Guidlines

Question 1

Define guidelines

Answer 1

A systemically develoed statement to assist practitioner and patient decisions about appropriate health care for specific circumstances

Authority of guileines

• depends on the amount the guideline is evidence based rather than opinion
• carrying the aurthority of the issuing organisation
• inheriting additional prestige from the jounral it is published
• being consensus statement providing a single opinion which adds wieght

Question 2

Discuss advantages and limitations of guidelines

Answer 2

ADVANTAGES

• translates current evidence into useable accessible practice guideline for clinicians
• synthesises a vast amount of information
• promotes consistency of care
• identifies interventions of proven efficacy
• discourages use of ineffective interventions
• set standard for practice -e.g medical negligence cases
• consumer guidelines can empower patients to make informed choices
• supports quality improvement activates
• identifies areas in which evidence is lacing to direct further research

LIMITATIONS

• process issuess
• Variable quality
• Clinical decision rules are uncommonly compared with non standardised care when they are
• 10% of ED related decision rules are shown to be superior to normal practice and 30% are found to be inferior
• little governance for guideline commitee membership or precoess
• may not be based on standard criteria
• may not be subject to independent review by either the commissioning organisation nor the publishing journal
• evidence for many clinics issues may be incomplete
• May not consider associated issues (cost effectiveness, medico legal, patient preferences, avialable resources.
• guidelines from different organisation may conflict
• use of guidelines
• time delay for physicians in adopting recommendation of new guidelines
• acceptance is not universal among medical and legal progressions
• updating - need regular review, needs process which allows early review if new evidence

Question 3

List NHMRC principles for guideline development

Answer 3

1) Guideline development and evaluation process should focus on outcomes
2) guidelines should be based on best avialable evidene and include a statement concerning the strength of the recommednation
3) evidence can be graded according to its level quality, releavance and strength
4) method used to synthesis the aviable evidence should be the strongest applicable.
5) process of guideline development should be multidisciplinary and include consumers early in the development process
6) guidlines should be flexible and adaptable to varying local conditions
7) guidelines are developed for dissemination and implementation with regards to their target audiences. their dissemination should ensure the practitioners and consumers become aware of them and use them
8) implementation and impact of the guidelines should be evaluated
9) guidelines should be updated regularly
10) these key preinciples should also underpin the development of any companion documents to guidelines and othe types of health advise

Question 4

Discuss process of establishing hospital guidelines

Answer 4

1) identify the area where performance needs to be improbved
2) gather information
- benchmarks and standards
- evidence based guidelines
- guidelines from other hosptial
3) involve all stake holders
- choose appropriate represntatives from relevant groups - may include, doctors, nurses, pharmacists, paramedics or other units
4) set objective and time fram
5) plan meeting agendas and reportinh requirements
6) develop draft guidelines and circulate for comment
- seek other guidelines to guide developement
- ensure is compatabile with other hospital guidelines
- include inclusions and exclusions criteria for use
- revise draft guideline as required
7) implementation
- set date
- educate staff
- use visual aids/ reminders
8) post implementation evaluation
- guideline compliance
- performance measures
- errors and adverse events
- utilisation
- chart review
9) adjust guideline accordingly with stake holder input
10) repeat measurement
11) continue education and guideline promotions until targes are acheived
12) reguarly review