1. Implementation of Clinical Guidelines Author: dr. Martin Rusnák

2. Implementation of Clinical Guidelines
Contents:
Assumptions
Getting guidelines into practice
Monitoring
Clinical audit

3. Assumptions
Clinical Practice Guidelines provide guidance on the appropriate treatment and care of people with specific diseases and conditions.
The organization which manages and leads the process of guidelines development and monitoring is the Ministry of Health.

4. Assumptions
3. Applying guidelines to individual care is always likely to require interpretation, even when recommendations are properly linked to evidence. Guidelines are not credited by the courts with a special “self evident” status, and clinical guidelines currently have a subservient role to that of the expert witness in court proceedings. Healthcare professionals should document the reasons for not following a guideline.

5. Getting guidelines into practice
Internal barriers - to the guideline itself
External barriers
Structural factors (e.g. financial disincentives)
Organisational factors (e.g. inappropriate skill mix, lack of facilities or equipment)
Peer group (e.g. local circumstances of clinical practice of care not in line with desired practice)
Individual factors (e.g. knowledge attitudes, skills)
Professional-patient interaction (e.g. problems with information processing)

6. Getting guidelines into practice
Consistently effective
Variably effective
Little or no effect
Unknown effectiveness
Educational
outreach
visits
Audit and feedback
Dissemination of the educational materials alone
Financial incentives
Decision support system and other reminders
Local opinion leaders
Didactic educational meetings
Administrative interventions
Interactive educational meetings
Local consensus processes
Multifaceted interventions
Patient mediated interventions
Mass media interventions

7. Monitoring What is monitored? Implementation in practice
International scientific developments
Indicators
Responsibilities
Interventions

8. Clinical Audit
Clinical audit - tool for improving practice, patient care or services provided
Objectives:
measure current practice and care against a set of explicit standards or criteria
identify areas for improvement
make changes to practice
re-audit to ensure that improvement has been achieved
Baseline data collection - Is practice in accordance with the guidance?

9. Clinical Audit - Cycle

10. Clinical Audit - Stages

11. Clinical Audit – definitions used in audit support, reports and history
Criterion - Measurable element derived from the key priorities for implementation of each piece of guidance.
Exceptions -Where implementation of guidance is not appropriate for a particular subgroup of the population
Settings - The type or level of Health System organization to which the criterion applies.
Standard - The desired percentage target within the audited sample. Usually set to 100%.

12. Clinical Audit – Definitions used in audit support, reports and history
Definitions - Definitions of any terms used in the audit criteria to promote consistency of approach and measurement
Data source - The source that we anticipate the required data could be collected from
Result - Either the number that met the standard in relation to the total or the percentage met in relation to the standard
Other findings - Added detail around the result
Comments -Comment on audit findings and the local context in which they exist

13. Clinical Audit – Data collection
Data collection tool has two parts:
The patient data collection tool is used to measure the care of individual patients and is based on the clinical/public health criteria.
The organisational data collection tool is used to collect data about how the service is delivered or organised and is based on the organisational criteria

14. Clinical Audit - Definitions used in the data collection tool
Patient details –Patient identifier, sex, age and ethnicity
Organisation / service - The organisation, department or service being audited.
Number – The criterion number
Statement - An explicit statement derived from the criteria against which clinical or organisational practice can be measured

15. Clinical Audit - Definitions used in the data collection tool
Yes / No - the data to be collected about an individual patient or organisation can be provided by a Yes/No response
NA / Exceptions – for the auditor to note where the particular data item is not applicable to the patient or where the patient meets a specified exception
Guidance / guideline ref. - Reference to the particular paragraph or recommendation in the guidance / guideline from which the audit criterion and data collection requirement have been derived.

16. Summary We have discussed how to Get guidelines into practice
Monitor outcomes of guidelines influence
Use clinical audit