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Developing and Writing Quality and Improvement Clinical Practice Guidelines

• Why do we develop a Clinical Practice Guideline?
• Who can write Clinical Practice Guidelines?
• Clinical Practice Guideline Development Process
• Development Resources
• Useful Guideline websites
• Clinical Practice Guideline Approval Process
• Guideline Evaluation

Why do we develop a Clinical Practice Guideline?

The need for a Clinical Practice 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

Please contact us with any ideas relevant to Clinical Practice Guideline Development.

Who can write Clinical Practice Guidelines?

Development of Clinical Practice Guidelines within the Royal Children's Hospital requires multidisciplinary involvement at all levels to ensure the guideline encompasses the requirements of relevant clinicians and patient groups.

Clinical Practice 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

Please contact us if you are interested in writing a Clinical Guideline.

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
  • 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.

Clinical Practice Guideline Development Process

Step 1	Determine topic Identify author/s
Step 2	Author discusses proposed topic with Quality and Improvement Guideline development team
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 and develop a plan for implementation and dissemination of the guideline.  Consider the impact the guideline may have on the organisation (e.g. financial and education resources required for implementation).  Discuss as required with Quality and Improvement team.
Step 11	Clinical Practice Guideline Reference Group review draft content using PAED agree tool, evidence table and implementation and dissemination plan and determine whether the guideline is to be disseminated to Clinical Leadership Team or other relevant committees for consideration and endorsement.
Step 12	Clinical Guideline approval once suggested changes are made to satisfactory level and the implementation and dissemination plan for the guideline has been developed.
Step 13	Clinical Guideline Approved (Signed off by relevant Dept Heads and Quality and Improvement 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

Development Resources

A 'Clinical Practice Guideline Development Package' has been developed to assist clinicians with the writing of Quality and Improvement Clinical Practice Guidelines at the Royal Children's Hospital.  It includes:

• Clinical Guideline background information
• Guide to Content Development
• Guide to Writing
• Clinical Guideline Review and Approval Process

Quality and Improvement Clinical Practice Guidelines: A Guide for Clinicians (PDF)
(Development Package)

Quality and Improvement Clinical Practice Guideline Template
(Download, type content straight on to template)

Quality and Improvement Clinical Practice Guideline Evidence Table
(Download, fill in electronically, list evidence and sources save with guideline draft. Submit to CQS with final draft)

Quality and Improvement Clinical Practice Guideline Development Form 
(Download, fill in electronically, list evidence and sources save with guideline draft. Submit to CQS with final draft)

Quality and Improvement Implementation and Dissemination Plan  
(Download, fill in electronically, list evidence and sources save with guideline draft. Submit to CQS with final draft)

Useful Guideline Websites

• 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, Australia
• Royal Australian College of Physicians
  www.racp.edu.au/
• UK NHS National Library of Guidelines Specialist Library
• National Institute of Clinical Studies
• National Health and Medical Research Council: publications
  

  

Clinical Practice Guideline Approval Process

All Clinical Practice Guidelines returned to the Quality and Improvement Guideline team will be evaluated with the PAED-AGREE tool by the Policy, Procedure and Guideline Coordinator in conjunction with the Clinical Practice Guidelines Reference Group. The PAED-AGREE tool is a modified evaluation tool based on the international standard for the evaluation of Clinical Guidelines developed by the Appraisal of Guidelines Research and Evaluation (AGREE) Collaboration.

Download PAED_AGREE TOOL  (Word 50KB)

Guidelines then will be circulated for approval by:

The Head of all relevant departments (directly effected by the Guideline)
The EBCP consultant and Clinical Guideline and Pathway Coordinator in the Quality and Improvement Unit.

 

Guideline Evaluation

** Adapted from NHMRC ¹ A guide to the development, implementation and 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.

The Royal Children's Hospital in accordance with NHMRC ¹ 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

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.