This document provides guidance for developing clinical practice guidelines at the Royal Children's Hospital in Melbourne, Australia. It outlines a 17 step process for guideline development that involves identifying a topic, forming an authoring team, reviewing evidence, drafting content, obtaining stakeholder feedback, finalizing and approving the guideline, implementing it, and evaluating its impact. Key principles include developing guidelines through a multidisciplinary process, basing them on the best available research evidence, and involving consumers throughout. The overall goal is to improve healthcare quality and outcomes for patients.
This document discusses clinical practice guidelines and their role in evidence-based practice. It provides definitions of clinical practice guidelines and discusses their increased use due to concerns over variability in care, costs, quality and liability. It notes guidelines can differ in comprehensiveness, format, review frequency and ease of use. While guidelines are distinct from evidence-based practice, high quality evidence-based guidelines including a systematic literature review can provide useful guidance. The document lists sources of guidelines and outlines a six-step process for developing evidence-based practice guidelines, including identifying topics, convening experts, systematically reviewing evidence, translating evidence into recommendations, using outside reviewers, and periodic updates. It also discusses critically appraising guidelines for validity and applicability.
This document outlines the clinical audit process which involves systematically reviewing patient care against criteria to improve outcomes. It discusses selecting an audit topic focused on processes related to common conditions or procedures. Best practice standards are identified from guidelines and literature. The audit process involves forming a team, setting aims and standards, collecting and analyzing quantitative and qualitative data from a sample, implementing changes, and re-auditing to confirm improvements. Data collection involves designing a questionnaire and obtaining department approval and ethics approval.
A basic introduction to POMR's Problem oriented medical records.
This is one approach to collect as much data as possible from a patient in order to provide accurate care to a patient. Initally proposed by Dr Lawrence (Larry) Weed this now has become one of the ways information has been collected
Clinical practice guidelines are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”They are intended to offer concise instructions on how to provide healthcare services.The most important benefit of clinical practice guidelines is their potential to improve both the quality or process of care and patient outcomes. Increasingly, clinicians and clinical managers must choose from numerous, sometimes differing, and occasionally contradictory, guidelines.
A personalized training workshop for the PRM Department Staff at KSUMC at large. The specific target audience is the CPG working groups and new committee members.
evidence based practice is best for the people working with patients
ebp should be used by the heath care provider.
ebp based upon clinical experties
best research evidence
patient preference and values
At the end of this presentation you will be able to:
Define evidence-based practice
Describe process & outline steps of EBP
Understand PICO elements & search strategy
Identify resources to support EBP
The focus of this presentation is nursing practice, although it is still of value to physicians and other health care professionals.
This document discusses clinical practice guidelines and their role in evidence-based practice. It provides definitions of clinical practice guidelines and discusses their increased use due to concerns over variability in care, costs, quality and liability. It notes guidelines can differ in comprehensiveness, format, review frequency and ease of use. While guidelines are distinct from evidence-based practice, high quality evidence-based guidelines including a systematic literature review can provide useful guidance. The document lists sources of guidelines and outlines a six-step process for developing evidence-based practice guidelines, including identifying topics, convening experts, systematically reviewing evidence, translating evidence into recommendations, using outside reviewers, and periodic updates. It also discusses critically appraising guidelines for validity and applicability.
This document outlines the clinical audit process which involves systematically reviewing patient care against criteria to improve outcomes. It discusses selecting an audit topic focused on processes related to common conditions or procedures. Best practice standards are identified from guidelines and literature. The audit process involves forming a team, setting aims and standards, collecting and analyzing quantitative and qualitative data from a sample, implementing changes, and re-auditing to confirm improvements. Data collection involves designing a questionnaire and obtaining department approval and ethics approval.
A basic introduction to POMR's Problem oriented medical records.
This is one approach to collect as much data as possible from a patient in order to provide accurate care to a patient. Initally proposed by Dr Lawrence (Larry) Weed this now has become one of the ways information has been collected
Clinical practice guidelines are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”They are intended to offer concise instructions on how to provide healthcare services.The most important benefit of clinical practice guidelines is their potential to improve both the quality or process of care and patient outcomes. Increasingly, clinicians and clinical managers must choose from numerous, sometimes differing, and occasionally contradictory, guidelines.
A personalized training workshop for the PRM Department Staff at KSUMC at large. The specific target audience is the CPG working groups and new committee members.
evidence based practice is best for the people working with patients
ebp should be used by the heath care provider.
ebp based upon clinical experties
best research evidence
patient preference and values
At the end of this presentation you will be able to:
Define evidence-based practice
Describe process & outline steps of EBP
Understand PICO elements & search strategy
Identify resources to support EBP
The focus of this presentation is nursing practice, although it is still of value to physicians and other health care professionals.
CLINICAL PATHWAY and CLINICAL PRACTICE GUIDELINESMary Ann Adiong
This document discusses clinical pathways and clinical practice guidelines. It defines clinical pathways as multidisciplinary plans of best clinical practices for specific patient groups. Clinical pathways help improve quality of care, reduce variation, and enhance communication. The document outlines the components and development process of clinical pathways, including establishing multidisciplinary teams, collecting data, and monitoring variances. It also discusses how clinical practice guidelines are evidence-based statements that optimize patient care through systematic reviews and benefit-harm assessments.
This document discusses the process of clinical auditing. It begins by defining clinical auditing as a quality improvement process that systematically reviews patient care against criteria to implement changes that improve outcomes. It then outlines the key stages of clinical auditing: choosing a topic by identifying an area for improvement; establishing criteria and standards; collecting and analyzing data; identifying if standards were met and reasons for any gaps; developing an action plan; and re-auditing to assess if improvements were achieved. The goals of clinical auditing are to ensure best practices are followed, reduce risks, and improve patient care.
Meta-analysis is defined as quantitatively combining and integrating the findings of multiple research studies on a particular topic. It was coined by Glass in 1976 and refers to analyzing the results of several studies that address a shared research hypothesis. The key steps in a meta-analysis involve defining a hypothesis, locating relevant studies, inputting empirical data, calculating an overall effect size by standardizing statistics, and analyzing any moderating variables if heterogeneity exists. An example provided is a meta-analysis on coping behaviors of cancer patients that would statistically analyze results from quantitative studies with similar age groups.
Clinical pathways are multidisciplinary plans that embed evidence-based best practices into patient care to improve outcomes and efficiency. They originated from process mapping in engineering and were later adapted for healthcare. Clinical pathways standardize care for common conditions while allowing flexibility for individual patients. When combined with clinical practice guidelines, pathways can reinforce evidence-based practices and support clinical decision making. However, pathways must be carefully implemented and evaluated to ensure they do not discourage personalized care or reduce quality.
Yes, the results are statistically significant since the confidence interval does not cross 1. The results are also precise since the confidence interval is narrow. There is no information given to determine if there is publication bias.
Critical appraisal of a journal articleDrSahilKumar
This document provides guidance on critically appraising journal articles. It defines critical appraisal as systematically identifying the strengths and weaknesses of research to assess validity and usefulness. Key aspects to evaluate include relevance of the research question, appropriateness of study design, addressing biases, adherence to original protocol, statistical analyses, and conflicts of interest. Checklists like CASP, CONSORT, and STROBE provide frameworks to appraise study methodologies like randomized trials, systematic reviews, and observational studies. The goal of critical appraisal is for clinicians to identify high-quality evidence to inform clinical practice.
The document discusses clinical decision making in evaluating and treating patients. It involves gathering subjective and objective data from patients, determining appropriate goals and treatment plans based on evaluation findings and clinical judgment, monitoring patient progress, and determining discharge. Treatment plans are adjusted based on a patient's response. Frequent re-evaluations ensure treatment strategies remain appropriate.
This document provides an outline and overview of clinical pathways. It begins with the history and origins of clinical pathways in the 1980s. It then defines clinical pathways as multidisciplinary tools to standardize and optimize care for specific patients based on evidence. The document discusses why pathways are used, including to improve quality of care, maximize efficiency, reduce variability, and support clinical effectiveness. It also covers potential issues, benefits, components of pathways, and how pathways are developed through a multidisciplinary process.
Critical appraisal is the process of carefully and systematically analyze the research paper to judge its trustworthiness, its value and relevance in a particular context. (Amanda Burls 2009)
A critical review must identify the strengths and limitations in a research paper and this should be carried out in a systematic manner.
The Critical Appraisal helps in developing the necessary skills to make sense of scientific evidence, based on validity, results and relevance.
Critical appraisal of randomized clinical trialsSamir Haffar
The document discusses key concepts in randomized clinical trials (RCTs), including:
1) RCTs are considered the gold standard for evaluating the effectiveness of interventions due to their ability to minimize bias through randomization and blinding.
2) Proper randomization aims to create comparable treatment and control groups, conceal allocation to prevent bias, and may involve simple, stratified or blocked methods.
3) Blinding (masking) of participants, investigators and assessors can decrease observation bias and is important for RCT validity, though full blinding is not always possible.
4) Intention-to-treat analysis includes all randomized patients to preserve comparable groups and prevent bias from non-compliance.
Utilization management is the evaluation of health care services, procedures, and facilities to determine their medical necessity, appropriateness, and efficiency according to established guidelines and health plan provisions. It aims to ensure effective and efficient use of health care resources and delivery of high quality, medically necessary care. Utilization management techniques include prospective review, concurrent review, retrospective review, and pre-certification of services. It utilizes clinical guidelines like McKesson's InterQual Criteria and Milliman Care Guidelines to standardize decision making. The goals of utilization management are to improve health outcomes, reduce over- and under-utilization of services, and lower health care costs.
Overview of the progress of the KSUMC Clinical Practice Guidelines Adaptation and Implementation Program in the Department of Pediatrics which is the most active department in the program
This document summarizes a research study on complex problem solving using a computer simulation called Syntex. The study involved 54 students from Zhejiang University divided into 18 groups. The groups made management decisions for a simulated company each month. The researchers found differences between the "best" and "worst" groups based on company performance. Best groups increased capital and hired more employees over time compared to worst groups. The researchers also analyzed decision making processes and information gathering between the groups. They explored perspectives including the problem solving process, group interactions, and cross-cultural differences. The document discusses research design, validity, variables measured, and limitations of generalizing the results.
This document discusses medication errors, including their definition, causes, types, and strategies to prevent them. Some key points:
- Medication errors are preventable events that may cause harm and can occur at any stage from prescribing to administration. They are common but underreported.
- Errors are often due to look-alike or sound-alike drug names, miscommunication, lack of knowledge, and environmental factors like interruptions.
- Common types of errors include prescribing errors, dispensing errors, and administration errors. Analgesics, antibiotics, anticoagulants are high-risk drug classes.
- Prevention strategies include education, standardized processes, double checks, limiting distractions, clear
Levels of evidence, recommendations & phases ofsanyal1981
This document discusses levels of evidence and phases of clinical trials. It defines evidence-based medicine as using current best evidence from systematic research to make decisions about patient care. Levels of evidence are ranked from 1A to 5 based on study design, with systematic reviews and randomized controlled trials ranked highest. Clinical trials progress through four phases to test safety, efficacy, and optimal use of new drugs or devices. Phase 1 assesses safety, phase 2 establishes efficacy, phase 3 confirms safety and efficacy in larger groups, and phase 4 studies monitor risks and benefits after marketing.
Levels of evidence, systematic review and guidelinesAboubakr Elnashar
1) Evidence-based medicine requires integrating the best research evidence with clinical expertise and patient values and circumstances.
2) Levels of evidence are used to rank types of medical studies, with systematic reviews and randomized controlled trials ranked highest.
3) Systematic reviews use explicit and reproducible methods to identify, select, and critically appraise relevant research to answer a specific clinical question.
This document outlines the process for conducting a systematic review. It defines a systematic review as a review that uses explicit and reproducible methods to identify, select, and critically appraise relevant research and collect and analyze data from the included studies. It notes that systematic reviews help address biases and provide more robust evidence than individual studies. The document describes the key steps in a systematic review as developing a focused question, performing a comprehensive search, applying inclusion/exclusion criteria, assessing study quality, extracting data, performing meta-analyses if appropriate, and interpreting results. It also discusses challenges such as ensuring systematic reviews address developing world priorities and include studies conducted in those settings.
The document discusses the methodology for adapting clinical practice guidelines at KNH hospital. It describes adapting existing high-quality guidelines from other contexts rather than developing new ones. The ADAPTE process is used, which involves setting up a working group, appraising relevant guidelines using AGREE II, adapting them based on the local population and context, assessing the adapted guideline, and finalizing the new guideline. The goal is to improve healthcare practices and decisions through implementing systematically adapted evidence-based guidelines.
CLINICAL PATHWAY and CLINICAL PRACTICE GUIDELINESMary Ann Adiong
This document discusses clinical pathways and clinical practice guidelines. It defines clinical pathways as multidisciplinary plans of best clinical practices for specific patient groups. Clinical pathways help improve quality of care, reduce variation, and enhance communication. The document outlines the components and development process of clinical pathways, including establishing multidisciplinary teams, collecting data, and monitoring variances. It also discusses how clinical practice guidelines are evidence-based statements that optimize patient care through systematic reviews and benefit-harm assessments.
This document discusses the process of clinical auditing. It begins by defining clinical auditing as a quality improvement process that systematically reviews patient care against criteria to implement changes that improve outcomes. It then outlines the key stages of clinical auditing: choosing a topic by identifying an area for improvement; establishing criteria and standards; collecting and analyzing data; identifying if standards were met and reasons for any gaps; developing an action plan; and re-auditing to assess if improvements were achieved. The goals of clinical auditing are to ensure best practices are followed, reduce risks, and improve patient care.
Meta-analysis is defined as quantitatively combining and integrating the findings of multiple research studies on a particular topic. It was coined by Glass in 1976 and refers to analyzing the results of several studies that address a shared research hypothesis. The key steps in a meta-analysis involve defining a hypothesis, locating relevant studies, inputting empirical data, calculating an overall effect size by standardizing statistics, and analyzing any moderating variables if heterogeneity exists. An example provided is a meta-analysis on coping behaviors of cancer patients that would statistically analyze results from quantitative studies with similar age groups.
Clinical pathways are multidisciplinary plans that embed evidence-based best practices into patient care to improve outcomes and efficiency. They originated from process mapping in engineering and were later adapted for healthcare. Clinical pathways standardize care for common conditions while allowing flexibility for individual patients. When combined with clinical practice guidelines, pathways can reinforce evidence-based practices and support clinical decision making. However, pathways must be carefully implemented and evaluated to ensure they do not discourage personalized care or reduce quality.
Yes, the results are statistically significant since the confidence interval does not cross 1. The results are also precise since the confidence interval is narrow. There is no information given to determine if there is publication bias.
Critical appraisal of a journal articleDrSahilKumar
This document provides guidance on critically appraising journal articles. It defines critical appraisal as systematically identifying the strengths and weaknesses of research to assess validity and usefulness. Key aspects to evaluate include relevance of the research question, appropriateness of study design, addressing biases, adherence to original protocol, statistical analyses, and conflicts of interest. Checklists like CASP, CONSORT, and STROBE provide frameworks to appraise study methodologies like randomized trials, systematic reviews, and observational studies. The goal of critical appraisal is for clinicians to identify high-quality evidence to inform clinical practice.
The document discusses clinical decision making in evaluating and treating patients. It involves gathering subjective and objective data from patients, determining appropriate goals and treatment plans based on evaluation findings and clinical judgment, monitoring patient progress, and determining discharge. Treatment plans are adjusted based on a patient's response. Frequent re-evaluations ensure treatment strategies remain appropriate.
This document provides an outline and overview of clinical pathways. It begins with the history and origins of clinical pathways in the 1980s. It then defines clinical pathways as multidisciplinary tools to standardize and optimize care for specific patients based on evidence. The document discusses why pathways are used, including to improve quality of care, maximize efficiency, reduce variability, and support clinical effectiveness. It also covers potential issues, benefits, components of pathways, and how pathways are developed through a multidisciplinary process.
Critical appraisal is the process of carefully and systematically analyze the research paper to judge its trustworthiness, its value and relevance in a particular context. (Amanda Burls 2009)
A critical review must identify the strengths and limitations in a research paper and this should be carried out in a systematic manner.
The Critical Appraisal helps in developing the necessary skills to make sense of scientific evidence, based on validity, results and relevance.
Critical appraisal of randomized clinical trialsSamir Haffar
The document discusses key concepts in randomized clinical trials (RCTs), including:
1) RCTs are considered the gold standard for evaluating the effectiveness of interventions due to their ability to minimize bias through randomization and blinding.
2) Proper randomization aims to create comparable treatment and control groups, conceal allocation to prevent bias, and may involve simple, stratified or blocked methods.
3) Blinding (masking) of participants, investigators and assessors can decrease observation bias and is important for RCT validity, though full blinding is not always possible.
4) Intention-to-treat analysis includes all randomized patients to preserve comparable groups and prevent bias from non-compliance.
Utilization management is the evaluation of health care services, procedures, and facilities to determine their medical necessity, appropriateness, and efficiency according to established guidelines and health plan provisions. It aims to ensure effective and efficient use of health care resources and delivery of high quality, medically necessary care. Utilization management techniques include prospective review, concurrent review, retrospective review, and pre-certification of services. It utilizes clinical guidelines like McKesson's InterQual Criteria and Milliman Care Guidelines to standardize decision making. The goals of utilization management are to improve health outcomes, reduce over- and under-utilization of services, and lower health care costs.
Overview of the progress of the KSUMC Clinical Practice Guidelines Adaptation and Implementation Program in the Department of Pediatrics which is the most active department in the program
This document summarizes a research study on complex problem solving using a computer simulation called Syntex. The study involved 54 students from Zhejiang University divided into 18 groups. The groups made management decisions for a simulated company each month. The researchers found differences between the "best" and "worst" groups based on company performance. Best groups increased capital and hired more employees over time compared to worst groups. The researchers also analyzed decision making processes and information gathering between the groups. They explored perspectives including the problem solving process, group interactions, and cross-cultural differences. The document discusses research design, validity, variables measured, and limitations of generalizing the results.
This document discusses medication errors, including their definition, causes, types, and strategies to prevent them. Some key points:
- Medication errors are preventable events that may cause harm and can occur at any stage from prescribing to administration. They are common but underreported.
- Errors are often due to look-alike or sound-alike drug names, miscommunication, lack of knowledge, and environmental factors like interruptions.
- Common types of errors include prescribing errors, dispensing errors, and administration errors. Analgesics, antibiotics, anticoagulants are high-risk drug classes.
- Prevention strategies include education, standardized processes, double checks, limiting distractions, clear
Levels of evidence, recommendations & phases ofsanyal1981
This document discusses levels of evidence and phases of clinical trials. It defines evidence-based medicine as using current best evidence from systematic research to make decisions about patient care. Levels of evidence are ranked from 1A to 5 based on study design, with systematic reviews and randomized controlled trials ranked highest. Clinical trials progress through four phases to test safety, efficacy, and optimal use of new drugs or devices. Phase 1 assesses safety, phase 2 establishes efficacy, phase 3 confirms safety and efficacy in larger groups, and phase 4 studies monitor risks and benefits after marketing.
Levels of evidence, systematic review and guidelinesAboubakr Elnashar
1) Evidence-based medicine requires integrating the best research evidence with clinical expertise and patient values and circumstances.
2) Levels of evidence are used to rank types of medical studies, with systematic reviews and randomized controlled trials ranked highest.
3) Systematic reviews use explicit and reproducible methods to identify, select, and critically appraise relevant research to answer a specific clinical question.
This document outlines the process for conducting a systematic review. It defines a systematic review as a review that uses explicit and reproducible methods to identify, select, and critically appraise relevant research and collect and analyze data from the included studies. It notes that systematic reviews help address biases and provide more robust evidence than individual studies. The document describes the key steps in a systematic review as developing a focused question, performing a comprehensive search, applying inclusion/exclusion criteria, assessing study quality, extracting data, performing meta-analyses if appropriate, and interpreting results. It also discusses challenges such as ensuring systematic reviews address developing world priorities and include studies conducted in those settings.
The document discusses the methodology for adapting clinical practice guidelines at KNH hospital. It describes adapting existing high-quality guidelines from other contexts rather than developing new ones. The ADAPTE process is used, which involves setting up a working group, appraising relevant guidelines using AGREE II, adapting them based on the local population and context, assessing the adapted guideline, and finalizing the new guideline. The goal is to improve healthcare practices and decisions through implementing systematically adapted evidence-based guidelines.
Utilización de la evidencia cualitativa para mejorar la inclusión de las pref...GuíaSalud
Tercera intervención de la Mesa 1 de la Jornada científica GuíaSalud 2017: La implicación de pacientes en el desarrollo de GPC. Una estrategia necesaria para mejorar la toma de decisiones. Simon Lewin
Clinical guidelines are systematically developed statements that provide practitioners and patients a ready resource for treatment options and their risks/benefits. They are based on synthesizing high-quality evidence from systematic reviews and research. The introduction of evidence-based medicine led to greater use of clinical research results in guidelines. Guidelines provide a manageable summary for busy practitioners. They are best developed by multidisciplinary panels and explicitly linking recommendations to evidence. PEDro is a major database for evidence-based physical therapy guidelines.
This document discusses the development of therapeutic guidelines. It defines therapeutic guidelines as clinical practice guidelines written for prescribers to provide treatment recommendations based on current evidence. The document outlines the need for guidelines to improve patient care quality and consistency while controlling healthcare costs. It describes the composition of guideline development groups and the multi-step process involved, including identifying the problem and literature, obtaining expert opinions, reviewing evidence, and disseminating the completed guidelines. Potential limitations of guidelines like complexity and physician acceptance are also discussed.
Development and Evaluation of clinical practice guideline (CPG) in psychiatryDiptadhi Mukherjee
The document discusses guidelines for clinical practice in psychiatry. It covers the development and evaluation of guidelines. Guideline development involves establishing a group with relevant expertise, systematically reviewing evidence, developing recommendations, and updating over time. Evaluation tools like AGREE assess guidelines across several domains including rigor of development, applicability, and independence. Most guidelines have room for improvement in areas like stakeholder involvement and addressing implementation. Indian guidelines aim to be relevant to local practice but could better integrate Indian research evidence.
NONPF - 1NURSE PRACTITIONER CORE COMPETENCIES April 201.docxkendalfarrier
NONPF - 1
NURSE PRACTITIONER CORE COMPETENCIES
April 2011
Amended 2012*
Task Force Members
Anne C. Thomas, PhD, ANP-BC, GNP - Chair
M. Katherine Crabtree, DNSc, FAAN, APRN-BC
Kathleen R. Delaney, PhD, PMH-NP
Mary Anne Dumas, PhD, RN, FNP-BC, FAANP
Ruth Kleinpell, PhD, RN, FAAN, FCCM
M. Cynthia Logsdon, PhD, WHNP-BC, FAAN
Julie Marfell, DNP, FNP-BC, FAANP
Donna G. Nativio, PhD, CRNP, FAAN
Note: Terms in bold are defined within the glossary found at the end of the competencies.
Preamble
In August 2008, NONPF endorsed the evolution of the Doctorate of Nursing Practice (DNP) as the entry
level for nurse practitioner (NP) practice (NONPF, 2008a). Nurse practitioner education, which is based
upon the NONPF competencies, recognizes that the student’s ability to show successful achievement of
the NONPF competencies for NP education is of greater value than the number of clinical hours the
student has performed (NONPF, 2008b).
The Nurse Practitioner Core Competencies (NP Core Competencies) integrate and build upon existing
Master’s and DNP core competencies and are guidelines for educational programs preparing NPs to
implement the full scope of practice as a licensed independent practitioner. The competencies are
essential behaviors of all NPs. These competencies are demonstrated upon graduation regardless of the
population focus of the program and are necessary for NPs to meet the complex challenges of translating
rapidly expanding knowledge into practice and function in a changing health care environment.
Nurse Practitioner graduates have knowledge, skills, and abilities that are essential to independent
clinical practice. The NP Core Competencies are acquired through mentored patient care experiences
with emphasis on independent and interprofessional practice; analytic skills for evaluating and
providing evidence-based, patient centered care across settings; and advanced knowledge of the
health care delivery system. Doctorally-prepared NPs apply knowledge of scientific foundations in
practice for quality care. They are able to apply skills in technology and information literacy, and engage
in practice inquiry to improve health outcomes, policy, and healthcare delivery. Areas of increased
knowledge, skills, and expertise include advanced communication skills, collaboration, complex decision
making, leadership, and the business of health care. The competencies elaborated here build upon
previous work that identified knowledge and skills essential to DNP competencies (AACN 1996; AACN,
2006; NONPF & National Panel, 2006) and are consistent with the recommendations of the Institute of
Medicine’s report, The Future of Nursing (IOM, 2011).
At completion of the NP program, the NP graduate possesses the nine (9) core competencies regardless
of population focus.
* Amended as result of additional validation through the 2011-2012 Population-Focused Competencies Task Force.
Competencies 7, 6, & 7 .
Quality circles originated in Japan after World War II and were inspired by W. Edwards Deming. Quality circles involve voluntary small groups of 6-12 employees who meet regularly to identify improvements in their work area. In healthcare, quality circles are used to (1) identify outstanding features of care, (2) identify obstacles to change, and (3) identify the need for more research. Examples of using quality circles in healthcare include reducing hospital-acquired infections, improving job satisfaction, and enhancing communication.
New microsoft office power point presentationEmani Aparna
Therapeutic guidelines are clinical practice guidelines that focus on treatment recommendations. They are developed by healthcare providers through a systematic process involving a literature review, obtaining expert opinions, developing recommendations, and assessing quality of evidence. Therapeutic guidelines provide standardized treatment protocols to improve patient outcomes and reduce healthcare costs. They are published in medical databases, websites of organizations like the American Heart Association, and government sources.
Clinical pathways provide a standardized, multidisciplinary care plan for specific diagnoses or procedures. They outline key steps, interventions, and expected outcomes for patients' hospital stays. Developing clinical pathways requires input from physicians, nurses, and other healthcare professionals to establish best practices based on evidence and optimize resource utilization and quality of care. Nurses play an important role in following the clinical pathway for patients, informing the team of any variances, and collaborating with other professionals.
Improving quality, safety and lives - the Patient Safety Collaborative Programme 2014-2019
Presentation from Chief Nursing Officer for England's Summit 2014
26 November 2014
Chapter 7. The Evidence for Evidence-Based Practice Implem.docxspoonerneddy
Chapter 7. The Evidence for Evidence-Based Practice
Implementation
Marita G. Titler
Background
Overview of Evidence-Based Practice
Evidence-based health care practices are available for a number of conditions such as asthma,
heart failure, and diabetes. However, these practices are not always implemented in care
delivery, and variation in practices abound.1–4 Traditionally, patient safety research has focused
on data analyses to identify patient safety issues and to demonstrate that a new practice will lead
to improved quality and patient safety.5 Much less research attention has been paid to how to
implement practices. Yet, only by putting into practice what is learned from research will care be
made safer.5 Implementing evidence-based safety practices are difficult and need strategies that
address the complexity of systems of care, individual practitioners, senior leadership, and—
ultimately—changing health care cultures to be evidence-based safety practice environments.5
Nursing has a rich history of using research in practice, pioneered by Florence Nightingale.6–
9 Although during the early and mid-1900s, few nurses contributed to this foundation initiated
by Nightingale,10 the nursing profession has more recently provided major leadership for
improving care through application of research findings in practice.11
Evidence-based practice (EBP) is the conscientious and judicious use of current best
evidence in conjunction with clinical expertise and patient values to guide health care
decisions.12–15 Best evidence includes empirical evidence from randomized controlled trials;
evidence from other scientific methods such as descriptive and qualitative research; as well as
use of information from case reports, scientific principles, and expert opinion. When enough
research evidence is available, the practice should be guided by research evidence in conjunction
with clinical expertise and patient values. In some cases, however, a sufficient research base may
not be available, and health care decisionmaking is derived principally from nonresearch
evidence sources such as expert opinion and scientific principles.16 As more research is done in a
specific area, the research evidence must be incorporated into the EBP.15
Models of Evidence-Based Practice
Multiple models of EBP are available and have been used in a variety of clinical settings.16–36
Although review of these models is beyond the scope of this chapter, common elements of these
models are selecting a practice topic (e.g., discharge instructions for individuals with heart
failure), critique and syntheses of evidence, implementation, evaluation of the impact on patient
care and provider performance, and consideration of the context/setting in which the practice is
implemented.15, 17 The learning that occurs during the process of translating research into
practice is valuable information to capture and feed back into the process, so that.
Chapter 7. The Evidence for Evidence-Based Practice Implem.docxmccormicknadine86
Chapter 7. The Evidence for Evidence-Based Practice
Implementation
Marita G. Titler
Background
Overview of Evidence-Based Practice
Evidence-based health care practices are available for a number of conditions such as asthma,
heart failure, and diabetes. However, these practices are not always implemented in care
delivery, and variation in practices abound.1–4 Traditionally, patient safety research has focused
on data analyses to identify patient safety issues and to demonstrate that a new practice will lead
to improved quality and patient safety.5 Much less research attention has been paid to how to
implement practices. Yet, only by putting into practice what is learned from research will care be
made safer.5 Implementing evidence-based safety practices are difficult and need strategies that
address the complexity of systems of care, individual practitioners, senior leadership, and—
ultimately—changing health care cultures to be evidence-based safety practice environments.5
Nursing has a rich history of using research in practice, pioneered by Florence Nightingale.6–
9 Although during the early and mid-1900s, few nurses contributed to this foundation initiated
by Nightingale,10 the nursing profession has more recently provided major leadership for
improving care through application of research findings in practice.11
Evidence-based practice (EBP) is the conscientious and judicious use of current best
evidence in conjunction with clinical expertise and patient values to guide health care
decisions.12–15 Best evidence includes empirical evidence from randomized controlled trials;
evidence from other scientific methods such as descriptive and qualitative research; as well as
use of information from case reports, scientific principles, and expert opinion. When enough
research evidence is available, the practice should be guided by research evidence in conjunction
with clinical expertise and patient values. In some cases, however, a sufficient research base may
not be available, and health care decisionmaking is derived principally from nonresearch
evidence sources such as expert opinion and scientific principles.16 As more research is done in a
specific area, the research evidence must be incorporated into the EBP.15
Models of Evidence-Based Practice
Multiple models of EBP are available and have been used in a variety of clinical settings.16–36
Although review of these models is beyond the scope of this chapter, common elements of these
models are selecting a practice topic (e.g., discharge instructions for individuals with heart
failure), critique and syntheses of evidence, implementation, evaluation of the impact on patient
care and provider performance, and consideration of the context/setting in which the practice is
implemented.15, 17 The learning that occurs during the process of translating research into
practice is valuable information to capture and feed back into the process, so that ...
1) Evidence based practice is a process through which scientific evidence is identified, appraised and applied in health care interventions to provide the best patient care.
2) It involves forming a team to develop, implement and evaluate an evidence based plan, searching databases to retrieve evidence, grading the strength of evidence, and developing standards for practice.
3) Barriers to evidence based practice include lack of time, administrative support, and difficulty changing practice habits, but it can improve patient and organizational outcomes when implemented successfully.
Pillar 6 of clinical governance focuses on clinical effectiveness and ensuring best practices based on evidence. The key elements of clinical effectiveness discussed in the document are: 1) Cost effectiveness analysis to determine value of interventions, 2) Critical appraisal of research evidence before using in decisions, 3) Use of clinical guidelines developed from evidence, 4) Implementation of evidence-based practice through guidelines and evaluation, and 5) Use of integrated care pathways to standardize patient care based on guidelines and monitor outcomes. The document provides details on each of these elements and how organizations can incorporate them to deliver effective, evidence-based clinical care.
Evidence-based practice in nursing involves integrating the best available research evidence, clinical expertise, and patient preferences to guide clinical decision-making and improve patient outcomes. It is a systematic approach that requires nurses to formulate clinical questions, search for relevant research, critically appraise the evidence, synthesize findings, integrate the evidence into care, and evaluate outcomes. Implementing evidence-based practice enhances patient care, ensures quality and safety, and advances the nursing profession through lifelong learning.
Evidence-based practice in nursing involves integrating the best available research evidence, clinical expertise, and patient preferences to guide clinical decision-making and improve patient outcomes. It is a systematic approach that requires nurses to formulate clinical questions, search for relevant research, critically appraise the evidence, synthesize findings, integrate the evidence into care, and evaluate outcomes. Implementing evidence-based practice enhances patient care, ensures quality and safety, and advances the nursing profession through lifelong learning.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Clinical practice guidelines
1. CLINICAL PRACTICE
GUIDELINES
A GUIDE FOR CLINICIANS
Developed by Clinical Quality and Safety
The Royal Children’s Hospital
Melbourne, Australia
Septe
mber 2007
1
2. TABLE OF CONTENTS
1. Introduction
2. Process for Content Development
3. Guideline for Content Development
4. Guideline for Writing Clinical Guidelines
5. Guideline Evaluation
6. Clinical Guideline Development Resources
7. Appendix
Further information
If you are interested in contributing to Clinical Practice Guidelines or have other queries, please contact:
Jody Smith
Clinical Guideline and Pathway Coordinator
Tel (03) 9345 6956
Pager 6956
Email: jody.smith@rch.org.au
Clinical Quality and Safety
Royal Children’s Hospital
Renata Kukuruzovic
Evidence Based Clinical Practice (EBCP) consultant paediatrician
Email: renata.kukuruzovic@rch.org.au
Clinical Quality and Safety
Royal Children’s Hospital
2
3. 1. INTRODUCTION
What are Clinical Practice Guidelines?
Clinical Guidelines are systematically developed statements based on the best available evidence designed
to assist practitioners with decisions about appropriate health care practices for specific clinical
circumstances. The process used to develop guidelines involves a thorough evaluation of evidence based
on outcomes of treatment or other health care procedures. Where research based evidence is not
available, consensus by experts forms the basis of the guideline.
The Hospital Clinical Guidelines have been developed in accordance with the National Health and Medical
Research Council (NHMRC) published recommendations 1, 2, 3 to support clinicians, with an emphasis on
the ongoing management of patients.
Why are these guidelines needed?
There has been a widespread move towards developing clinical practice guidelines, which are designed to:
Improve the quality of health care.
Reduce the use of unnecessary, ineffective or harmful interventions.
Facilitate the treatment of patients with maximum chance of benefit, with minimum risk of
harm, and at an acceptable cost.
Recent research has shown that clinical practice guidelines can be effective in bringing about change and
improving health outcomes. They are underpinned by the evidence based clinical practice principles of
good decision making which takes account of patients' preferences and values, clinicians values and
experience, the best available evidence and the availability of resources.1
Key principles for developing guidelines (NHMRC)1
There are nine key principles for developing guidelines these include:
1. Process for developing and evaluating clinical practice guidelines should focus on outcomes.
2. Clinical practice guidelines should be based on the best available evidence and should include a
statement about the strength of their recommendations. Evidence can be graded according to its
level, quality, relevance and strength.
3. Taking the evidence - of whatever level, quality, relevance or strength - and turning it into a
clinically useful recommendation depends upon the judgement, experience and good sense of the
group developing the guidelines.
4. The process of guideline development should be multidisciplinary and include consumers.
Involving a range of generalist and specialist clinicians, allied health professionals and consumers
will improve the quality and continuity of care and will make it more likely that the guidelines will be
adopted.
5. Guidelines should be flexible and adaptable taking into account clinical settings, costs and
constraints. Provision should be made for accommodating the different values and preferences of
patients and families.
6. Guidelines should be developed with research constraints in mind.
3
4. 7. Guidelines are developed to be disseminated and implemented taking into account their target
audiences. They should also be disseminated in such a way that practitioners and consumers
become aware of them and use them.
8. The implementation and impact of guidelines should be evaluated.
9. Guidelines should be revised regularly.
WRITING CLINICAL PRACTICE GUIDELINES
Aims
The aim of this document is to facilitate staff at RCH in the development, writing and evaluation of
multidisciplinary clinical practice guidelines.
Why do we develop a Clinical Practice Guideline?
The need for a Clinical Guideline is identified as a result of:
• Reflective practice
• Variations of practice within the hospital
• New study findings
• An adverse event or potentially dangerous practice
Who can write Clinical Practice Guidelines?
Development of Clinical Guidelines within the Royal Children's Hospital requires
multidisciplinary involvement at all levels to ensure the clinical guideline encompasses the requirements of
relevant clinicians and patient groups.
Clinical Guidelines can be written by:
• Clinicians
• Working Groups e.g. a multidisciplinary team managing a patient group
• Specific departments e.g. Haematology, Dermatology, General Surgery
Consumer involvement (Family Centred Care)
For guidelines to have a Family Centred Focus consumer involvement is recommended in the development
process from the outset. Consumer input focuses on incorporating the core concepts of Patient and
Family Centred Care including:
Dignity and Respect
• Respect family knowledge, values, beliefs and cultural backgrounds in the delivery of care.
Information Sharing
• Providing families with timely, accurate and complete information enabling them to participate
in and care and decision making.
Participation
4
5. • Patients and families are encouraged and supported in participating in care and decision
making at their chosen level.
Collaboration
• Facilitate patients, families, clinicians and leaders to work collaboratively in the development,
implementation and evaluation of guidelines, education and the delivery of care.
(Institute for Family Centered Care http://www.familycenteredcare.org/).
Consumer input is not intended to focus on clinical recommendations based on the best available
evidence.
The consumer approach should be individualised for each guideline and authors should contact us for
assistance with this aspect of guideline development.
References
1. National Health and Medical Research Council (NHMRC) 1999. A guide to the development, implementation and evaluation
of clinical practice guidelines.
2. National Health and Medical Research Council (NHMRC) 2000. How to use the evidence: assessment and application of
scientific evidence.
3. National Health and Medical Research Council (NHMRC) 2000. How to put evidence into practice: implementation and
dissemination strategies.
5
6. 2. THE PROCESS FOR CLINICAL PRACTICE GUIDELINE CONTENT DEVELOPMENT
If you are intending to develop a clinical practice guideline contact Clinical Guideline and Pathway
Coordinator on ext/page 6956 to learn more about the process.
Step 1 Determine topic Identify author/s
Step 2 Author discusses proposed topic with Guideline development team (Renata Kukuruzovic & Jody
Smith).
Step 3 Download the 'Clinical Guideline Development Tools' including: a guide for clinicians, guideline
template, evidence table, checklist for the guideline development and implementation.
Step 4 Consult with appropriate key stakeholders (medical, allied health, nursing and consumers).
Involve them in the revision of drafts and consensus of opinion where there is a lack of evidence
Step 5 Review guideline websites and current practice.
Step 6 Contact RCH library complete a literature search.
Step 7 Author meets with Guideline Team to present evidence
Step 9 Attend next available guideline development workshop
Step 10 Formulate draft, utilising feedback from key stakeholders, evaluate evidence using table.
Step 11 Guideline team review draft content using PAED agree tool
Step 12 Clinical Guideline approval once suggested changes are made to satisfactory level.
Step 13 Clinical Guideline Approved (Signed off by relevant Dept Heads and CQS guideline team)
Step 14 Guideline published on the intranet
Step 15 Review of implementation and dissemination of the guideline (approximately 3 months post
implementation)
Step 16 Author conducts a post implementation evaluation at 12 months evaluating health outcomes for
patients and changes in clinical practice
Step 17 Guideline to be reviewed every 3 yrs +/- audit
6
7. 3. CONTENT DEVELOPMENT (more information on some of the steps)
Step 4: Key Stakeholders
The overseeing multidisciplinary panel should include representatives from all relevant groups
e.g. clinicians (nurses, doctors, and allied health) with specialist expertise and clinicians with general
expertise, other relevant health professionals, representatives from consumer groups, professionals with
expertise in guideline development.
Step 5: Search Existing Material
Review relevant current practice, guidelines, clinical pathways, and educational resources relating to the
topic within the Royal Children’s Hospital.
Search evidence based CPG websites nationally and internationally for guideline topic.
Critique Guidelines, take note of the level of evidence used to develop guideline content and
recommendations and the method of evidence collection utilised by the guideline site.
Guideline Sites include:
• National Guideline Clearing House http://www.guideline.gov/
• National Institute for Health and Clinical Excellence (NICE)
http://guidance.nice.org.uk/CG/published
• New Zealand Guidelines Group http://www.nzgg.org.nz/
• Scottish Intercollegiate Guidelines network http://www.sign.ac.uk/guidelines/published/
• British Medical Journal http://bmj.bmjjournals.com/cgi/collection/guidelines
• Royal College of Nursing http://www.rcna.org.au/site/search.php
• Royal Australian College of Physicians http://www.racp.edu.au/hpu/evidence/index.htm
• UK NHS http://libraries.nelh.nhs.uk/guidelinesFinder/
• National Institute of Clinical Studies http://www.nhmrc.gov.au/nics/asp/index.asp
• National Health and Medical Research Council
http://www.nhmrc.gov.au/publications/categories/index.htm
Step 6: Evidence Based Literature Searching and Formulating the Evidence table
Identify clinical questions to identify key search term using PICO format to complete a thorough literature
search e.g.
o Population – e.g. children with bronchiolitis
o Intervention – e.g. do bronchodilators
o Comparator – e.g. compared with placebo, or other treatments e.g. glucocorticoids
o Outcome – e.g. show improved clinical scores, reduced hospital stay etc.
Evidence based literature databases can be accessed through ‘Library Services’ on the RCH Intranet Site.
http://www.rch.org.au/library/dbases.htm.
Databases include:
• Clin-eguide (formerly ClinicalResource@Ovid).
• MDConsult
• SUMSearch
• The Cochrane Library
• Clinical Evidence
• EBM Reviews - ACP Journal Club
7
8. A copy of the literature search strategy and results should be saved and must be submitted to CQS
with the final draft of the guideline to assist future guideline review.
The RCH library in conjunction with CQS facilitates a literature search to assist in finding the evidence (this
is a prerequisite for developing a Hospital Clinical Guideline). Contact Jody Smith on 6956 or via email
jody.smith@rch.org.au to make a booking.
Step 7: Grade and Record level of evidence in the evidence table
• Refer to Evidence table template in the resource section of this booklet or on the website under
development resources http://www.rch.org.au/emplibrary/rchcpg/HCGEvidenceTable.doc
• CQS facilitate a Clinical Practice Guideline development workshop on a regular basis to assist in
the development of guidelines including searching and critiquing the evidence.
• Please record details on the evidence table and return to Clinical Quality and Safety (CQS) with
guideline draft electronically.
The Hierarchy of evidence is based on the National Health and Medical Research Council (2000) and
Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001)
Level I Evidence obtained from a systematic review of all relevant randomised control trials.
Level II Evidence obtained from at least one properly designed randomised control trial.
Level ΙΙΙ-1 Evidence obtained from well-designed pseudo-randomised controlled trials (alternative
allocation or some other method).
Level ΙΙΙ-2 Evidence obtained from comparative studies (including systematic reviews of such
studies) with concurrent controls and allocation not randomised cohort studies, case
control studies, or interrupted time series with a control group.
Level ΙΙΙ-3 Evidence obtained from comparative studies with historical control, two or more single–
arm studies, or interrupted time series without a parallel control group.
Level ΙV Evidence obtained from case-series, either post-test or pre-test and post test.
Level V Expert opinion without critical appraisal, or based on physiology, bench research, or
historically based clinical principles.
Please note: Clinical guidelines are based on reviews of the best available evidence. Level 1 evidence
represents the gold standard for intervention studies; however it is not available for all areas of practice and
frequently guidelines will use lower levels of evidence or consensus opinion where no studies are available.
This NHMRC Hierarchy can be used to grade the “level of evidence” however it does not give information
about the “quality of evidence”, e.g. an RCT is level II evidence, however an RCT may be of poor quality
and therefore this evidence would not be included in a guideline or review.
NB: Short courses are also available through CQS and CEBU (University of Melbourne) in critical appraisal.
We strongly suggest that the main author take the opportunity to undertake one of these courses if they are
unfamiliar with different study types and critical appraisal of studies.
8
9. Step 9: Formulate draft
• Refer to Clinical Practice Guideline template in the resource section of this booklet or on the
website under development resources
http://www.rch.org.au/emplibrary/rchcpg/Guideline_template.doc
• Use the template to structure guideline. This encourages uniformity but it can be modified slightly to
suit guideline content requirements.
Content
• Keep the audience in mind when writing guidelines. Guideline topics are rarely restricted to one
discipline so they must be relevant to medical staff, nursing staff and allied health.
• The guideline also needs to include content specific to the variety of settings in which the target
patient group or clinical practice is present. For example, does the guideline include management
in the community, in the ward environment and/or the acute care setting?
• Work out what content is essential to the guideline and what content can be part of a resource
document, a link to another site or a link to a PDF document etc.
• If a consensus of expert opinion is used to determine Guideline content due to an absence of
available evidence or if there is discrepancy in evidence this should be stated in the Guideline and
reflected in the evidence table.
Steps 10 to 13: Clinical guideline review process
• The draft Clinical Guideline needs to be circulated to relevant stakeholders for feedback and
approval.
• If the guideline has hospital wide implications to practice and/or resources the guideline should be
presented/discussed at Executive Clinical Leadership level.
• The final draft is returned to CQS and reviewed by the Clinical Guideline and Pathway Coordinator
and Evidence Based Clinical Practice (EBCP) Consultant using the PAED-AGREE tool to appraise
the content of the guideline.
• The guideline will then be presented to the Clinical Guidelines Reference Group*
• Feedback from the appraisal is presented to the author
• The Clinical Guideline is again reviewed and once satisfactory signed off by relevant Departmental
Head/s, and the EBCP consultant and Clinical Guideline and Pathway Coordinator
• Once approved the Clinical Guideline will then be published on the Clinical Guidelines Site on the
RCH Intranet.
Steps 14 to 16: Evaluation of clinical practice guidelines
The purpose of evaluating clinical practice guidelines is to assess the validity of the guidelines and the
effectiveness of their dissemination and implementation.
An evaluation plan should be generated when guidelines are being developed, and this plan should take
into account what data the evaluation will require e.g. data on processes, practices and outcomes.
9
10. The Royal Children’s Hospital in accordance with NHMRC1 recommends that Clinical practice guidelines
are evaluated at least once every three years. RCH also recommends that the author/s of Clinical Practice
Guidelines conduct a post implementation evaluation at 12 months evaluating health outcomes for patients.
An evaluation plan of clinical practice guidelines should consider some or all of the following: 1
• Assessment of guideline dissemination
• Assessment of whether or not clinical practice is moving towards the guidelines’ recommendations
• Assessment of whether or not health outcomes have changed
• assessment of the guidelines’ impact on consumer’ knowledge and understanding
• an economic evaluation of the guideline process
Evaluations may include conducting audits on patient files, audits of other relevant clinic records,
customised surveys and other data collection initiatives. It may be appropriate to also collect data that can
be usefully compared against national data.
For assistance in developing an evaluation plan and conducting evaluations, please contact the Evaluation
and Analysis Coordinator in CQS on ext 5153 or email nichole.lister@rch.org.au
Useful resources for evaluation:
1
National Health and medical Research Council (NHMRC) 1999. A guide to the development,
implementation and evaluation of clinical practice guidelines.
Available at: http://www.nhmrc.gov.au/publications/synopses/cp30syn.htm
Date accessed: 22-06-07
2
Eccles M and Grimshaw J. 2004. Selecting, presenting and delivery clinical guidelines: are there any
“magic bullets”? MJA 80 (6 Suppl): S52-S54
Available at: http://www.mja.com.au/public/issues/180_06_150304/ecc10749_fm.html
Date accessed: 22-06-07.
10
11. RESOURCES:
Clinical Guideline Template
Clinical Guideline Evidence Table
Clinical Guideline Development Form
Clinical Guideline Implementation and Evaluation Form
The ‘AGREE’ Tool – Appraisal of Guidelines for Research and Evaluation (HCG Use only)
11
12. Appendix 1:
*Clinical Guidelines Reference Group
The Hospital Clinical Guidelines Reference Group facilitates best practice in patient management via the
process of facilitating multidisciplinary evidence based clinical practice guidelines at The Royal Children's
Hospital. They are directly accountable to the Royal Children's Hospital (RCH) Quality and Safety
Committee.
The objectives of the Hospital Clinical Guidelines Reference
• Guide the process of development, implementation and publication of guidelines at RCH (except
those managed by the Clinical Practice Guideline group).
• Ensure the quality of guideline content is maintained, based on the best available evidence and the
development, review and approval processes are consistent.
• Encourage all disciplines at RCH to be involved in guideline development.
• Ensure there are appropriate processes for adequate communication with all stakeholders involved
in the guideline development including consumers.
• Work collaboratively with other guideline authorship groups (e.g. Clinical Practice Guideline group)
to enhance organisational processes for Evidence Based Clinical Practice (EBCP).
• Review guideline drafts and initiate the revision of existing Hospital Clinical Guidelines 3rd yearly or
more frequently as indicated.
Meetings
The Hospital Clinical Guidelines Reference Group meets on the second Monday of the Month over a 12
month period.
A Quorum will compromise of 50% of the reference group members.
12