Clinical practice guidelines
- Lois Thomas, RN, PhD
- Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
This article describes the development, implementation, and appraisal of clinical practice guidelines. It also explores ways of increasing their use in nursing.
Clinical practice guidelines are “systematically developed statements to assist practitioner decisions about appropriate health care for specific clinical circumstances.”1 Guidelines can be used to reduce inappropriate variations in practice and to promote the delivery of high quality, evidence-based health care. They may also provide a mechanism by which healthcare professionals can be made accountable for clinical activities.2 Although most of the development and evaluation of clinical guidelines has occurred in the field of medicine, nurses are becoming more interested in the use of guidelines as one means of facilitating evidence-based practice.
Clinical guidelines can be developed either locally (internal guidelines) or regionally or nationally (external guidelines). Although internal guidelines may need fewer resources and may be more likely to be adopted into clinical practice because of local ownership,3, 4 local groups may not have the skills required for guideline development.5 An alternative is the development of guidelines at regional or national levels and subsequent modification to suit local circumstances.5, 6
Guideline development has 4 stages. 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. 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.7 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 …