how to create an evidence- based guideline eric finlay january 2008
TRANSCRIPT
How to create an evidence-How to create an evidence-based guidelinebased guideline
Eric Finlay January 2008Eric Finlay January 2008
EBM GuidelinesEBM Guidelines
Choosing a topicChoosing a topic
Developing a questionDeveloping a question
Finding the evidenceFinding the evidence
Evaluating the evidenceEvaluating the evidence
Write the guidelineWrite the guideline
Implement the guidelineImplement the guideline
EBM GuidelineEBM Guideline
Why?Why?
Where?Where?
What?What?
How?How?
Why?Why?
What the RCPCH says 1What the RCPCH says 1
Clinical guidelines are increasingly being developed in order to help improve the health outcomes for patients and to help reduce unacceptable variations in clinical practice. However, guidelines can only be effective if they are developed to the highest standards and are based upon the best available evidence. Clinical guidelines must also be seen to be of value to clinicians so that they are implemented in everyday clinical practice.
Choose a topicChoose a topic
Remember creating a guideline is Remember creating a guideline is resource-intensive and time-consumingresource-intensive and time-consuming
Perceived need?Perceived need?
What is to be gained by the guideline?What is to be gained by the guideline?
What is the scope of the guideline?What is the scope of the guideline?
Measure current practiceMeasure current practice
Knowing what is currently happening is Knowing what is currently happening is very usefulvery useful
AuditAudit
Survey MonkeySurvey Monkey
Talk to your stakeholdersTalk to your stakeholders
Where?Where?
Not a problem here-BAPNNot a problem here-BAPN
Organisation analysisOrganisation analysis
‘‘The culture and politics of many organisations The culture and politics of many organisations constrain the degree of transformation and constrain the degree of transformation and change in which they can successfully engage’ change in which they can successfully engage’ Morgan 1989Morgan 1989Organisations are well integrated entities within Organisations are well integrated entities within which everybody works harmoniously together- which everybody works harmoniously together- the reality is very different’ the reality is very different’ J Hayes 2002J Hayes 2002‘‘My Arse’ My Arse’ Ricky Tomlinson 2008Ricky Tomlinson 2008To change an organisation you must first To change an organisation you must first understand it!understand it!
What?What?
What the RCPCH says 2What the RCPCH says 2
Appropriate, efficient and cost effective Appropriate, efficient and cost effective healthcarehealthcare
Important part of clinical governanceImportant part of clinical governance
Rigorously developedRigorously developed
Transparent methodTransparent method
Careful planningCareful planning
Searching the medical databasesSearching the medical databases
Get your question rightGet your question right
Know where to lookKnow where to look
Know your synonymsKnow your synonyms
ChunkingChunking
Save your search stringsSave your search strings
That all important questionThat all important question
What do you want the search to answer?What do you want the search to answer?
PICO(T)PICO(T)
The question then forms the structure of The question then forms the structure of your search.your search.
Finding the evidenceFinding the evidence
Your question should lead youYour question should lead you
Know your databasesKnow your databases
The more databases searched the more The more databases searched the more sensitive the searchsensitive the search
Know your synonymsKnow your synonyms
Increase the number of search terms Increase the number of search terms increase your search sensitivityincrease your search sensitivity
Look at Cochrane search strings for Look at Cochrane search strings for synonymssynonyms
DatabasesDatabases
Medline/PubmedMedline/Pubmed
CinahlCinahl
EmbaseEmbase
AMEDAMED
Biomed CentralBiomed Central
CochraneCochrane
DH-DataDH-Data
BNIBNI
Psyche-infoPsyche-info
LISALISA
EmeraldEmerald
ERICERIC
BEIBEI
HMICHMIC
ChunkingChunking
Join all your (P) synonyms with ORJoin all your (P) synonyms with ORJoin all your (I) synonyms with ORJoin all your (I) synonyms with ORJoin all your (C) synonyms with ORJoin all your (C) synonyms with ORJoin all your (O) synonyms with ORJoin all your (O) synonyms with OR
Now P AND I AND C AND ONow P AND I AND C AND O
That’s chunkingThat’s chunking
Example of synonymsExample of synonyms
(haemodialysis catheter) OR (tesio-cath) (haemodialysis catheter) OR (tesio-cath) OR (central venous dialysis catheter) OR OR (central venous dialysis catheter) OR (vascular access) OR (vascular access) (vascular access) OR (vascular access) OR (central venous catheter) OR (central-OR (central venous catheter) OR (central-venous catheter) OR (francis catheter) OR venous catheter) OR (francis catheter) OR (vascath) OR (permcath) OR (vascath) OR (permcath) OR (haemodialysis venous catheter) OR (haemodialysis venous catheter) OR (central venous line) OR ('central venous (central venous line) OR ('central venous line') OR (dialysis catheter*)line') OR (dialysis catheter*)
Watch outWatch out
Only add in limits at the end if despite chunking Only add in limits at the end if despite chunking you still have hundreds of pagesyou still have hundreds of pages
MESHMESH
CochraneCochrane
Save your searches-my NCBISave your searches-my NCBI
Avoid NOTAvoid NOT
Critical AppraisalCritical Appraisal
CASP toolsCASP tools
Look for flaws- written and omissionsLook for flaws- written and omissions
Can you use it?Can you use it?
Is it applicable and transferable?Is it applicable and transferable?
Write the guidelineWrite the guideline
Be concrete, unambiguous and use Be concrete, unambiguous and use specific terms.specific terms.
Key recommendationsKey recommendations
Audit criteriaAudit criteria
Algorithms/pathwaysAlgorithms/pathways
Short version/comprehensive versionShort version/comprehensive version
Educational packagesEducational packages
How?How?
ImplementationImplementation
The hardest partThe hardest part Find out where the stakeholders standFind out where the stakeholders stand
Actively for, passive, active againstActively for, passive, active against
What are the resistive forcesWhat are the resistive forces
How can these resistive forces be underminedHow can these resistive forces be undermined Strategic planningStrategic planning
Best to erode resistance rather than push Best to erode resistance rather than push harderharder
Organisational AnalysisOrganisational Analysis
SWOTSWOT Strengths, weaknesses, opportunities and threatsStrengths, weaknesses, opportunities and threats
PESTELIPESTELI Political, economic, sociological, technological, Political, economic, sociological, technological,
ecological, legislative and industryecological, legislative and industry
Force-fieldForce-field Driving forces against resistive forcesDriving forces against resistive forces
The Seven S’sThe Seven S’s Strategy, structure, system, staff, style, shared validity Strategy, structure, system, staff, style, shared validity
and skillsand skills
Peer review and UpdatingPeer review and Updating
All guidelines will be reviewed by the All guidelines will be reviewed by the Clinical Standards CommitteeClinical Standards Committee
Must be up-to-date to be usefulMust be up-to-date to be useful
Set and update date based on frequency Set and update date based on frequency of relevant publications in the preceding of relevant publications in the preceding year.year.
In ConclusionIn Conclusion
This is effectively a systematic review This is effectively a systematic review without the statistical analysis.without the statistical analysis.
Choose something that interests you as Choose something that interests you as well as is clinically relevant.well as is clinically relevant.
Choose a small subject, or a small portion Choose a small subject, or a small portion of a larger one.of a larger one.
Set yourself deadlines for each of the Set yourself deadlines for each of the stages.stages.
FinallyFinally
www.bapn.orgwww.bapn.org is your best friend. is your best friend.