Building Practice Guidelines for Health Practitioners: Information Professionals in Health Care Settings Can Provide Research to Underpin Treatment Guidelines and Educate Practitioners about Best Practices

By Allen, Nancy | Information Outlook, January-February 2014 | Go to article overview

Building Practice Guidelines for Health Practitioners: Information Professionals in Health Care Settings Can Provide Research to Underpin Treatment Guidelines and Educate Practitioners about Best Practices


Allen, Nancy, Information Outlook


When treating patients, health care providers take several factors into account--including the relevant scientific literature and their patients' preferences--before making decisions. Prominent among the sources of information they consult are clinical practice guidelines (OPGs), which are statements that contain recommendations intended to optimize patient care. CPGs evaluate the quality of the relevant scientific literature and assess the likely benefits and harms of a particular treatment, allowing health care providers to select the optimal care regimen for an individual patient based on medical evidence.

The sheer number of clinical practice guidelines available makes it difficult for health care providers to determine which guidelines are of high quality. The Guidelines international Network database, for example, contains more than 3,700 CPGs from 39 countries, while in the United States, the National Guidelines Clearinghouse has nearly 2,700 CPGs (iOM 2011).

To enable health care providers to more easily identify high-quality, trustworthy guidelines, the institute of Medicine, a division of the U.S. based National Academy of Sciences, published a report, Clinical Practice Guidelines We Can Trust, in 2011. The report acknowledged the increasing number of CPGs published by professional societies like the American College of Chest Physicians and the Association of Neuroscience Nurses and set forth eight standards for developing and evaluating guidelines (see Table 1) to help practitioners discern appropriate care for their patients.

Developing Practice Guidelines

At Children's Mercy Hospital in Kansas City, Missouri, the Office of Evidenced Based Practice (Office of EBP) is responsible for identifying, modifying, implementing, and evaluating the outcomes of clinical practice guidelines. I am the EBP research specialist in the office. Along with the director of EBP, the medical director of EBP, the medical librarians, the Quality improvement Program managers, and the data analysts and statisticians, I coordinate the work that surrounds CPGs at our hospital.

Although CPGs are the backbone of our work, we also create evidence profiles for specific questions. For example, the hospital's Safety Committee may desire a review of techniques to care for central venous catheters, the value analysis professionals may want a review of products that are available to prevent pressure ulcers in hospitalized children, or the Weight Management Program may need to obtain a review of non-nutritive sweeteners.

Whenever a question comes into the Office of EBP, we first form a guideline team comprising members from all medical and functional areas the project will touch (thereby increasing the odds of the team's success). Thus, for a guideline centered in the Emergency Department, the team will include physicians, advance practice nurses, and pharmacists who specialize in emergency medicine. In general, we require at least two physicians on each team; the other core team members are medical librarians, nurses, consumer representatives, pharmacists, educators, electronic health record (EHR) specialists, and Quality Improvement Program managers. Allied health care professionals such as respiratory therapists and dietitians serve on teams that pertain to their discipline. The director of EBP and I serve as facilitators, with one of us assigned to each team.

The tools and steps involved in evaluating, modifying and creating CPGs are not familiar to most health care professionals. Although schools of medicine, nursing and allied health teach the tools of EBP, it is a recent addition to most curricula. As a result, the first task of any guideline team is to educate the group about the principles of EBP, the guideline standards from the IOM, and the tools used to create CPGs.

To begin the guideline formation process, we teach the basics of asking questions. As a librarian, I know from conducting reference interviews that the better the question, the better the search results. …

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