CLINICAL GUIDELINES

DEFINITION
Definition: (old) "Systematically developed statements to assist practitioner and patient
decisions about appropriate health care for specific clinical circumstances" (Institute of
Medicine 1990).
Definition: (old) are statement that include recommendations intended to optimize patient care
that are informed by systematic review of evidence and an assessment of the benefits and
harms of alternative care options.
-Committee on Standards for Developing Trustworthy CPG's (IOM-AHRQ)
o Aka clinical protocol, clinical practice guidelines (CPGS), medical guidelines, practice
guidelines; evidence-based documents that serve as decision making guidelines

FOCUSED ON:
 Prevention/Early Detection
 Diagnosis
 Treatment
 Monitoring
 Patient Education
 Referrals to a specialist or to the hospital

PRINCIPLES OF A GOOD CLINICAL PRACTICE

GUIDELINES
 Clarity
 All terms are clearly defined
 No gray areas that may confuse a healthcare provider
 Ex. A CPG provides you an intervention or a course of care for patient SBP > 130 mmHg,
but does not offer an alternative for SBP < 130 mmHg
 Compatibility
 All components must be accepted by various concerned disciplines
 Ex. A CPS states that a nurse, in the absence of a physician for more than 3 minutes,
may by himself administer 1 ampule of epinephrine on a crashing patient. The is
unacceptable in nursing practice
 Clear rationales
 A good CPG also provides rationales for every recommendation it has
 Evidence-based
 Sensitivity to practical sues
 Not simply because a resource is available, a CPG should outright recommend it.
 Culture, economy and other logistics should be considered
 Ex. A CPG recommending the use of complete first aid kit by company x where the
products may be too expensive for the population or not available locally

BENEFITS OF CLINICAL PRACTICE GUIDELINES

 Helps improve health outcomes
 Can potentially reduce mortality and morbidity for certain conditions
 Improve consistency of care
 May improve frequency of performance of procedures for patient management and care
 Promotes standardization of care
 May help reduce healthcare costs

LIMITATIONS OF CLINICAL PRACTICE GUIDELINES

 General patient approach
 Requires in-depth understanding and interpretation of scientific evidences by guideline
developers
 Recommendations in the guidelines come from professional opinions of the members of the
guideline
 Development committee
 Needs may not be prioritized correctly

WHO NEEDS CLINICAL PRACTICE GUIDELINES?

 Doctors
 Nurses
 Decision-makers
 Patients
 Public

4 STAGES OF GUIDELINE DEVELOPMENT

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1. Firstly, it is essential that guidelines are based on the best available research
evidence, and therefore a detailed literature search is done to identify
evidence from research studies about the appropriateness and effectiveness of
different clinical strategies.
2. Next, using the research evidence, guideline construction takes place, usually
through some form of small group work, with representation from as many
interested parties as possible.
3. Then, the guideline is tested by asking professionals not involved in the
guideline development to review it for clarity, internal consistency, and
acceptability. The guideline can then be tested in selected healthcare settings
to see whether it is feasible for use in routine practice.
4. Finally, the guideline should be reviewed after a specified time period and
modified to take into account new knowledge.