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Clinical Practice Guidelines

Roberta Tipton

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Naomi Gold
Liaison to the following: Honors Living Learning Community (HLLC), RU-N Writing Program, Office of Transfer Students, Anthropology, Life Sciences (with Bonnie Fong), Nursing, Philosophy, Psychology (with Bonnie Fong), Religious Studies, and Sociology.
The John Cotton Dana Library
Subjects: Writing & Citation


Defined by the Institute of Medicine (1992) as "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances," clinical guidelines are important components in the delivery of evidence based health care practice. By incorporating guidelines into their practice, nurses anticipate minimizing risks to their patients, improving the quality of their care, and increasing cost effectiveness. Although clinical guidelines have been shown to benefit patient care, they remain a challenge to locate.

The effectiveness of clinical guidelines depends on the methodology used in their development as well as the composition of the group involved. The group members should be from multiple disciplines and represent patients as well as health care professionals. By providing such a broad base of expertise and views, the authoring agency adds to the validity and acceptability of the guidelines. All group participants have a chance to discuss and resolve differences in their values and clarify their roles in guideline implementation.

The development is rigorous and carefully controlled. It usually begins with the consideration of whether a problem is an appropriate subject for a guideline. Successful guidelines usually focus on a problem that occurs frequently, receives differing treatments, has a high cost, involves a societal issue or has been a vocalized concern of the patient population. Then the group engages in a thorough and systematic literature review to uncover relevant published and unpublished studies. From the evidence in the research studies, the group drafts a series of recommendations which are submitted to other patient and professional groups for review. After the comments of these groups are incorporated into the recommendations, the guideline development group works on reaching a consensus. Guideline development proceeds from the revised recommendations. The Institute of Medicine state in 1992 that guidelines should be valid, reproducible, reliable, representative, applicable to the patient population, flexible, clear, meticulous, reviewed regularly, and be amenable to clinical audit. In view of the extensive effort involved in guideline development, it is not surprising to find that the primary sources are government agencies and professional medical and nursing associations.

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