Instructions for Use
In caring for the elderly and ensuring that their medication errors occur rarely, the Joanna Institute of Evidence Based Practice Nursing and Midwifery has prepared a procedure which has to be appraised keenly if it has to be used in taking care of elderly patients. This set of instructions come in a form of items organized in domain form and is aimed at capturing dimensions of a guideline quality. The six domains are as follows:
Scope and purpose
The main concern is to deal with the potential involved in health impacts using a guideline relating to the society and the population of patients. The main aim(s) of this guideline is expected to reflect and give a detailed description the health benefits expected which should be specific to the clinical problem of concern. An example of statements that are specific would be as follows:
Preventing (long term) complications of patients with diabetes mellitus;
Lowering the risk of subsequent vascular events in patients with previous myocardial infarction; and rational prescribing of antipressants in a cost-effective way.
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The description of the clinical questions asked in the guideline should be availed; this is particularly referred to the recommendations given as asked in the statements above. The recommendations should address issues such as:
How many times is the HbA1 supposed to be measured in patients with diabetes mellitus annually?
What should the daily dosage of aspirin for patients diagnosed with acute myocardial infarction?
Are selective serotonin reuptake inhibitors (SSRIs) more cost-effective than tricyclic
antidepressants (TCAs) in treatment of patients with depression? (I AGREE) (Portney, & Watkins, 2009).
This item places its main concern for specific persons (professionals) who at one point get involved at the stages of development. This refers to persons who may be involved in the steering group, members in the team who might have been involved in the research through the selection and reviewing/rating of the evidence gathered as well as individuals involved in the formulation of the final recommendations (Koch, et al. 2008).
Information concerning the patients’ experiences and their expectations on healthcare should be in line with the development of clinical guidelines. This emphasis ensures there are clear patients’ perspectives which are in line with clinical guideline development. As an example, the group involved in the development process can involve patients’ experiences in the group. This information can be achieved through interviewing of patients, patients’ literature reviews. These could be possible experiences taken by the group representatives hence the consideration of these by the group as a whole. As this is so, there should be evidence that the following process has been conducted (Schneider, Whitehead, & Elliott, 2007).
For these guidelines, the target users should be clearly known. This is with cause that they are able to establish and determine if the following guidelines are relevant to their field of practice thus enabling them focus. An example is target users specialized in low back pains in the guidelines-these include such professionals as general practitioners, rheumatologists, neurologists, orthopaedic surgeons and physiotherapists (Taylor, Kermode, & Roberts, 2006).
In this case, a guideline should undergo pre-tests before availing it to end users in the field. This should be done prior to the publication of the guideline. This is done with a reason to avoid misconception of ideas as these guidelines are rooted to other hospital or care practices. (I AGREE)
Rigour of development
In reference to the development of the theory, there should be provision of the strategies use d in the collection of the information to search for evidence. This should have an inclusion of search terms that have been used, the consultation sources and the dates of covering the literature as used in the guidelines. These sources may come from hand searching journals, databases of systematic reviews, collecting reviews from conference proceedings as well as electronic databases. (I AGREE).
In this reference, all researched ideas should be supported by evidence which should explain the criteria used for the inclusion or exclusion of details in the guideline. This should be done with a clear and explicit description stating reasons for the inclusion and the exclusion of evidence taken from randomized clinical trials and the exclusion of articles that are not written in English. (I DISAGREE) (Parsons, 2003).
This also involves descriptive methods used in the formulation of recommendations and how final decisions are arrived at. The methods used in achieving this include: formal consensus techniques and/or a voting system. With this, areas of disagreement and the methods involved in resolving them should be specified. (I AGREE)
The development of the guideline should have health benefits, risk of recommendations put forward and the side effects referring to the ailment. An example is a guideline developed to cater for management of cancer disease. This will include an overall discussion of the effects of the various outcomes. This refers to the adverse effects, quality of life, chances of survival and a discussion which shows comparison of the differences involved from one treatment to another. For this issues addressed, there should be clear indication of evidence to achieve a quality guideline. (I AGREE)
In the development of the evidence, the existence of an explicit link should be available; this concerns the recommendations and the evidence under which they are based thus each of the outlined recommendations should be linked with a list containing the references under which they are based on. (I AGREE)
Before the release of a guideline, the writers should ensure that a proper review is conducted; this should be done externally. This should not necessarily be done with members of the development group but the process should be undertaken by clinical experts in the clinical field including methodological experts. This should also involve several and/or a member of the patients’ representatives. Through trying to achieve a composed guideline, there must be availability or the description of the methodology used to conduct the external review. This is supposed to include a list of reviewers and their affiliation. (I AGREE)
As these guidelines are supposed to be used in bigger institutions, a clear guideline should be able to reflect the current research done. It should be clear on the procedures which are to be used in the updating process of the guideline. (I AGREE)
Clarity and Presentation
A precise and concrete recommendation is vital and of which appropriate management of the patient’s group. This is with the permission of the body of evidence concerned. An example is the prescription of antibiotics to children of two years older with acute otitis media if there is persistence in three day’s time or if there is increase in complaints after consultation has been made despite adequate treatment with use of painkillers; As a result of such cases, amoxicillin should be administered for seven days (and a supply of a dosage scheme). On the other hand, a vague recommendation is the indication of antibiotics for cases with abnormalities or complications. However, there is no clear evidence that there may be uncertainty about the best way for the management of such cases. In this case, the uncertainty should be stated in the guideline, and I thus DISAGREE.
Application of the recommendations at times requires changes in the current organization of care within a service or clinic. These may act as a barrier in using them in daily practice. This occurs as certain organizational changes are needed to suite the organizations recommendations and should be discussed. E.g. a guideline on stroke may recommend care is co-ordinate through stroke units and stroke services or rather a guideline on diabetes in primary care may require that patients are attended and followed up in diabetic clinics. (I AGREE) (Osborne & Webster, 2004).
The development of guidelines can receive funding through external sources. This refers to sources such as the government and charity organizations. This may be supported by statements that the views and interests of the funding body have no influence on the final recommendations ( Portney, & Watkins, 2009). This should be clearly stated in the guideline if it was not developed from external funding. (I AGREE)
In the management and proper services to a population of patients, it is wise to have a team of developers who will come up with clear stipulated ideas and procedures in the various treatments. This will prevent conflict as every professional will only touch on his specialized field thus the provision of proper services in clinics.
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