Implementation of Clinical Guidelines Author: dr. Martin Rusnák

1. Implementation of Clinical Guidelines • Author: dr. Martin Rusnák rusnakm@truni.sk

2. Implementation of Clinical Guidelines • Contents: • Assumptions • Getting guidelines into practice • Monitoring • Clinical audit rusnakm@truni.sk

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. rusnakm@truni.sk

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. rusnakm@truni.sk

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) rusnakm@truni.sk

6. Getting guidelines into practice rusnakm@truni.sk

7. Monitoring • What is monitored? • Implementation in practice • International scientific developments • Indicators • Responsibilities • Interventions rusnakm@truni.sk

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? rusnakm@truni.sk

9. Clinical Audit - Cycle rusnakm@truni.sk

10. Clinical Audit - Stages rusnakm@truni.sk

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%. rusnakm@truni.sk

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 rusnakm@truni.sk

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 rusnakm@truni.sk

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 rusnakm@truni.sk

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. rusnakm@truni.sk

16. Summary • We have discussed how to • Get guidelines into practice • Monitor outcomes of guidelines influence • Use clinical audit rusnakm@truni.sk