Policy Title/Number:
Writing Guidelines for APN Protocols
Manual:
Clinical Policy Manual
Categories:
Resource Manual Reference Information
Contributors:
CL 10-02.01
Susan Gent, Administrative Director, Center for Advanced
practice Nursing and Allied Health and VMG Nursing
Michelle Terrell, Nurse Practitioner Manager, Pediatric Critical
Care
Review Responsibility:
APRN Advanced Practice and Standards Committee
Effective Date:
Last Revised Date:
November 2010
April 13, 2012
Team Members Performing:
All faculty and staff
All faculty and staff providing direct patient care or contact
MD
RN
LPN
VUSN/VUSM Students
Other licensed staff (specify):
Other non-licensed staff (specify):
X Not Applicable
Guidelines Applicable to:
VPH
VUSM
VUSN
Other (specify):
Exceptions (specify):
X Not Applicable
* Includes satellite sites unless otherwise specified.
Specific Education Requirements:
Yes
No
X Not Applicable
Physician Order Requirements:
Yes
No
X Not Applicable
2
WRITING GUIDELINES
I.
Outcome Goal:
To provide guidance for writing Advanced Practice Registered Nurse (APRN)
Protocols in the approved format.
II.
Policy:
APRN Protocols (referred to hereafter as “protocols”), both area/practice specific
and multi-practice, are written in the approved format, using the directions in this
document as a guide. VUMC specific protocols are developed and written using a
standardized, approved format.
III.
Specific Information:
A.
Protocols outline the baseline practice and/or performance expectations for
APRNs.
B.
APRN protocols are required by the Tennessee State Board of Medical
Examiners.
C.
Refrain from making a protocol document a teaching tool.
D.
Maintain a brief, "bullet" style or table format whenever possible.
E.
All sections are mandatory. Do not remove or change any sections. If a
section does not apply, simply indicate the section is not applicable in the
text.
F.
Avoid using trade names and brand names; use generic terminology
whenever possible. If a trade name must be used, indicate patent, copyright,
and trademark with appropriate symbol or citation.
G.
Avoid using staff names and phone numbers of individuals and/or
departments.
H.
Protocols should include references and follow APA format. Include links to
web based sites in the References section and not in the body of the protocol.
I.
Evidence- based guidelines will be included as a reference(s) whenever
applicable and appropriate to content.
CLINICAL POLICY MANUAL
WRITING GUIDELINES
J.
When using abbreviations, please use the full name/definition when it is first
used in the document followed by the abbreviation in parentheses. Please
refer to the abbreviations policy. (VUMC Abbreviations Policy)
K.
Outline of approved format:
Template:
Cataloging Information:
Protocol Name and number
(Each protocol should be submitted as a single,
unique file)
Defined:
Name: Title should be brief and avoid use of
terms such as policy, protocol, standard,
guidelines, etc. Population (such as “Adult),
Disease process or name of procedure (such
as “Diabetes Management” or “Chest tube
insertion”) is sufficient.
Number: order of document in the Protocol
Manual; assigned by manual managers in the
Center for Advanced Practice Nursing and
Allied Health (CAPNAH)
Practice Site Location(s)
Choose site(s) where protocol will be used in
APRN practice
Developed and Approved by
Must include Medical Director of Practice,
APRN Supervising Physician, APRN
Manager and Contributing APRN (with
credentials and titles), and all APRNs who
will use the protocol.
Effective Date (last reviewed and
updated)
Indicates last date protocol reviewed and
revised. Must be revised every 2 years.
Supersedes (initial date approved, if this
is has undergone review approved date)
Indicates original date if the protocol has
been reviewed.
4
Template:
Body:
Defined:
I.
Population
Target patient population. (such as “Adults in
Cardiac Critical Care Unit”)
II.
Indications
Brief statement regarding indication(s) for
use of protocol. (Such as “Adults requiring
chest tube insertion for pneumothorax,
pleural effusion” etc.)
III.
Definitions
Define appropriate roles; define any
acronyms or abbreviations, etc. Avoid brand
names.
IV. Additional Competencies
Required
Competency required above core APN
practice. Such as, additional privilege
required additional certification or training.
(For a procedure, this should include how
many procedures must be performed while
supervised and independently to gain
privilege for advanced procedure. This
should correspond to those on “Additional
Competencies Requested” form from the One
Packet.)
V.
Assessment
Describe the typical physical assessment and
history for the disease process or clinical
diagnosis applicable to the protocol.
VI.
Diagnostic Data
Describe typical diagnostic data to be
obtained (lab, radiology, and other
diagnostics) in relation to the protocol.
VII.
Differential Diagnosis
List other possible diagnoses requiring “rule
out” and/or further evaluation.
VIII. Goal(s) of Treatment
Expected patient outcomes related to
treatment of the disease process.
IX.
List specific interventions and treatments.
Medication doses should not be indicated but
list classes and/or specific medications. If
doses are specified discuss criteria for not
following the indicated dose (i.e. renal
dysfunction, titration, therapeutic levels,
Intervention/Treatment
CLINICAL POLICY MANUAL
WRITING GUIDELINES
Template:
Defined:
etc.). By regulation, criteria for when to
consult physician must be included.
X.
Complications
List specific complications for the disease
process and treatment; include monitoring
criteria and specific interventions for
complications.
XI.
Medications by Formulary
By regulation, medications used in
intervention/treatment must be listed by
formulary category. List medications
typically used in conjunction with this
procedure or practice (include procedure
medications and discharge medications).
Refer to the Tennessee Notice and Formulary
for a category list at www.CAPNAH.org.
XII.
References
List relevant references used in the
development of the protocol. Use APA
format.
B. Guidelines Development Process:
a. Protocols are reviewed every 2 years and revised, if needed, by the APN, and
Supervising Physician
b. Identify responsible author/facilitator. Consult APN Protocol Committee
Chair if first-time author.
c. Identify stakeholders/clinical experts.
d. Complete review of published standards and clinical evidence related to the
protocol topic (community and literature).
e. Develop first draft of protocols. Consult APN Protocol Committee Chair for
any questions as needed.
f. Stakeholders review first draft and provide feedback to author/facilitator.
g. Send final draft to anyone the practice protocol applies (i.e., all APRNs in
group practice, all physicians in group practice as indicated, Medical Director
of medical practice) for review/recommendations prior to submitting protocol
to the Center for Advanced Practice Nursing and Allied Health (CAPNAH).
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C. Web References:
American Psychological Association (APA) Guide. Retrieved April 17, 2007,
from: http://apastyle.apa.org/.
APRN Protocol Templates. Retrieved from:
http://www.mc.vanderbilt.edu/root/vumc.php?site=CAPNAH&doc=25120
D. Endorsement:
Advanced Practice Standards Committee (APSC)
E. Approval:
Clare Thomson-Smith
Susan Gent
CLINICAL POLICY MANUAL
WRITING GUIDELINES