Evaluating and applying clinical practice guidelines

Clinical practice guidelines (CPG) hold great potential for providing a summary of large volumes of clinical evidence and a related set of practical recommendations. Nurse practitioners should become aware of the range of available CPGs and methods by which they can be evaluated for use. Appropriate evaluation of CPGs should include their overall reliability and validity, as well as their applicability in specific situations. This article provides an overview of an appropriate evaluation method and serves as an introduction to future columns presenting individual CPGs.     

Evaluating the quality of clinical practice guidelines

OBJECTIVE: To review and identify established methods for evaluating the quality of practice guidelines and to use a selected assessment tool to assess 2 chiropractic practice guideline documents. METHODS: A search of the medical literature was performed to identify current methods and procedures for practice guideline evaluation. Two chiropractic practice guideline documents, Vertebral Subluxation in Chiropractic Practice (CCP) and Guidelines for Chiropractic Quality Assurance and Practice Parameters (Mercy) were then independently evaluated for validity by 10 appraisers using the identified appraisal tool. The appraisal scores were tabulated, and consensus appraisals were generated for the CCP and Mercy guideline documents. RESULTS: The "Appraisal Instrument for Clinical Guidelines" (Cluzeau instrument) was identified as a reliable and valid method of guideline evaluation. The result of the application of this appraisal tool in the assessment of the CCP and Mercy guideline documents was that the former scored notably lower than the latter. On the basis of the results of the guideline appraisals, the CCP document is not recommended, and its guidelines are not considered suitable for application in chiropractic practice. The Mercy guidelines are recommended for application in chiropractic practice, with the proviso that new scientific data should be considered. CONCLUSIONS: The literature reviewed suggests that professional organizations or groups should undertake a critical review of guidelines using available critical guideline appraisal tools. Guideline validity appraisal should be done before acceptance by the chiropractic profession. To avoid unwarranted utilization of poorly constructed guidelines, it is strongly recommended that all future guidelines be reviewed for validity and scientific accuracy with the findings published in a medically indexed journal before they are adopted by the chiropractic community.     

Evaluating software for the clinical laboratory.

A set of guidelines to assist in structuring the software-evaluation process is presented. In recent years, laboratory professionals have increasingly assumed responsibility for the evaluation of software to be used in the laboratory for patient testing or administrative functions. This is a positive trend that brings user expertise to the selection of computer software but one that mandates the development of appropriate software evaluation procedures on the part of laboratory personnel. Software should be chosen that best conforms to the needs of the laboratory. Proper evaluation of available software is critical. Documentation should be reviewed, the software should be tested, capabilities must be compared with accrediting or licensing bodies' standards, and vendor support should be assessed. Development of a well-defined procedure for software evaluation will ensure selection of software that solves, not creates, problems.     

Evidence-based clinical practice.

Healthcare professionals are trying to facilitate the use of evidence-based decision making for individual patients and patient populations they are privileged to serve. The authors describe an evidence-based multidisciplinary clinical practice model developed at the University of Colorado Hospital along with a clinical example of how the model was used to improve quality and decrease costs.     

Evaluating our end-of-life practice

Ferrand et al's recent study of witholding and withdrawing life support in intensive care units in France reminds us that reporting end-of-life practices is an important step towards enhancing end-of-life care. The study highlights differences between the parentalistic approach to decision making in Europe, and the patient autonomy model in the USA. However, the reasons intensivists report for witholding or withdrawing life support are similar in both cultures. Intensivists in France make decisions despite a lack of formal guidelines in their country. This study should serve as a stimulus for educating the public and motivating more groups to monitor their end-of-life practices.     

Evaluating the efficacy of reflective practice within the context of clinical supervision

This paper explores the efficacy of reflective practice within the context of clinical supervision. It examines some potential limitations that reflective practice has within the context of clinical supervision drawing upon the literature and the early stages of the author's empirical work. It concludes that whilst there is considerable congruence in the use of reflective practice within clinical supervision sessions, there are potential disadvantages in making the assumption that reflective practice should be an integral part of all forms of clinical supervision.     

Evaluating best practice guidelines

Clinical practice guidelines are developed with the purpose of improving patient care. The Registered Nurses Association of Ontario (RNAO) Nursing Best Practice Guidelines (BPG) Project was implemented in 1999. It has resulted in the development, implementation and evaluation of 17 BPGs with agencies in different healthcare sectors. This article describes the process, challenges and lessons learned by the team responsible for evaluating the BPGs.