Critique of Clinical Practice Guidelines

This essay critically analyzes two clinical practice guidelines for wound management using the AGREE II tool. It compares the guidelines, focusing on their scope, purpose, stakeholder involvement, methods, and presentation clarity. The essay analyzes the strengths and weaknesses of each guideline and suggests possible reasons for their differences. It concludes by highlighting the importance of clinical practice guidelines in providing evidence-based guidance for healthcare professionals.

Critique of clinical
practice guidelines using
the AGREE 11 tool

Table of Contents
INTRODUCTION..............................................................................................................................................3
Critique the literature............................................................................................................................3
Compare the clinical guidelines........................................................................................................4
3 Focussing on the differences; suggest possible reasons why........................................7
Conclusion.........................................................................................................................................................8
REFERENCES.................................................................................................................................................10

·INTRODUCTION
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. This essay will use AGREE II tool to
critique two wound management clinical guidelines including Standards for wound
prevention and management of Wounds Australia and Wound care guideline conducted
by Queensland University of Technology. It will focus on comparing the guidelines and
choose the suitable one that can be applied in practice.
l壱Critique the literature
To critically appraise the chosen two guidelines, the AGREE II
tool has been used to help in assessing the trustworthiness, finding how relevant or
applicable of the study results of published papers are (AGREE Next Steps Consortium
2016). To that end, the AGREE instrument is a tool that assesses the methodological
rigour and transparency in which a guideline is developed (AGREE Next Steps
Consortium 2016). The purpose of the AGREE II is to provide a framework to assess the
quality of guidelines, provide a methodological strategy for the development of
guidelines; and inform what information and how information ought to be reported in
guidelines (AGREE Next Steps Consortium' 2016). The AGREE II replaces the original
instrument as the preferred tool and can be used as part of an overall quality mandate
aimed to improve health care (AGREE Next Steps Consortium,2016).
The first guideline ‘Standards for wound prevention and
management’ has provided a specific overall purpose which is described at the preface
and introduction. It mentions that these standards presented in this revised third edition
provide a valuable framework for promoting best practice in wound prevention and
management for health professionals and health care workers’ practice (Wounds
Australia 2016). The third edition of this guideline underwent extensive reviews of over
30 organizations feedback and contribution, for example, from professional, educational
and peak bodies as appropriate (Wounds Australia 2016). The clinical guideline is
rigorous and one of the reasons having been that it has total of 6 ‘score 7’ from the rigor
of development checklist. Also, this particular article consists with many valuable quality

of evidence and the clinical impact is present with regard to the issues of wound
management and prevention. Although it had a potential bias presentation in the study,
due to the quantity of evidence provide, the research noted the minimizing of bias.
For the second guideline, it provides an understandable and
clear goal that health professionals can use this wound care management. Logistic of the
study may be one of the articles’ limitations as the demanded sample size is significant,
as well as treatment effectiveness, requiring more resources from the researchers which
may result in a potential disadvantage on the applicability of the trial to the local setting
(Walczak, and et.al., 2014). Although the systematic review article may be at risk of bias
being present in the method of initial studies selection, the four steps of article selection
process and an implement of an analysing tool to the relevant data for the study
prominently minimised the study selection bias. The comprehensive identification of
relevant information for the relevant articles in the study is also evident as the researcher
provided the sources and databases in the review (Fontes and et.al., 2017).
l壱Compare the clinical guidelines
Both the above guidelines provides clear goals of using wound
care management by health professionals. Therefore, comparison between both clinical
practice guidelines by using Agree 11 tool has been discussed as per the following-
Bases of comparisonStandards for wound prevention and managementWound care 1.
Scope and purposeThe overall objective in standards for wound prevention and
management are systematically described in guidelines of Agree11 tool and health
questions are not described specifically. The main purpose is to guide evidence based
care in order to prevent the development of wound (Jeffcoate and et. al., 2016).The main
purpose is that it provides clear and understandable goal in order to use them for
management of wound care. There is lack of description of overall objective of the
guidelines. The health questions are also not covered in systematic manner. The main
purpose is to ensure safe practice and maintain standards of evidence based practice in
wound management.2. DescriptionIt has been described clearly about to whom
guidelines are meant to apply as it covers all the objectives of wound care management.It
has been described in adequate manner about to whom it is meant to apply these

guidelines. For e.g.- patients, public etc. This also assist in achieving organizational
objectives as well.
3. Involvement of stakeholderThis includes all type of professional groups
stakeholders.The stakeholders that are involved in this are from all professionals
groups.4. Target usersThe target users of guidelines like health professionals or patients
etc are defined clearly and views as well as preferences of targeted patients or public's
have been sought.Here also target users of guidelines are defined in clear and adequate
manner. Thus, views and preferences have been sought.
5.Methods usedIn these guidelines, there have been used systematic methods in order to
search for evidence. Criteria regarding selection of evidence are also clearly described in
these guidelines. Systematic methods have not been used in order to search for evidence
and criteria are also not described clearly for selecting evidence. Further, strengths and
weakness of body of evidence is not clearly defined in these guidelines.6. Link There is
an definitive link between recommendations and evidence that are supporting.There is no
link between recommendations and supporting evidence.7. ProcedureThe procedure in
order to update these guidelines has been provided in this.The procedure regarding
updation is not provided in this.8. Presenting criteriaIt presents criteria of monitoring and
auditing It does not present any criteria regarding monitoring and auditing.9.
ConsiderationThese guidelines do not consider various health benefits, side effects and
risks for formulating recommendations.It considers health benefits, side effects and risks
in order to formulate the recommendations.10. Presentation clarityIn these guidelines
there is unique clarity of presentation as it consists of recommendations that are specific
and ambiguous. Thus, it also presents different option regarding wound or other health
issues and their management process. Due to this, health professionals can easily identify
key recommendations so that they can cure wound easily.Thus, in this guidelines there is
no specific and ambiguous recommendations. But it provides options for various health
issues and other health conditions in an adequate manner as they are presented clearly in
guidelines. This helps health professionals in order to identify easy recommendations for
wound care without any pain to patient.11. ReviewThis guideline was reviewed by

experts prior before publishing it into market or hospitals.This is not reviewed by any
experts before being published in market or hospitals.12. Applicable methodThis guides
health professionals by providing them with advice or tools regarding recommendations
that has to be applied or put into practice in terms of wound management. Hence, it has
also been considered about implications of various resources that helps in applying
recommendations on wound care management. It has also been described in it about
facilitators and barriers to its application. The competing interests of development of
guideline group members have been recorded or addressed very rarely in this.These
guidelines rarely provide advice or tools about recommendations used or has to be put in
practice by health professionals in order to manage wound care. It has not been
considered about implications of potential resources in order to apply recommendations
regarding wound care. Thus, competing interest of development of guideline have not
been addressed or recorded at all.13. QualityThe overall quality of these guideline is very
high as it presents everything in a clear manner as compared to wound care management
guidelines. The health professionals will find easy to refer this and manage cure of the
patient accordingly.The overall quality of these guidelines is not so high as compared to
standard for wound prevention and management because there is lack of clarity in
presentation regarding recommendations or other resources that may be applicable in
terms of wound management of a patient and cure it as soon as possible for the health
professionals or doctors. Thus, from above comparison it has been analysed that
guideline 1 that is standards for wound prevention and management is more better than
guideline 2 that is Wound care promoting healthy skin tool. This is analysed because of
number of aspects that has been discussed here. Guideline 1 has presented clearly about
all the recommendation that has to be used by health professionals in order to manage
wound cure of patient in adequate and relaxed manner. It also provides various
procedures and policies regarding management of wound and is applicable to all targeted
users and doctors. Further, it also provides various measures of health issues and options
of various recommendations that help them in preventing such illness.
l壱3 Focussing on the differences; suggest possible reasons why

Standard for the wound management is better wound care promoting healthy skin
as it provide the better organisational culture which helps them in making the effective
organisation than wound care promoting healthy skin (Rosenberg and et. al., 2014). The
standard for wound management provide the extensive guidelines which are beneficial to
clinical-practice. As it is a new organisation which build a new strategies that makes it
better and different from the guideline second wound care promoting healthy skin
(Hingorani and et. al., 2016).
Today's organisations are more customer oriented that drives a quick and
strategic planning which standard for management provides. Implementation of science
in technology helps standard for wound management guideline becoming better than the
wound care promoting healthy skin. Standard for the wound management provide some
principles which include that every individual must receive the information of need and
option for the comprehensive and multidisciplinary assessments. It also serve a complete
wound assessment form which shows the progression of the wound improvement or
deterioration. One of the important reason which made the standard management for the
wound better than the wound care promoting healthy skin is that availability of resources
to the organisation (Jeffcoate and et. al., 2016). As standard management for wound
provides the appropriate resources to their organisation which increases the effectiveness
of the working of the standard wound management and their organisation for making
appropriate use of that resources.
·Conclusion
This assignment can conclude that wound care management is an important
element of clinical practice as it helps in treating patients in an effective manner. There
are certain protocols, policies and procedures that have to be followed while treating a
patient. These guidelines are important as it provides assistance to practitioners or
professionals that have to perform this task. There are various tools that aid in wound
care management with different strategies that can be used. Goals have been created as
well, which helps in understanding how proper treatment has to be done. Clinical
professionals are able to identify what kind of wounds have been formed and what
treatments will be required. Guidelines have significantly helped in understanding the
type of medical situation and how to apply solutions in practical life.

It has also further inferred that clinical practice guidelines offer an insight of
treatments and provide professionals access to evidence and sources that can help them in
improving facilities as well as making decisions. They are able to use safe medications
and methods of therapy while treating wounds. They are also aware of their
responsibility and accountability while providing care to patients. They ensure that they
attend and effectively treat wounds and at the same time, stay sensitive to individual's
beliefs, values and culture. There are also moral and ethical dilemmas that have to be
addressed by professionals while handling wound management and prevention.

·REFERENCES
AGREE Next Steps Consortium 2016, The AGREE Reporting Checklist: a tool to
improve reporting of clinical practice guidelines.
Fontes, C.M.B., de Menezes, D.V., Borgato, M.H & Luis, M.R. (2017) Communicating
bad news: an integrative review of the nursing literature. Revista brasileira de
enfermagem. 70(5). 1089-1095.
Hingorani, A., and et.al., , 2016. The management of diabetic foot: a clinical practice
guideline by the Society for Vascular Surgery in collaboration with the American
Podiatric Medical Association and the Society for Vascular Medicine. Journal of
vascular surgery. 63(2). pp.3S-21S.
Jeffcoate, W.J., and et.al., 2016. Reporting standards of studies and papers on the
prevention and management of foot ulcers in diabetes: required details and markers
of good quality. The lancet Diabetes & endocrinology. 4(9). pp.781-788.
Rosenberg, L., and et.al., 2014. A novel rapid and selective enzymatic debridement agent
for burn wound management: a multi-center RCT. Burns. 40(3). pp.466-474.
Walczak, A., N Butow, P., M Clayton, J., H N Tattersall, M., M Davidson, P., Young, J.,
& M Epstein, R. (2014) Discussing Prognosis and End of Life Care in the Final
Year of Life: Randomised Controlled Trial of a Nurse-led communication support
Programs for Patients and Caregivers. BMJ Open. 4(6). 1-11.
Wounds Australia 2016, Standards for Wound Prevention and Management, 3rd edition,
Cambridge Media: Osborne Park, WA.
https://nursingeducationexpert.com/critical-appraisal-of-clinical-practice-guidelines/
http://www.woundsaustralia.com.au/publications/
2012_AWMA_Pan_Pacific_Guidelines.pdf
https://www.ausmed.com/articles/wound-care/
https://www.slideshare.net/abenedicto/clinical-practice-guidelines