Clinical Guidelines Assessments - Research Paper Example

?Running head: Clinical guidelines assessments Clinical guidelines assessments Insert Insert Grade Insert May 25, Clinical guidelines assessments 1. The principal steps in developing a clinical guideline practice The different medical conditions require different health care services. There is need to develop guidelines that will guide the medical practitioners the best clinical practice (Turner, 2009, p.3). Clinical guidelines are directives that are systematically designed to help the health practitioner to decide on the best health care to provide to a patient depending on the clinical conditions that are encountered (EONS Clinical Guidelines, n.d, p.4). The steps in developing the guidelines are as follows Consider the needs of the guidelines by considering how it will affect the current medical condition of a given patient (Thomson et al, 1995). Consider the variations that are witnessed in the current practice. Ensure that the proposed guidelines are clear and there is room for improvement. Consider the cost and benefits of the new guidelines. The guidelines should improve the quality of healthcare services (Woolf et al, 1999). There is need to consider the benefits of the guidelines to the patients, the clinical nurse and whether they can be implemented easily. The resources that are necessary for the implementation of the new guidelines should also be evaluated. Consider the availability and sustainability of these resources. The next step is to establish the parameters of the new guideline. Establish the limit and focus of the guidelines by focusing on the targeted population. There is need to develop the period within which the guidelines could be developed and implemented. There is also a need to establish the medical interventions that will be available (EONS Clinical Guidelines, n.d, p.12). The next step is to identify and appraise the evidence (Feldstein, 2005, p.11). Consider the effectiveness of the guidelines that have been in practice. Carry out research and get information on the outcomes that were recorded in the patients through these guidelines. It is then necessary to identify the other issues that were not evident from the studies and categorize the evidences (EONS Clinical Guidelines, n.d, p.12). The next step is to draft the guidelines. The changes that have been introduced are stated clearly with the expected results. The practitioner outlines the opinion that supports the changes in practice that has been introduced and provides and assessment on their ability to be implemented (EONS Clinical Guidelines, n.d, p.12). 2. Briefly describe the purpose of AGREE instrument AGREE is an international association of different medical practitioners that aim at developing ways of formulating and evaluating the clinical guidelines. It is noted that there is need to adopt recommendations based on clear evidences (Michie & Lester, 2006, p.2). The association developed the AGREE instrument that performs the following roles. As an appraisal instrument for individual recommendations, the AGREE instrument was developed to provide a basis through which the quality of the guidelines could be assessed and the necessary adjustments made. It also provides a framework to provide a methodological strategy for the development of guidelines It also provides a direction on the types of information to be included in the guideline. It provides a direction on how to format such information. (The AGREE Next Steps Consortium, 2009, p.5). 3. Identify the domains covered by AGREE instrument and briefly describe each domain The AGREE instrument can be divided into six domains that have 23 items (The AGREE Next Steps Consortium, 2009, p.5). These include the following: Scope and purpose- this domain contains the aims and objectives of the clinical guidelines. It also defines the targeted patient population and clinical issues that are addressed (The AGREE Collaboration, 2001, p.5) Stakeholder involvement: - this domain provides a detail of how the guidelines are linked to the views and opinions of the clinicians who are to use them. Rigor of development: this contains the processes that were included in the development of the evidences. This section also includes the methods that have been used in formulating the recommendations. There is also a description on when to make the necessary adjustments. It checks the relationship between the evidences and the recommendations provided (The AGREE Collaboration, 2001, p.5). Clarity and presentation: this section deals with the clarity of the language that is used in the guideline and its format. It considers if the recommendations are not ambiguous and can be identified easily. Applicability: this section considers the tools that support the guidelines and the possible barriers in a applying the recommendations. It also focuses on the implications of the clinical guidelines on the patients, health care providers and the health care service in general (The AGREE Collaboration, 2001, p.5) Editorial independence: this section highlights the freedom that the developers of the guidelines have in providing recommendations and in recognizing fact that there could be conflicting views from the developers (Grill et al, 2000, p.1; The AGREE Collaboration, 2001, p.5). When would you be likely to use AGREE and when would you use GLIA-10 An appraisal instruments assess the development of clinical guidelines (Cluzeau, 1999, p.2). AGREE is an appraisal guideline that assumes that a given clinical guideline had been tested and is fit for approval. It expects the recommendations to be clear and representing the views of various clinical experts. It also requires that the barriers to the implementation of the recommendations have been identified and addressed. In this, respect, the AGREE instrument is mainly used at the draft stage of the development of the guidelines. The instrument is also used to assess the effectiveness of a guideline that has been adopted. On the other hand, GLIA is concerned with the implementation part of the guideline development. It has been noted that some of the guidelines that have been developed are hard to put into practice as compared to others (Kashyap et al, 2011, p.1). GLIA is used to assess the Implementability of the guidelines that have been developed. GLIA considers various factors related to the implementation like decidability, executability, computability, validity, and measurability among many others. GLIA is also applied in assessing the recommendations and can be used to identify the barriers to the implementation of the guidelines (Shiffman et al, 2005, p.5). From the evidence statement listed below, formulate three recommendations and complete the GLIA instrument for each of the recommendation. The recommendations that are contained in a guideline should have strong evidences that support them (Burgers et al, 2003, p.31). From the evidences, the following recommendations can be formulated. Recommendations 1. It is highly recommended that coxibs should be given to patients before or after operations as pain relievers except for patients that have undergone coronary artery bypass surgery and those that have pre-existing renal impairments. There is evidence that coxibs are good in relieving postoperative pain. It is also evident that coxibs can be given before operation and the preoperative coxibs will help in reducing the pain experienced after operations. There is also evidence that the victims that have undergone bypass surgery operations should not be administered with parecoxib followed by valdecoxib. 2. It is also highly recommended that aspirin should not be given to victims who have undergone tonsillectomy. Enough evidence is provided that asserts that aspiring generally increases bleeding after the throat operation to remove tonsils. 3. It is also recommended that paracetamol be given in combination with non-selective NSAIDS for the victims with acute pain except for those who have renal impairments and those that have undergone other operations previously and on condition the limit of adverse effects of nsNSAIDS allow for their use. There is evidence that the combination of non-selective NSAIDS with paracetamol provides quick relief for acute pain as compared to the use of paracetamol alone. There is evidence that shows that nsNSAIDS increase a need for re-operation due to bleeding following tonsillectomy. Evidence shows that non-selective NSAIDS have adverse renal effects on victims with pre-existing renal impairments GLIA instrument for the recommendation 1 Recommendation number 1 EXECUTABILITY Y 10) Is the recommended action (what to do) stated specifically and unambiguously? Y 11) Is sufficient detail provided or referenced (about how to do it) to allow the intended audience to perform the recommended action. Recommendation number 1 DECIDABILITY Y 12) Would the guideline's intended audience consistently determine whether each condition in the recommendation has been satisfied? Y 13) Are all reasonable combinations of conditions addressed? Y 14) If this recommendation contains more than one condition, is the logical relationship (ANDs and ORs) between conditions clear? Recommendation Number 1 VALIDITY Y 15) Is the justification for the recommendation stated explicitly? Y 16) Is the quality of evidence that supports each recommendation stated explicitly? Recommendation Number 1 FLEXIBILITY Y 17) Is the strength of each recommendation stated explicitly? ? 18) Does the recommendation specify patient characteristics (such as coincident drug therapy and common co-morbid conditions) that require or permit individualization? Y 19) Does the recommendation specify practice characteristics (such as location and availability of support services) that require or permit modification? Recommendation Number 1 EFFECT ON PROCESS OF CARE Y 20) Can the recommendation be carried out without substantial disruption in current workflow? Y 21) Can the recommendation be pilot tested without substantial resource commitment? Recommendation Number 1 MEASURABILITY Y 22) Can adherence to this recommendation be measured? Y 23) Can outcomes of this recommendation be measured? Recommendation Number 1 NOVELTY/INNOVATION Y 24) Can the recommendation be performed by the guideline’s intended users without acquisition of new knowledge or skills? ? 25) Is the recommendation consistent with existing attitudes and beliefs of the guideline’s intended audience? Y 26) Is the recommendation consistent with patient expectations? In general, patients expect their concerns to be taken seriously, benefits of interventions to exceed risks, and adverse outcomes to fall within an acceptable range Recommendation Number 1 COMPUTABILITY N/A 27) Are all patient data needed for this recommendation available electronically in the system in which it is to be implemented? N/A 28) Is each condition of the recommendation defined at a level of specificity suitable for electronic implementation? N/A 29) Is each recommended action defined at a level of specificity suitable for electronic implementation? N/A 30) Is it clear by what means a recommended action can be executed in an electronic setting, e.g., creating a prescription, medical order, or referral, creating an Electronic mail notification, or displaying a dialog box? GLIA instrument for the recommendation 2 Recommendation number 2 EXECUTABILITY Y 10) Is the recommended action (what to do) stated specifically and unambiguously? Y 11) Is sufficient detail provided or referenced (about how to do it) to allow the intended audience to perform the recommended action. Recommendation number 2 DECIDABILITY Y 12) Would the guideline's intended audience consistently determine whether each condition in the recommendation has been satisfied? Y 13) Are all reasonable combinations of conditions addressed? N/A 14) If this recommendation contains more than one condition, is the logical relationship (ANDs and ORs) between conditions clear? Recommendation Number 2 VALIDITY Y 15) Is the justification for the recommendation stated explicitly? Y 16) Is the quality of evidence that supports each recommendation stated explicitly? Recommendation Number 2 FLEXIBILITY Y 17) Is the strength of each recommendation stated explicitly? ? 18) Does the recommendation specify patient characteristics (such as coincident drug therapy and common co-morbid conditions) that require or permit individualization? Y 19) Does the recommendation specify practice characteristics (such as location and availability of support services) that require or permit modification? Recommendation Number 2 EFFECT ON PROCESS OF CARE Y 20) Can the recommendation be carried out without substantial disruption in current workflow? Y 21) Can the recommendation be pilot tested without substantial resource commitment? Recommendation Number 2 MEASURABILITY Y 22) Can adherence to this recommendation be measured? Y 23) Can outcomes of this recommendation be measured? Recommendation Number 2 NOVELTY/INNOVATION Y 24) Can the recommendation be performed by the guideline’s intended users without acquisition of new knowledge or skills? Y 25) Is the recommendation consistent with existing attitudes and beliefs of the guideline’s intended audience? Y 26) Is the recommendation consistent with patient expectations? In general, patients expect their concerns to be taken seriously, benefits of interventions to exceed risks, and adverse outcomes to fall within an acceptable range Recommendation Number 2 COMPUTABILITY N/A 27) Are all patient data needed for this recommendation available electronically in the system in which it is to be implemented? N/A 28) Is each condition of the recommendation defined at a level of specificity suitable for electronic implementation? N/A 29) Is each recommended action defined at a level of specificity suitable for electronic implementation? N/A 30) Is it clear by what means a recommended action can be executed in an electronic setting, e.g., creating a prescription, medical order, or referral, creating an Electronic mail notification, or displaying a dialog box? GLIA instrument for the recommendation 3 Recommendation number 3 EXECUTABILITY Y 10) Is the recommended action (what to do) stated specifically and unambiguously? Y 11) Is sufficient detail provided or referenced (about how to do it) to allow the intended audience to perform the recommended action. Recommendation number 3 DECIDABILITY Y 12) Would the guideline's intended audience consistently determine whether each condition in the recommendation has been satisfied? Y 13) Are all reasonable combinations of conditions addressed? Y 14) If this recommendation contains more than one condition, is the logical relationship (ANDs and ORs) between conditions clear? Recommendation Number 3 VALIDITY Y 15) Is the justification for the recommendation stated explicitly? N 16) Is the quality of evidence that supports each recommendation stated explicitly? Comments The evidences that are provided are not clear on the effects that nsNSAIDS have on victims that have undergone tonsillectomy. It is shown that the non-selective NSAIDS increase the need for re-operation due to bleeding while there are other claims that they do not increase the risks of operations due to bleeding following tonsillectomy. Recommendation Number 3 FLEXIBILITY Y 17) Is the strength of each recommendation stated explicitly? ? 18) Does the recommendation specify patient characteristics (such as coincident drug therapy and common co-morbid conditions) that require or permit individualization? Y 19) Does the recommendation specify practice characteristics (such as location and availability of support services) that require or permit modification? Recommendation Number 3 EFFECT ON PROCESS OF CARE Y 20) Can the recommendation be carried out without substantial disruption in current workflow? Y 21) Can the recommendation be pilot tested without substantial resource commitment? Recommendation Number 3 MEASURABILITY Y 22) Can adherence to this recommendation be measured? Y 23) Can outcomes of this recommendation be measured? Recommendation Number 3 NOVELTY/INNOVATION Y 24) Can the recommendation be performed by the guideline’s intended users without acquisition of new knowledge or skills? Y 25) Is the recommendation consistent with existing attitudes and beliefs of the guideline’s intended audience? Y 26) Is the recommendation consistent with patient expectations? In general, patients expect their concerns to be taken seriously, benefits of interventions to exceed risks, and adverse outcomes to fall within an acceptable range Recommendation Number 3 COMPUTABILITY N/A 27) Are all patient data needed for this recommendation available electronically in the system in which it is to be implemented? N/A 28) Is each condition of the recommendation defined at a level of specificity suitable for electronic implementation? N/A 29) Is each recommended action defined at a level of specificity suitable for electronic implementation? N/A 30) Is it clear by what means a recommended action can be executed in an electronic setting, e.g., creating a prescription, medical order, or referral, creating an Electronic mail notification, or displaying a dialog box? Reference List Burgers, J. et al. 2003. Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs. International journal for quality in Health care, 15(1), 31-45. Cluzeau, F. et al. 1999. Development and applications of a generic methodology to assess the quality of clinical guidelines. International journal for quality in Health care, 11(1), 21-28. (Online). Available from: http://intqhc.oxfordjournals.org/content/11/1/21.full.pdf (accessed May 25, 2011). EONS Clinical Guidelines. N.d. Section 1: What is a guideline? Guidelines implementation Toolkit. (Online). Available from: http://www.cancernurse.eu/documents/EONSClinicalGuidelinesSection1-en.pdf (accessed May 25, 2011). Feldstein, D. A., 2005. Evidence-based practice is here to stay. Wisconsin Med Journal, 104(3): 11. Grill, R. et al. 2000. Practice guidelines developed by specialty societies: the need for a critical appraisal. Lancet, 355: 103–06. (Online). Available from: http://asr.regione.emilia-romagna.it/wcm/asr/aree_di_programma/fit/fit_governoclinico/pubblicazioni/practice_guidel/link/practice_guidel.pdf (accessed May 25, 2011). Kashyap, N et al. 2011. GuideLine Implementability Appraisal v.2.0. CT: Yale Center for Medical Informatics. Michie, S. and Lester, K. 2006. Words matter: increasing the implementation of clinical Guidelines. Qual. Saf. Health Care,14;367-370. Shiffman, R. et al. 2005. The GuideLine Implementability Appraisal (GLIA): development of an instrument to identify obstacles to guideline implementation. BMC Medical Informatics and Decision Making, 5:23. The AGREE Collaboration. 2001. Appraisals of Guidelines for Research & Evaluation (AGREE) Instrument. (Online). Available from: http://www.agreecollaboration.org/pdf/agreeinstrumentfinal.pdf (accessed May 25, 2011). The AGREE Next Step Consortium. 2009. Appraisals of Guidelines for Research & Evaluation II. The Agree Research Trust. Thomson, R. et al. 1995. Fortnightly Review: How to ensure that guidelines are effective. BMJ, 311: 237–42. Turner, T., 2009. Developing evidence-based clinical practice guidelines in hospitals in Australia, Indonesia, Malaysia, the Philippines and Thailand: values, requirements and barriers. BMC Health Services Research, 9:235. Woolf, S. et al. 1999. Potential benefits, limitations, and harms of clinical guidelines. BMJ, 318(7182): 527–530. (Online). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1114973/ (accessed May 25, 2011). Read More