Informing Practice with Evidence

This article discusses the importance of clinical practice guidelines in improving healthcare practices. It covers the development, implementation, and appraisal of guidelines, as well as the factors that affect their trustworthiness and quality. The article also highlights the benefits and limitations of using guidelines in healthcare.

Informing Practice with Evidence
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Table of Contents
Introduction...........................................................................................................................................3
Main Context.........................................................................................................................................3
Conclusion...........................................................................................................................................15
References...........................................................................................................................................17
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Introduction
The Institute of Medicine has described the clinical practice guidelines as the statements
which include a recommendation for optimizing patients care informed by the systematic
evidence review and an assessment of the harms and benefits of the alternative care options
(Crosby, 2011). The guidelines need to be developed by multidisciplinary experts on the
basis of systematic review evidence in order to provide an appropriate description of the
logical relationship between health outcomes and alternative care. The guidelines provide a
huge benefit to the patients by decreasing unnecessary or ineffective interventions and
ensuring greater consistency in care. The guidelines promote the development of secondary
material implementation to further support informed decision making and patient education.
The guidelines are being used by the clinicians for making decisions based on the quality
improvement efforts, support coverage for proper services and best evidence. It has assisted
to bridge the gap between best practice, policy, patient choice and local contexts. It is
considered to be one of the most essential parts for enhancing the quality of healthcare
practices. The main focus would be examining the clinical guidelines, developing the
guideline, implementing the guideline and appraising the guideline (Graham, 2011).
Main Context
Guidelines
Clinical practice guidelines are referred to as the systematically developed statements for
assisting patient and healthcare practitioners within the healthcare industry (Henry., 2013).
The statement consisted of recommendations that relied on the evidence from the systematic
review and combination of published healthcare literatures. It includes statements of expected
healthcare practices, comparing and improving the practices and setting a standard or
benchmarks for carrying out the audit process. The healthcare organizations always focus on
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improving the quality of the healthcare practices and it can be achieved with the
implementation of appropriate guidelines (Hoffman, Bennett & Del Mar 2019).
The clinical practice guidelines are being used for decreasing inappropriate variations in
healthcare practices and promoting the delivery of evidence-based and high-quality
healthcare processes (Hoffmann, Bennett & Del Mar 2017). It provides a mechanism with
the help of which healthcare practitioners can be made accountable for clinical activities. In
the field of medicine, the use of the guidelines has been increased as a mean to facilitate
evidence-based practice. The guidelines are very much effective in changing the behavior of
midwives, nurses and other health professionals. It is being used for improving the health
outcomes for the patients by providing a framework within which the work should be carried
out. The patients sometimes receive different care as it depends on the hospital, clinician or
location.
The guideline ensures that the patients should receive care in an apporpriate manner
irrespective of whom or where they are treated. The clinicians are being appropriately guided
who are not sure how to proceed, achieve consistency of care and following the treatment
policies (John, Irukulla, Mendall&Abulafi, 2009). It creates a boundary between harms and
benefits which becomes easy for the healthcare professionals to carry out their healthcare
practices. The healthcare organizations and government bodies have also found that clinical
guidelines are very much effective in decreasing cost and improving healthcare outcomes. It
has also given attention to unrecognized clinical services, health issue, neglected patient
populations, high-risk groups, and preventive interventions. It assists to determine dangerous,
wasteful and ineffective practices and reinforce the techniques of critical appraisal.
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The limitation of clinical practice guidelines is that the suggestions can be wrong and the
guideline developers may not have adequate knowledge about what is appropriate for the
patients (Kapp, 2012). The scientific evidence about giving recommendations is often
lacking, misinterpreted or misleading. The development groups can often lack the skills,
resources and time to scrutinize and gather every piece of evidence. The recommendations
can be influenced by clinical experience and opinions. The treatments and tests that the
experts believe are appropriate for patients can be inferior. An inappropriate clinical
guideline will not only be dangerous for the patients but also for the healthcare professionals.
It can affect the quality of the healthcare services provided to the patients.
Developing a Guideline
The process of developing clinical practice guidelines need to be based on specific rules in
order to avoid misunderstanding, disagreement, confusion, and recommendations (Keele,
2011). The development of the guideline should be based on the determination of the scope,
purpose and needs of the audience, panel consisting of developers, specifying the
recommendations, making decisions on the basis of importance of outcomes, finding and
summarizing evidence to support each recommendations, determining the quality of the
evidence that are available, examining the balance of undesirable and desirable consequences
for a specific course of action, formulating recommendations consisting their strength and
considering a system for the evaluation and implementation of the guideline. The topics of
the guideline should be selected that will create a significant impact on the practices of
medicine. The purposes of the clinical practice guideline need to be clearly specified to the
target audience in order to understand its importance. The target audience should be informed
clearly and also specifying the principle of therapeutic or diagnostic options. The methods
that would be applied should be explained and how it will help to achieve the desired
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outcomes (Kumar, 2010). The development of the guidelines are based on the approach
suggested by many experts of International guidelines development consisting of National
Institute for Health and Care Excellence (NICE) that follows some rules of avoiding
disagreement, misleading and misunderstanding recommendations.
There are certain factors that affect the trustworthiness and quality of the clinical practice
guidelines. The factors are differences in the quality of the scientific studies, limitations in the
systematic reviews on which the clinical practice guidelines are developed, lack of
transparency of methodologies, failure to organize multi-stakeholders, not able to manage
conflicts of interest and failure of using rigorous methodologies in the development of
clinical practice guidelines (Lisotto&Zanchin, 2012).. Apart from this, patients with
economically and socially disadvantaged also created problems while carrying out the
process. The lack of adequate knowledge, skills, and support of the staff members also affects
the quality of the guidelines. Attitude and behavior of the healthcare practitioners also
influence their view towards the guidelines. It is very much important for healthcare
professionals to takes into account the factors before the development and implementation of
the clinical practice guidelines.
Implementing a Guideline
It is aimed by clinical practice guideline to improve patients' health through guiding an
individual in a clinical setting. The guidelines especially related to primary disease
prevention or health promotions are starting of supporting informed patient choices. It also
advises that patients and clinicians should involve in shared discussing for identifying the
best way of adopting guideline to individuals. Clinicians and organizations need to identify
that which guidelines are products and worthy of adoption (Mabbott, 2011). This process of
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making a decision could be daunting. Clinicians and organizations need to consider below-
mentioned points before implementing clinical practice guideline:
Identify a clinical area to promote best practice
The first thing that needs to be considered is selecting an area in which to promote best
practice. There are multiple reasons for selecting an area like, the associated burden and the
prevalence of the condition, concerns regarding gaps in care and large variations in practice,
associated cost with various practice options, the likelihood that a particular guideline will be
successful in affecting practice, a needs of keeping practice updated or evidence-based, or
consciousness of the existence of relevant evidence-based guideline (McCluskey & Bishop,
2009).
Establish an interdisciplinary guideline evaluation group
If an organization seems interested in providing best practice an evaluation group of a local
interdisciplinary guideline needs to be established. It should contain key stakeholders who
supposed to get affected through the selection of guideline recommendation, including
individuals or patients from the community. It could be helpful in developing ownership of
resulting decisions. Clinicians must select an appraisal process. Guideline appraisal
instruments are considered for comparing guideline and assessing systematically using the
same criteria (Rubin & Bellamy, 2012).
Search for and retrieve guidelines
Next step is clarifying the issue of particular interest. Criteria for searching and selecting
guideline for review are identified based on the area of interest. These criteria might cover
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publication language or date of the publication. Clinicians need to ensure that they must not
miss a high-quality guideline. There must be a systematic search all for relevant guideline
related to the topic (Sumsion, 2010).
Assess the guidelines
It is important to select a valid guideline and clinicians might follow three separates steps for
identifying whether a guideline is valid or not. The steps are assessing the quality of the
guideline as a whole, controlling the currency of the guideline and assessing the clinical
content of guideline recommendation systematically.
Seek external review of the proposed local guideline
If a clinician is undertaking a guideline for the evaluation, the result needs to be shared with
the policymakers, local practitioners and stakeholder to review and comment. It is important
to go through with this process even if a single guideline is being undertaken in its entirety
(Thistlethwaite, 2013).
Appraisal practice of health assessment of children and young people in out-of-home-
care
Scope and purpose (Domain 1)
The scope and purpose are reflecting the aim of the guideline, clinical questions, and targeted
group. The selected guideline has focused on both children and young people. It is intended
to provide best practice guideline to health professionals on the health assessment process,
and appropriate assessment tools, for children and young people in statutory Out-of-Home
Care (OOHC).
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Stakeholder involvement (Domain 2)
The stakeholder of the guideline represents the thinking of the targeted user. They have
developed LHD policies, procedures, protocols, guidelines and other documents relating to
the provision of health services consistent with these Guidelines. Health services for children
and young people in OOHC understand and comply with the Guidelines and locally
developed procedures and protocols for their implementation (Agreetrust, 2019).
Rigour development (Domain 3)
Third domain refers to the rigor of development that is considered to be a process of
collecting synthesizing the evidence used to formulate recommendations. (Nws Health,
2019). The health assessment process of children and young people in statutory OOHC is
guided by the Health Pathway, with a focus on the individual child or young person’s
circumstances and needs. A Medline search strategy was developed initially and modified
appropriately for other databases that were searched included- Medline, Cochrane, Embase,
PsycINFO, Scopus, Web of Science.
Clarity of presentation (Domain 4)
The guideline is so vivid and the language and structure are clearly understandable. The
structure of the guideline is also quite impressive. It provides all relevant details in the first
page itself under the key principles. The format of the selected guideline also looks
professional.
Applicability (Domain 5)
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Score 4: The chosen guideline provides best practice guidelines for health professionals on
the health assessment process and appropriate assessment tools for all children and young
people. The guideline includes access to services and systems as barriers and enablers to
health care. Improved systems and processes in NSW have partially addressed systemic and
interagency problems that represent barriers to children and young people in OOHC
accessing health services.
Editorial independence (Domain 6)
The editor has expressed the view of all experts very nicely and independently. The
formulating recommendations are also competing with interests.
Conclusion
Clinical practice guidelines are referred to as the systematically developed statements for
assisting patient and practitioner decisions about proper healthcare for particular clinical
situations. The clinical practice guidelines are being used for decreasing inappropriate
variations in healthcare practice and promoting the delivery of evidence-based and high-
quality healthcare. The process of developing clinical practice guidelines need to be based on
specific rules in order to avoid misunderstanding, disagreement, confusion, and
recommendations. There are certain factors that affect the trustworthiness and quality of
clinical practice guidelines. The factors are differences in the quality of the scientific studies,
limitations in the systematic reviews on which the clinical practice guidelines are based, lack
of transparency of methodologies of development groups, failure to organize multi-
stakeholders, not able to manage conflicts of interest and failure of using rigorous
methodologies in the development of clinical practice guidelines.
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