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1 jens meier zagreb guidelines 2019 04 28
- 1. Writing and implementation of guidelines, story in between and practical advices Prof. Dr. Jens Meier Clinic for Anesthesiology and Critical Care Medicine Kepler University Linz
- 2. Which care do we want to deliver? patient satisfaction high medical and nursing quality economical and effective optimized processes
- 3. The standard of care in transfusion
- 4. Which care do we want to deliver? patient satisfaction high medical and nursing quality economical and effective optimized processes Do you achieve this in PBM?
- 5. Overconfidence Are you an above average lover? > 75 % yes < 25 % no
- 6. Are there any differences?
- 7. The situation in my country Gombotz, Transfusion, 2007
- 8. Knowledge transfer Gombotz, Transfusion, 2014 Center before PBM implementation after PBM implementation
- 9. Transfusion policy is like...
- 10. What creates this diversity?
- 11. 9 types of procedural nonadeherence • No perception of relevant information (input) • Misperception of information (pattern matching) • Procedural design (input, interpretation) • Procedural experience/training (long-term memory) • Cultural aspects (influencing factors) • Personality aspects/attitudes (influencing factors) • Situational factors (influencing factors) • Decision-making heuristics (decision making) • awareness and attention management
- 12. Types of violations • routine violations: common practice becoming group norm • optimizing violations: challenge when rules are too restrictive • situational violations: dictated by immediate environment • exceptional violations: unusual or unfamiliar circumstances
- 14. There is urgency for a guideline
- 15. Why do we need guidelines? • Overwhelming amount of the literature • Inadequacy of textbooks • Difficulty synthesizing evidence and translating into practice
- 16. What makes a good guideline? • Valid • Reproducible • Cost-effective • Representative / multidisciplinary • Clinically applicable • Flexible • Clear • Reviewable • Amenable to clinical audit
- 17. How are evidence-based guidelines developed? • Identifying and refining the subject area of a guideline • Running guideline development groups • Identifying and assessing the evidence • Translating evidence into a clinical practice guideline • Reviewing and updating guidelines
- 18. The WHO way for guideline development
- 19. The WHO way of a guideline
- 20. Who should write a guideline? Professor Practitioner • lots of theoretical knowledge • well known • trustable • knows nothing about daily practice • sponsored by industry • good theoretical knowledge • often unknown • trustable ? • knows everything about daily practice • does not know the whole story • sponsored by industry
- 21. The WHO way of a guideline
- 22. What is a PICO question?
- 23. What is a PICO question? among elderly patients does restrictive transfusion versus liberal transfusion affect mortality
- 24. What is a PICO question? among elderly patients does restrictive transfusion versus liberal transfusion affect mortality among patients > 85 years does Hb>11 g/dl versus Hb<11g/dl affect morbidity
- 25. The WHO way of a guideline
- 27. The WHO way of a guideline
- 31. What are the typical steps of guideline development • Convert the need for info into an answerable question • Track down the best evidence • Critically appraise that evidence • Integrate the appraisal with one’s clinical expertise and the individual patient
- 32. Critique for the guideline process • De-emphasizes patient values • Doesn’t account for individual variation • Devalues clinical judgment • Leads to therapeutic nihilism
- 33. Conclusions