Writing Evidence Based Clinical Protocols

Clinical GuidelinesSystematically developed statements designed to assist the health care team and their patients to make appropriate decisions about a specific condition or treatment Arise following an examination of the current best evidence, and other knowledge relevant to a specific health problem

Clinical ProtocolsPractice area specificSpecify details concerning the treatment/and or procedure endorsed by the employing agency.Used to inform those involved in litigationMay include a summary of the most important sections of the relevant clinical guideline/s.

Clinical protocolsContent based on common sense as well as information about effectivenessProvide benchmarks for audits of quality of care

Evidence Based Protocol DevelopmentRequirementsOld protocol (if exists)New evidence (BPIS, research findings, legislation, reports etc)

The new protocol should integrate local expertise and local context of practice with the best available evidenceEvidenceLocal Expertise

Agency ExpertiseStaffNeedsEvidence Based Decisions, StrategiesContext of CareEvidence

Consider the EvidenceHow good is the evidence? (Quality)How relevant is the evidence to our setting? (Relevance) Are the financial, physical and human resources available to support the recommended practice? (Feasibility)

If yes to all 3 questionsCompare the existing protocol with the new information

No differences detected Add to existing protocolRelevant informationRationalesReferences

Differences detected Determine the degree of differenceConsider the impact of introducing changeIf appropriate, amend the existing protocol to reflect desired (best) practiceImplement education to communicate change to practice

NotesEvidence cannot be changed, the choice is to use it (in its entirety) or notIf evidence is incorporated into a protocol, but not used, the practitioner must be able to justify why the protocol was not followed.Sometimes it may be better to rely on clinical judgement (e.g. vital signs)

No Current Procedure?Ascertain requirement for new protocolDetermine the current (unwritten) practice?Check whether a protocol already exists elsewhere (websites or other hospitals)Draw up a draft protocol based on current practice which incorporates evidence feasible and relevant to your setting

Components of a protocolAimKey pointsEquipment requiredRequired actionsReferences

AimReflect/s what the care aims to achieveDesignates an outcome measure for the assessment of quality

Key points (Optional)Absolute indications, contra indications or special precautions May specify the level of asepsis requiredDescribes any special competencies required of the operatorIncludes clarification or definition of unfamiliar termsIndicates the need for consent

EquipmentLists equipment always required for the procedure.Specifies sizes (e.g. 19G needle, 10 mL syringe) where appropriateLists additional equipment/additional requirements which may be required in certain circumstances - together with the indication for their use

ProcedureEach step of the procedure is described in sequence.A new number is used for each step

Additional InformationRelevant evidence relating to the step is described opposite the action. Does not include any steps required for the procedureMay also include helpful hints and special precautions.

Example of an Action Statement

Procedure

Additional information

MRSA status

Swab patients who have been hospital-ised or worked in a hospital outside of WA in the previous 12 months

Previous hospitalisation is the major risk factor for acquisition of MRSA23.

Screening at risk patients may reduce nosocomial spread and the risk of endemic colonisation and infection within the hospital.

ReferencesWhere the recommended practice has a source, superscript numbers are used to refer the reader to the appropriate reference.1Include the entire reference at the end of the procedure

Reference ListList the resources/references used to develop the procedureInclude the Level of Evidence or Review Author/s. Date of publication. Title of article or book. (Journal title if applicable in bold). vol:issue no:page nos. (34:4:245-56) (Level II) If the source is the internet, include the date of access as well as the date of publication

Source informationDate Issued: February 2008Authorised by: Author/s of DocumentReview Date: February 2010