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Introduction to Clinical Practice Guidelines

Introduction to Clinical Practice Guidelines. What is Evidence-Based Practice?. Evidence-Based Practice (EBP) combines the best research evidence with clinical expertise EBP integrates patient needs, values, and preferences to provide individualized plans of care

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Introduction to Clinical Practice Guidelines

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  1. Introduction to Clinical Practice Guidelines

  2. What is Evidence-Based Practice? • Evidence-Based Practice (EBP) combines the best research evidence with clinical expertise • EBP integrates patient needs, values, and preferences to provide individualized plans of care • EBP is the synthesis or combination of quality research studies to address a practice problem • EBP ensures quality care and patient safety

  3. What is a CPG? • CPG stands for Clinical Practice Guideline. CPG may also be referred to as BPG, or Best Practice Guideline • Supports evidence-based nursing practice • Guides the transfer of evidence-based practices into the clinical setting • Important to find the strongest evidence related to the clinical issue or problem the nurse or clinician hopes to improve • Developed with the purpose of improving patient care

  4. How is a CPG created? • First, identify what clinical issues or problems exist. Determine what needs to be guided by current best practice? • CPG is based on the BEST available evidence • Important terms to describe research studies: • VALIDITY – the extent to which a study accurately measures and answers the questions being asked • RELIABILITY – refers to consistency; in other words, the action will produce the same results over and over

  5. CPG Recommendations • Each Clinical Practice Guideline (CPG) has a stated number of recommendations • Each recommendation has evidence to support it ranging in quality from expert opinion (weak) to systematic reviews (strong), and unfiltered to filtered (refer to EBM Pyramid next slide) • In general, stronger research evidence gets better support and “buy in” for CPG implementation • But…keep in mind…well done qualitative studies, well-referenced reports, expert opinions, and so forth are valid and can inform CPGs. Therefore, don’t overlook their importance in clinical practice!

  6. Evidence-based Medicine (EBM) Pyramid Oregon Health & Science University [OHSU], 2018; Trustees of Dartmouth College and Yale University, 2006).

  7. Where is a CPG used? Clinical Practice Guidelines (CPG) are used by practitioners, including nurses, in a variety of health care settings such as long term care facilities, hospitals, and clinics

  8. Example of CPG Let’s take a look at a CPG: Assessment and Management of Pain https://rnao.ca/sites/rnao-ca/files/AssessAndManagementOfPain_15_WEB-_FINAL_DEC_2.pdf

  9. Sample Sources of Clinical Practice Guidelines • Registered Nurses’ Association of Ontario (RNA0) • https://rnao.ca/bpg/guidelines • Cincinnati Children’s Hospital • https://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/recommendations • U.S. Department of Veterans Affairs • https://www.healthquality.va.gov/

  10. Rating Scales • Many types of rating scales (schemes) are used to determine the quality of research evidence within a Clinical Practice Guideline (CPG) • Language varies among systems to rate the strength and quality of recommendations, such as letters (e.g. A, B, C), levels (e.g. I, II, III), and words (e.g. strong, weak) • Example of a rating scale: Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool • Instead of numbers or letters, the GRADE tool simply classifies the quality of evidence as “high, moderate, low, or very low,” and the strength of recommendation as “strong” and “weak”

  11. Why Do We Care? • CPGs are a big help to busy nurses…as long as the CPG is based on good evidence! • The benefit is consistency • Since the CPG is supported by evidence, each patient is cared for in the same way for the same reason – every time • Improves patient outcomes

  12. Classroom Activity • Searching for a Clinical Practice Guideline (CPG) • The class will divide into small groups of three to five students • Each group of students will search for a CPG using laptops, tablets, or smart phones (refer to “sample sources” slide) - allow 15-20 minutes • Think of a clinical practice problem -which CPG interests the group related to the problem? • Does the CPG correspond to the types of patients you, as students, are caring for in the clinical setting? • Each student group will select two (2) recommendations from the CPG and be prepared to discuss in class (Note: Faculty will provide blank handouts to students – one per group)

  13. Clinical Activities • During your clinical experience, student nurses will ask about current or past Clinical Practice Guidelines (CPG) or Best Practice Guidelines (BPG) used on their unit • Ask the help of nurses, managers, and other resource individuals as appropriate • If possible, locate a copy of the guideline and bring to post-conference • Does the guideline go along with what is learned in the classroom? • Be prepared to share your findings in post-conference

  14. Open Discussion • Discuss the Clinical Practice Guidelines (CPG) found in the classroom and clinical settings • What stands out about the guideline? • How can the guideline be used to improve patient care? • What are the oldest/newest guidelines? • What years were they developed? • Evidence changes quickly! • Continuous improvement is needed in clinical practice based on new knowledge

  15. Evaluation • Complete the pre and post session evaluation tool • Thank you for your participation!

  16. References Cruz, J. E., Fahim, G., & Moore, K. (2015). Practice guideline, development, grading, and assessment. P & T, 40(12), 854- 857. Edwards, N., Davies, B., Ploeg, J., Dobbins, M., Skelly, J., Griffin, P., & Ralphs-Thibodeau, S. (2005). Evaluating best practice guidelines. Canadian Nurse, 101(2), 19- 23. Evans, D. (2003). Hierarchy of evidence: A framework for ranking evidence evaluating healthcare interventions.Journal of Clinical Nursing, 12(1), 77-84.  Guyatt, G., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., & Schunermann, H.J., for the GRADE Working Group (2008). GRADE: An emerging consensus of rating quality of evidence and strength of recommendation. BMJ, 336, 924-926. Horntvedt, M. T., Nordsteien, A., Fermann, T., & Severinsson, E. (2018). Strategies for teaching evidence-based practice in nursing education: a thematic literature review. BMC Medical Education, 18(172), 1-11. Jeffs, L., Beswick, S., Lo, J., Campbell, H., Byer, C., & Ferris, E. (2013). Hospital nurses’ perceptions associated with implementing multiple guidelines: A qualitative study. Journal of Nursing Education and Practice, 3(2), 31-40. Miller, S.A., & Forrest, J.L. (2009). Translating evidence-based decision making into practice: Appraising and applying the evidence. Journal of Evidence-based Dental Practice, 9(4), 164-182. National Institute for Complementary and Integrative Health (NIH). (2017). Clinical practice guidelines. Retrieved from https://nccih.nih.gov/health/providers/clinicalpractice.htm Oregon Health & Science University, (2018). Evidence-based Practice Toolkit for Nursing. Johns Hopkins Nursing EBP: Levels of Evidence. Retrieved from: http://libguides.ohsu.edu/ebptoolkit/levelsofevidence

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