Eric Finlay January 2008

EBM Guidelines
Choosing a topic
Developing a question
Finding the evidence
Evaluating the evidence
Write the guideline
Implement the guideline

Why?
Where?
What?
How?

Clinical guidelines are increasingly being developed in order to help improve the health outcomes for patients and to help reduce unacceptable variations in clinical practice.
However, guidelines can only be effective if they are developed to the highest standards and are based upon the best available evidence. Clinical guidelines must also be seen to be of value to clinicians so that they are implemented in everyday clinical practice.

Remember creating a guideline is resource-intensive and time-consuming
Perceived need?
What is to be gained by the guideline?
What is the scope of the guideline?

Knowing what is currently happening is very useful
Audit
Survey Monkey
Talk to your stakeholders

Not a problem here-BAPN

‘The culture and politics of many organisations constrain the degree of transformation and change in which they can successfully engage’
Morgan 1989
Organisations are well integrated entities within which everybody works harmoniously togetherthe reality is very different’ J Hayes 2002
‘My Arse’ Ricky Tomlinson 2008
To change an organisation you must first understand it!

Appropriate, efficient and cost effective healthcare
Important part of clinical governance
Rigorously developed
Transparent method
Careful planning

Searching the medical databases
Get your question right
Know where to look
Know your synonyms
Chunking
Save your search strings

What do you want the search to answer?
PICO(T)
The question then forms the structure of your search.

Your question should lead you
Know your databases
The more databases searched the more sensitive the search

Increase the number of search terms increase your search sensitivity
Look at Cochrane search strings for synonyms

Medline/Pubmed
Cinahl
Embase
AMED
Biomed Central
Cochrane
DH-Data
BNI
Psyche-info
LISA
Emerald
ERIC
BEI
HMIC

Join all your (P) synonyms with OR
Join all your (I) synonyms with OR
Join all your (C) synonyms with OR
Join all your (O) synonyms with OR
Now P AND I AND C AND O
That’s chunking

(haemodialysis catheter) OR (tesio-cath)
OR (central venous dialysis catheter) OR
(vascular access) OR (vascular access)
OR (central venous catheter) OR (centralvenous catheter) OR (francis catheter) OR
(vascath) OR (permcath) OR
(haemodialysis venous catheter) OR
(central venous line) OR ('central venous line') OR (dialysis catheter*)

Only add in limits at the end if despite chunking you still have hundreds of pages
MESH
Cochrane
Save your searches-my NCBI
Avoid NOT

CASP tools
Look for flaws- written and omissions
Can you use it?
Is it applicable and transferable?

Be concrete, unambiguous and use specific terms.
Key recommendations
Audit criteria
Algorithms/pathways
Short version/comprehensive version
Educational packages

The hardest part

Find out where the stakeholders stand
Actively for, passive, active against
What are the resistive forces
How can these resistive forces be undermined

Strategic planning
Best to erode resistance rather than push harder

SWOT

Strengths, weaknesses, opportunities and threats
PESTELI

Political, economic, sociological, technological, ecological, legislative and industry
Force-field

Driving forces against resistive forces
The Seven S’s

Strategy, structure, system, staff, style, shared validity and skills

All guidelines will be reviewed by the
Clinical Standards Committee
Must be up-to-date to be useful
Set and update date based on frequency of relevant publications in the preceding year.

This is effectively a systematic review without the statistical analysis.
Choose something that interests you as well as is clinically relevant.
Choose a small subject, or a small portion of a larger one.
Set yourself deadlines for each of the stages.

www.bapn.org
is your best friend.