program requires expertise, experience and professionalism from multiple disciplines. Only rarely are these services covered by payers. I believe the lack of coverage of these valuable services sends a message trivializing the role of the IH professional in the care of the metabolic and bariatric surgery patient. The efforts of our ASMBS leadership and the OAC to gain access to care and coverage of treatment options has propelled us forward in the coverage of surgery as a treatment option. I believe we, as IH professionals, have to continue to delineate our role and our impact on the care of these patients. The development of specific recommendations and protocols to improve the quality of care provided by the IH professional, gives us an opportunity to do so.

connect: How has the role of IH changed over the years in terms of its contributions to science and clinical practice?

A look at upcoming ASMBS educational events - the Spring Event and ObesityWeek 2014 - offers multiple examples of the contributions to science made by our IH colleagues. One of the components I value so greatly during the IH sessions is the mixture of presenters. We have contributions from those who have a strong academic and research background as well as contributions from those in private practice settings.

connect: One of the committee’s goals is to develop a New Program Start-Up Tool Kit. What kind of information and resources will be included in the tool kit?

We are all very excited about the Tool Kit. We will begin with a basic kit to assist new programs as they build from the ground up. The Tool Kit will also include components to assist existing programs in taking their program to the next level. We see this as an ongoing project that will launch with an initial set of templates and resources that we will continue to build over time. Specific categories will center around: service line development and program start-up, facility accommodations, equipment and supplies, business development, program structure/staffing/team model, staff education, patient education, and of course,
clinical guidelines.

connect: How can ASMBS IH members get more involved and submit recommended ideas for guidelines and position statements to the committee?

Watch for emails from ASMBS requesting your comments on the guidelines and share your recommendations. If you have a recommendation for a guideline or position statement, please email it to