1. Writing Evidence Based Clinical Protocols

2. Clinical Guidelines  Systematically developed statements designed to assist the health care team and their patients to make appropriate decisions about a specific condition or treatment  Arise following an examination of the current best evidence, and other knowledge relevant to a specific health problem

3. Clinical Protocols  Practice area specific  Specify details concerning the treatment/and or procedure endorsed by the employing agency.  Used to inform those involved in litigation  May include a summary of the most important sections of the relevant clinical guideline/s.

4. Clinical protocols  Content based on common sense as well as information about effectiveness  Provide benchmarks for audits of quality of care

5. Evidence Based Protocol Development Requirements  Old protocol (if exists)  New ‘evidence’ (BPIS, research findings, legislation, reports etc)

6. The new protocol should integrate local expertise and local context of practice with the best available evidence Evidence Local Expertise

7. AgencyExpertiseAgencyExpertiseStaffNeedsStaffNeeds Evidence Based Decisions, Strategies Context of Care Evidence

8. Consider the ‘Evidence’ How good is the evidence? (Quality) How relevant is the evidence to our setting? (Relevance) Are the financial, physical and human resources available to support the recommended practice? (Feasibility)

9. Compare the existing protocol with the new information If yes to all 3 questions

10. No differences detected Add to existing protocol  Relevant information  Rationales  References

11. Differences detected 1. Determine the degree of difference 2. Consider the impact of introducing change 3. If appropriate, amend the existing protocol to reflect desired (best) practice 4. Implement education to communicate change to practice

12. Notes  Evidence cannot be changed, the choice is to use it (in its entirety) or not  If evidence is incorporated into a protocol, but not used, the practitioner must be able to justify why the protocol was not followed.  Sometimes it may be better to rely on clinical judgement (e.g. vital signs)

13. No Current Procedure?  Ascertain requirement for new protocol  Determine the current (unwritten) practice?  Check whether a protocol already exists elsewhere (websites or other hospitals)  Draw up a draft protocol based on current practice which incorporates evidence feasible and relevant to your setting

14. Components of a protocol  Aim  Key points  Equipment required  Required actions  References

15. Aim Reflect/s what the care aims to achieve Designates an outcome measure for the assessment of quality

16. Key points (Optional)  Absolute indications, contra indications or special precautions  May specify the level of asepsis required  Describes any special competencies required of the operator  Includes clarification or definition of unfamiliar terms  Indicates the need for consent

17. Equipment  Lists equipment always required for the procedure.  Specifies sizes (e.g. 19G needle, 10 mL syringe) where appropriate  Lists additional equipment/additional requirements which may be required in certain circumstances - together with the indication for their use

18. Procedure  Each step of the procedure is described in sequence.  A new number is used for each step

19. Additional Information  Relevant evidence relating to the step is described opposite the action.  Does not include any steps required for the procedure  May also include helpful hints and special precautions.

20. Example of an Action Statement

22. References  Where the recommended practice has a source, superscript numbers are used to refer the reader to the appropriate reference. 1  Include the entire reference at the end of the procedure

23. Reference List  List the resources/references used to develop the procedure  Include the Level of Evidence or ‘Review’  Author/s. Date of publication. Title of article or book. (Journal title if applicable in bold). vol:issue no:page nos. (34:4:245-56) (Level II)  If the source is the internet, include the date of access as well as the date of publication

24. Source information Date Issued: February 2008 Authorised by: Author/s of Document Review Date: February 2010