CLINICAL

PRACTICE
GUIDELINES
BY: Ma. Sylvia
Emilie B.
Beales

The

standard definition
ofClinical practice
guidelines(CPGs) is that
ofField and Lohr [1990]:
"systematically developed
statements to assist
practitioners and patient
decisions about appropriate
health care for specific
circumstances".

Guidelines are designed to support the decision-making

processes in patient care. The content of a guideline is
based on a systematic review of clinical evidence - the
main source for evidence-based care.
The movement towards evidence-based healthcare has
been gaining ground quickly over the past few years,
motivated by clinicians, politicians and management
concerned about quality, consistency and costs. CPGs,
based on standardised best practice, have been shown
to be capable of supporting improvements in quality and
consistency in healthcare. Many have been developed,
though the process is time- and resource-consuming.
Many have been disseminated, though largely in the
relatively difficult to use format of narrative text. As yet
they have not had a major impact on medical practice,
but their importance is growing.

PURPOSES OF GUIDELINES
To

describe appropriate care based on the best

available scientific evidence and broad
consensus;
To reduce inappropriate variation in practice;
To provide a more rational basis for referral;
To provide a focus for continuing education;
To promote efficient use of resources;
To Act as focus for quality control, including audit;
To highlight shortcomings of existing literature
and suggest appropriate future research.

Guidelines and protocols

Clinical protocols can be seen as more
specific than guidelines, defined in geater
detail. Protocols provide "a comprehensive
set of rigid criteria outlining the
management steps for a single clinical
condition or aspects of organisation""

Computerised guidelines
Computerised guidelines encode evidence-based
recommendations for and can automatically generate
recommendations about what medical procedures to
perform tailored for an individual patient. Computerised
guidelines offer benefits over and above those offered by
paper-based guidelines:
They offer a readily accessible reference, providing
selective access to guideline knowledge.
They help reveal errors in the content of a guideline;
They help improve the clarity of a guideline, e.g. in
decision criteria and clinical recommendations;
They help offer better descriptions of patient states;
They can automatically propose timely, patient-specific
decision support and reminders.

CLINICAL PATHWAYS
Clinical

pathwaysare standardised,
evidence-based multidisciplinary
management plans, which identify an
appropriate sequence
ofclinicalinterventions, timeframes,
milestones and expected outcomes for
an homogenous patient group
(Queensland HealthClinical
PathwaysBoard definition 2002)

NURSING AUDIT
Nursing

auditis a detailed
review and evaluation of selected
clinical records by qualified
professional personnel for
evaluating quality
ofnursingcare. A concurrent
nursing auditis performed
during ongoingnursingcare.

Clinical auditis a process that has been defined

as "aquality improvementprocess that seeks to
improve patient care and outcomes through
systematic review of care against explicit criteria
and the implementation of change"

UTILIZATION REVIEW
Utilization

reviewis a health
insurance company's opportunity
toreviewa request for medical
treatment. The purpose of
thereviewis to confirm that the plan
provides coverage for your medical
services. It also helps the company
minimize costs and determine if the
recommended treatment is
appropriate.

COMPLAINT ANALYSIS

 Morbidity

and mortality(M&M)
conferences
are traditional, recurring conferences held by
medical services at academic medical centers,
most large private medical and surgical
practices, and other medical centers. They are
usuallypeer reviewsof mistakes occurring
during the care of patients. The objectives of a
well-run M&M conference are to learn from
complications and errors, to modify behavior
and judgment based on previous experiences,
and to prevent repetition of errors leading to
complications.

SENTINEL EVENTS MONITORING

ASentinel

Eventis defined byThe Joint

Commission(TJC) as any unanticipated event in a
healthcare setting resulting in death or serious
physical or psychological injury to a patient or
patients, not related to the natural course of the
patient's illness. Sentinel events specifically include
loss of a limb or gross motor function, and any event
for which a recurrence would carry a risk of a serious
adverse outcome. Sentinel events are identified under
TJC accreditation policies to help aid inroot cause
analysisand to assist in development of preventative
measures. The Joint Commission tracks events in a
database to ensure events are adequately analyzed
and undesirable trends or decreases in performance
are caught early and mitigated.

CREDENTIALING and PREVILEGING

The

companion piece
tocredentialingis privileging,
which is the process of authorizing
a licensed or certified healthcare
practitioner's specific scope of
patient care services.Privilegingis
performed in conjunction with an
evaluation of an individual's clinical
qualifications and/or performance.

VARIANCE REPORTING and

ANALYSIS
Avariance

reportis a way for

business executives to gauge
their company's performance
by comparing one set of
figures to another. This usually
means comparing a planned
amount to an actual amount.

Thank
you