1. Quality Health Care Nursing 870

2. Quality Health Care
“The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (IOM, 2000, p. 211).

3. How many glasses of water should I drink every day?

4. What is the best treatment for a cold?

5. Standard of Care
Refers to the degree of attentiveness, caution and prudence that a reasonable person in the circumstances would exercise. Or: how similarly qualified practitioners would have managed the patient's care under the same or similar circumstances.

6. Standards of Care
Standards of practice (care): A model of established practice commonly accepted as correct
Resources to help NPs understand Standards of Care available at:

7. Evidenced Based Practice
“The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients (Sackett, et al. 1996, p. 71).

8. Evidenced Based Practice
Levels of evidence include:
Systematic Reviews/Meta-analyses
Randomized controlled trials (RCT)
Individual research studies
Studies without randomization
Quasi-experimental designs
Non-experimental designs
Expert opinion

9. Clinical Practice Guidelines
“Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (Field & Lohr, 1990, p. 38).

10. Clinical Practice Guidelines: Purpose
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

11. Clinical Practice Guidelines: Purpose
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

12. Clinical Practice Guidelines: Purpose
To assist clinicians and patients make appropriate decisions about health care by
Describing a range of generally accepted approaches for the diagnosis, management, or prevention of specific diseases or conditions.
Defining practices that meet the needs of most patients in most circumstances.

13. Clinical Practice Guidelines
Recommendations are not fixed protocols that must be followed.
Clinicians and patients need to develop individual treatment plans that are tailored to the specific needs and circumstances of the patient

14. Clinical Practice Guidelines
They define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients.
The statements contain recommendations that are based on evidence from a rigorous systematic review and synthesis of the published medical literature.

15. Clinical Practice Guidelines
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.

16. Clinical Guidelines Need to identify reliable resources
More than 3,700 guidelines from 39 countries
Additional 2,700 guidelines in National Guidelines Clearinghouse
IOM developed recommendations for reliable Guidelines (2011)
For now:
Use up-to-date information
Use reliable sites/resources
Professional Organizations
National Clearinghouse

17. Sample guidelines from the NIH’s National Heart, Lung & Blood Institute

18. Clinical Guidelines Examples of Reliable Sites
AAFP:
AHRQ : National Guidelines Clearinghouse
Many others
Look for guidelines specific to diseases at specialty organization web sites

19. Clinical Practice Guidelines
Recommendations are not fixed protocols that must be followed.
Clinicians and patients need to develop individual treatment plans that are tailored to the specific needs and circumstances of the patient

20. References
Field MJ, Lohr KN (Eds). Clinical Practice Guidelines: Directions for a New Program, Institute of Medicine, Washington, DC: National Academy Press, 1990.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
Sackett, D. L., Rosenbert, M. D., Muir Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312,

21. Additional Resources
The Institute of Medicine of the National Academies. Available at:
U. S. Department of Health & Human Services. Agency for Healthcare Research and Quality (AHRQ). Measuring Healthcare Quality. Available at:
U. S. Department of Health & Human Services. Agency for Healthcare Research and Quality (AHRQ). National Quality Measure Clearinghouse. Available at: