By: Brandie Zimmerman Jill Keller-Jerome Jamie Paiva Amy Fox

 A non-profit organization (IOM, 2013).  Serves as an advisor to the nation to improve health (Institute of Medicine [IOM], 2011).  Provides unbiased advice to the public and decision makers (IOM, 2013).  Provides advice to assist governmental officials and private sectors to make evidence based health decisions relating to biomedical science, medicine and health (IOM, 2013).  Comprised of over 2000 volunteer members that bring knowledge and expertise to the health care field (IOM, 2013).  Hosts committees, roundtables and forums that discuss pressing health related issues (IOM, 2013).

 Established in 1970 (IOM, 2013).  An extension of the National Academy of Sciences (IOM, 2013).  Originally chartered under President Abraham Lincoln in 1863 (IOM, 2013).  Current President of the IOM is Harvey V. Fineberg (IOM, 2013).

 The Institute of Medicine has developed 8 standards for developing clinical practice guidelines (IOM, 2013).  These guidelines are established to exclude bias and utilized as a framework in making decisions concerning health and health care (IOM, 2013).

Establishing Transparency  This is a detailed process involved in the development of the Clinical Practice Guidelines (CPG) and details the plan of how the CPG is paid for and made known to the public (IOM, 2011).

Management of Conflict of Interest (COI)  Members of the Guideline Development Group (GDG) should have little to no financial or personal interest that would influence the decisions made by the group.  GDG members must provide written disclosure detailing financial income and any other patient or public activities that may be relevant to decisions made while developing a CPG. Disclosure of any COI are to be made explaining the COI and how it would affect developmental processes prior to starting any work.  Members and their families are expected to divest from any financial opportunities and avoid any marketing or planning committees that could be involved in interests related to the CPG.  Guidelines must be followed if a GDG member has a COI. The member must not be a chair or a co-chair of the group. The group must be made up of only a minority of people with a COI, and no person that is funding should have any involvement with a CPG (IOM, 2011).

Guideline Development Group (GDG) Composition  The GDG should be comprised of a multidisciplinary team of individuals which includes experts, clinicians, patients and representatives from the public (IOM, 2011).

Clinical Practice Guideline - Systematic Review Intersection  The IOM standards will be implemented when systematic reviews are processed. The guideline development group and the systematic review team will work together to conduct reviews that regard specific guidelines (IOM, 2011).

Establishing Evidence for and Rating Strength of Recommendations  This is used for establishing evidence foundations and rating the strength of recommendations, which have specific steps.  An explanation for recommendations, potential benefits and harms are expected. A summary of relevant evidence, explanation of values, opinion, theory, and clinical experience in deriving the recommendation are also expected.  A rating of the level of recommendation, a rating of the strength of recommendation, and the explanation of any difference of recommendation are used (IOM, 2011).

Articulation of Recommendations  Standards should be articulated in a standardized form, which will precisely detail the recommendation action, and when it should be performed.  An evaluation of wording of the recommendation will be performed. (IOM, 2011).

External Review  Those that review CPG should be external from the IOM and should be comprised of all relevant subject matter experts, agencies, organizations, patients, and public representatives. All of their reviews will remain confidential.  All comments and rationales submitted for modifying, adding, or omitting CPGs will be stored.  A draft of the CPG will be made available to the public for review before publication (IOM, 2011).

Updating  A timeline with specific dates for CPG publication, evidence reviews, and proposed future publication dates should be documented in the CPG.  New literature should be continuously monitored to evaluate the continued validity of the CPG, and should be updated to reflect the newest evidence of clinical best practices (IOM, 2011).

Influence and Relevance in Nursing Practice

Brandie Zimmerman In my current practice area of critical care, IOM practice standards influence my nursing practice by setting guidelines for clinical practice. The IOM has developed 8 standards of practice guidelines to ensure balance across the continuum of care. These standards detail the guidelines set forth by the IOM to improve patient care, safety, and satisfaction. The IOM influences a multitude of practice areas to develop, “trustworthy clinical practice guidelines” (Institute of Medicine [IOM], 2011). These guidelines influence nursing education. According to Hickey, Forbes and Greenfield (2010), the IOM has set core competencies for nursing education. These competencies were implemented to supplement the reported deficiencies in patient care, safety and satisfaction. These guidelines were established utilizing the 8 standards of practice for developing clinical practice guidelines, as instituted by the IOM (2011). These core competency changes influence my clinical practice as a Baccalaureate student. The changing demographic of the population, and thus patient population, calls for a reform in nursing education. The IOM standards are initiated to meet these changes and facilitate the transition of utilizing the core competency changes necessary for the future of the ever changing health care field (Hickey et al., 2010).

Jill Keller-Jerome The Institute of Medicine (IOM) influences my current area of practice within the Michigan Department of Corrections by making suggestions for improvements in correctional health care through error reduction. With the current staff reduction and increase in workload within correctional health care systems, many of which are overburdened and fiscally constrained, adoption of change is slow. The (IOM) convened a panel of correctional experts which recommended 60 patient safety standards focusing on such issues as creating safety cultures at organizational, supervisory, and staff levels through: changes to policy and training; ensuring staff competency and reducing medication errors; encouraging the transfer of information between and within practice settings; developing mechanisms to detect errors or near misses; and to shift the emphasis from blaming staff to fixing systems. Stern, Greifinger and Mellow (2010) explain that these standards will provide improvement via providing better tools to enhance patient safety as well as the safety of the nurse (p. 2115). By being equipped with adequate resources for improvement within the correctional healthcare system, this will help ensure that our patients receive the care that they need. Reinforcing this change with interdisciplinary collaboration will further patient safety. This will improve awareness, and protect the nurse from liability. The main objective is that safety and well-being is not compromised.

The Institute of Medicine’s (IOM) clinical practice guidelines (CPG) assist health care providers by acting as a guide for evaluating the soundness of scientific literature that pertains to their patients diagnosis and treatment options. At the same time this allows the provider to consider the patient’s unique needs and circumstances in selecting appropriate medical interventions. These CPGs also assist the public by ensuring that this same information is made available to them and all other stakeholders for review. In my current position as a medical/surgical nurse, the IOM’s CPG influence my practice by providing my patients and their providers with the clinically sound, unbiased data about their condition, disease, or illness and the treatment options available so they can make decisions together. Keuhn (2011) points out that patients are more involved in their own care than ever due to the accessibility of information on the internet, and want to ensure that they are obtaining the same information that their care providers are for a congruency in care (p. 1847). The CPGs effect the nursing interventions I use and treatments I provide to my patients on a daily basis. Jamie Paiva

Amy Fox The Clinical Practice Guidelines (CPG) of the Institute of Medicine (IOM) encourage nurses to continue their education and also are working to reform scope-of- practice regulations among the states. According to the IOM, in order to have successful healthcare reform nurses need to be involved in decisions in healthcare such as lowering costs while providing high quality healthcare. In my profession as a labor and delivery nurse the CPG’s provide standards in regards to patient safety. According to Keuhn (2011), the report calls for an increase in nurses with a baccalaureate degree from 50% to 80% by 2020 (p. 2346). The report is also encouraging Masters and Doctorate degrees. The IOM standards are helping to reform healthcare and give nurses more opportunity to make decisions. Among the issues that are projected to be reformed are regulations of advanced practice nurses when it comes to admitting patients to the hospital and prescribing medicines.

Institute of Medicine. (2011, March). Clinical practice guidelines we can trust. Retrieved from Trust/Clinical%20Practice%20Guidelines%202011%20Insert.pdf. Institute of Medicine. (2013, November). About the IOM. Retrieved from Hickey, M.T., Forbes, M. & Greenfield, S. (2010). Integrating the Institute of Medicine competencies in a baccalaureate curricular revision: Process and strategies. Journal of Professional Nursing, 26, Keuhn, B. (2010). IOM: Boost nurses’ role in health care. The Journal of the American Medical Association, 304(18): doi: /jama Keuhn, B. (2011). IOM sets out "gold standard" practices for creating guidelines, systematic reviews. The Journal of the American Medical Association, 305(18), doi: /jama Stern, M., Greifinger, R., & Mellow, J. (2010). Patient safety: Moving the bar in prison health care standards. The American Journal of Public Health, 100(11), doi: /AJPH