Using consensus methods to develop clinical practice guidelines for intensive care: The Intensive Care Collaborative project
Section snippets
Background
Clinical practices or procedures based on the best available evidence are essential resources within an intensive care unit (ICU).1 Maintaining the currency of a local clinical practice manual is challenging however, particularly in relation to the time required, other workload pressures and the availability of senior nursing staff with relevant skills to interrogate the literature. The Intensive Care Coordination and Monitoring Unit (ICCMU) was established in 2003 to collect information
Method
The aim of the Intensive Care Collaborative project was to develop CPGs for six common intensive care practices using a group process approach. This entailed: synthesising the current evidence base around each practice; and developing recommendations for practice incorporating the research evidence and expert opinion where evidence was lacking. The models used to assist development of the methods included: the AGREE Collaboration;12 and Promoting Action on Research Implementation in Health
Results
In total, 55 participants from all nine Area Health Services in NSW attended the seminar (15 Clinical Nurse Consultants; 18 clinical/nurse educators; 8 Nurse Managers; 14 Clinical Nurse Specialists). Twenty-nine pre-seminar surveys (response rate 49%) were returned with 171 requests for potential topics. These were categorised into eight groups: (1) routine care of the critically ill (n = 53); (2) ventilation (n = 49); (3) speciality areas (n = 27); (4) haemodynamic monitoring (n = 25); (5) drug
Discussion
This Intensive Care Collaborative project conducted by the NSW Intensive Care Coordination and Monitoring Unit enabled the development of six clinical practice guidelines using a mixed-method group consensus approach—using electronic communications in the initial development phases of guideline scope identification and literature review, utilising a NGT at a consensus conference, and then seeking external validation using Delphi panels. While the project was coordinated centrally, the impetus
Conclusion
This paper described a project where the tools of evidence-based practice (systematic reviews) were combined with structured group techniques (nominal group, Delphi panel and CDC) to develop CPGs and their related literature reviews for six common clinical nursing practices in intensive care. Other related papers will report the specific details for each guideline, including the recommendations for clinical practice based on the available body of research evidence or expert consensus. All
Financial disclosure
The Intensive Care Collaborative project was primarily funded from internal funding of ICCMU, NSW Health. Participants in the GDNs were supported by their employing units. Three rural participants were supported by the Rural Education fund to attend the CDC. Travel and accommodation costs of the academic facilitators were paid by ICCMU. Elsevier Publications attended the Education seminar. No trade sponsorship was solicited for the CDC and no industry representatives were involved in any aspect
Acknowledgements
The Authors acknowledge the invaluable involvement of all GDN and EVP members. Panel participants are acknowledged in each of the full guideline documents available at the ICCMU website (http://intensivecare.hsnet.nsw.gov.au).
Academic facilitators—Arterial guideline: Dr. Tina Jones Manager, Australian Centre for Evidence-Based Clinical Practice, Flinders Medical Centre and Senior Lecturer, Faculty of Health Sciences, Flinders University. CVC guideline: Dr. Judy Currey Senior Lecturer, School of
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