Standards for Clinical Guideline Development'

1
Standards for Clinical Guideline
Development.

• Jan Haxby / Heather Kitchen
• Childrens Services
• Northern Lincolnshire Goole NHS Trust
• October 2003

2
Background

• No agreed process for guideline development
• History Practice Development Nurse developed
  nursing guidelines without consultation
• Guidelines not acknowledged or utilised by
  nursing staff or medical staff
• Guidelines not reviewed
• Staff often not aware of a guidelines existence
• NLAG created 2001 previously 2 separate
  hospital sites with different ways of working

3
What was required

• Divisional agreement that guideline development
  is a governance issue
• Divisional agreement of the need to provide
  equitable childrens services delivering EBP
• Divisional agreement to work towards joint
  guidelines
• single pathway, or
• Individual pathways within 1 document where
  agreement could not be reached but Clinical
  Governance group would not ratify individual
  pathways unless there was appropriate
  justification.
• Divisional paper written by Clinical Governance
  Co-ordinator using national recommendations
• Paper agreed across the Divison (2 main hospital
  sites) for adoption by nursing and medical staff
  this process took 9 months.

4
The Process setting up the systems

• Childrens Services across 2 main sites 30 miles
  apart
• 2 Childrens Wards, 2 Neonatal Units, 2 Child
  Development Centres, 1 Childrens Community
  Nursing Team across the 2 sites.
• Created 2 cross-site multi-disciplinary groups
• 1 group develop and review paediatric guidelines
  and 1 group develop and review neonatal guideline
  - meet monthly

5
The Process setting up the systems

• Each group agreed terms of reference, ground
  rules and membership.
• The groups are a sub-group of the Childrens
  Clinical Governance group and feed into that group

6
The Process setting up the systems

• Each group undertook a stock take of
  guidelines/leaflets for each site
• Immediately joined existing guidelines or
  leaflets where they were the same/similar.
• Priority guidelines identified by the 2 groups
  for review or development according to known
  risks, clinical incident trends, complaints and
  national or local information/guidance/recommendat
  ions.

7
The Process setting up the systems

• 1 database was created in conjunction with IT
  department
• To store current guidelines
• To archive expired guidelines
• To Flag guidelines due for review
• To store corresponding patient information
  leaflets
• To store information regarding individual
  guidelines/leaflets e.g. author, references,
  dates

8
The Process Guideline development Principles

• Guideline, and where appropriate, information
  leaflet commissioned by the group and developed
  by practitioner/s or the group.
• Must be a Consultation process, this includes
  service users.
• Ratification by Clinical Governance group
• Single pathway document wherever possible
• Clear author
• Clear aim, date produced, date for review
• Clear Evidence base where possible
• Evidence of consultation process, including
  feedback from service users

9
The Process Guideline development Principles

• Agreed process for Dissemination through team
  forums Implementation
• expectation that staff are made aware.
• Guidelines/leaflets made available via the Trust
  Intranet initially - until all stored on database
• Regular Review of guidelines
• 3 yearly or sooner if locally or nationally
  indicated.
• Audit - recognised as a key part of the process
• Audit and feedback is required to inform
  professionals about the outcomes of implementing
  new guidelines.

10
Guideline development

• Neonatal Blood Transfusion
• Administration of Sucrose
• Guthrie Guideline
• Neonatal Nasal Swabs
• Hypoglycaemia

11
Group progress ...

• Slow progressions
• difficulty agreeing priorities within 2 groups
• Difficulty agreeing EBP!!!
• Difficulty agreeing terminology
• Need perseverance
• need to keep group members engaged in the process
  to ensure ownership
• need to re-visit group terms of reference, ground
  rules and priorities
• Division plans to review the implementation of
  the paper/recommendations in January 2004

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THE END