● NCCN Clinical Practice Guidelines in Oncology, National Comprehensive Cancer Network : The NCCN Clinical Practice Guidelines in Oncology are the recognized standards for clinical policy in oncology. To date, they are the most comprehensive and most frequently updated clinical practice guidelines available in any area of medicine. The guidelines are updated on an ongoing basis. Treatment recommendations are specific and implemented through performance measurement. Issues addressed include cancer detection; prevention and risk reduction; workup; and diagnosis, treatment, and supportive care: https://www.nccn. org/professionals/physician_gls/default.aspx ● UK’s National Institute for Health and Care Excellence : Referred to as Guidance Lists in the United Kingdom, this site has more than 1,110 practice guidelines: https://www.nice. org.uk/guidance/published Resources to help healthcare professionals locate various practice guidelines also are available (Meyer, 2018; University of Washington Health Sciences Library, 2019): ● ClinicalKey : Select “Guidelines” in the browse menu. A search box allows for the search of a particular topic or guideline: https://www.clinicalkey.com/#!/ ● DynaMed Plus : Healthcare professionals begin by searching for the desired topic or guideline. Guidelines and resources will then be listed in the left-side menu. DynaMed Plus gathers guidelines from national and international sources: https://search.ebscohost.com/login.aspx?authtype=ip,uid&p rofile=dmp ● ECRI Guidelines Trust : ECRI Guidelines Trust has replaced the National Guideline Clearinghouse. It is a publicly available web-based repository of objective evidence-based clinical practice guideline content. Its purpose is to provide physicians, nurses, other clinical specialties, and members of the healthcare community with up-to-date clinical practices to advance safe and effective patient care. This centralized repository includes evidence-based guidance developed by nationally and internationally recognized medical organizations and medical specialty societies: https:// guidelines.ecri.org/ ● PubMed : PubMed comprises more than 20 million citations. There is a quick start guide to help facilitate searches: https://www.ncbi.nlm.nih.gov/pubmed?otool=yalelib ● UpToDate : After searching for the topic in question, society guideline links appear in the menu. Guidelines are gathered from both national and international organizations: https:// www.uptodate.com/contents/overview-of-clinical-practice- guidelines Nursing consideration: Many guidelines are accessible on the Internet. It is important to ensure that the most current guidelines are used and that these guidelines are based on a systematic review of the scientific evidence developed by a panel of experts. Guidelines must be accepted at employing organizations (Meyer, 2018). How can nurses and other healthcare professionals be sure that the websites they are using to obtain clinical guidelines contain accurate and up-to-date information? The University of Washington’s Health Sciences Library offers the following suggestions for evaluating websites (Schnall, n.d.). The guidelines have been adapted to focus on clinical guidelines websites: ● Authority . ○ Are the guidelines’ authors clearly identified? ○ Are the credentials of the authors provided? Barriers to the implementation of EBP in nursing It seems only logical that all organizations should support EBP. However, nurses have identified significant barriers to its implementation. These barriers must be recognized and eliminated or reduced as much as possible.
○ Are the authors affiliated with a healthcare system or professional association? Do the authors have any declared conflicts of interest? ○ Do the authors have credibility in the fields the guidelines are written for? ○ Is contact information provided for the authors? ● Accuracy . ○ Is the information provided in the guidelines accurate? ○ Are references listed? Were they written within the last 3 years? If not, are they considered “classic” information? ○ Are sources of information clearly stated? ○ Is there an explanation of the research methods that were used to gather data? ● Objectivity . ○ Is the purpose of the site clearly stated? ○ Is the information presented without bias? Are any conflicts of interest apparent? ○ Is sponsorship acknowledged? Does sponsorship bias the information presented? ● Coverage . ○ Does the site meet the needs of the healthcare professionals? ○ Are the guidelines comprehensive? Do they address all-important key aspects of care? ○ Does the site provide any extra features or information not available from other sources or in other formats? Is the information provided current? Is the website itself current? ○ Are links current? Do links supplement information important to guideline implementation? ● Design . ○ How is the website organized? Is it easy to navigate? ○ Is there an internal search engine? ○ Can the site be accessed on a reliable basis? The National Heart, Lung, and Blood Institute appoints panels of experts to conduct systematic evidence reviews to facilitate clinical practice guideline development. These experts are not paid and are selected for their scientific and clinical expertise. Persons with apparent financial conflicts and those with professional or intellectual bias are excluded from panel membership. ● Currency . ○ However, conflicts of interest are sometimes identified among members of the writing and review groups. The following actions handle such conflicts (National Heart, Lung, and Blood Institute, n.d.): ● Members voluntarily verbally disclose any potential conflicts of interest to each other during a general meeting. They must then recuse themselves from voting. ● A methodologist is hired to work with writing groups to provide objectivity in data analysis and in the ranking of evidence via the preparation of evidence tables and facilitating consensus. ● Expert panels provide opportunities for public review and comments via the National Heart, Lung, and Blood Institute or a scheduled public forum. In summary, reliable, current, and trustworthy clinical practice guidelines should be based on a systematic literature review. The most valid research findings are identified and used to write or update the clinical guidelines. The quality, reliability, and validity of evidence determines if a particular patient intervention is warranted. The impact of guideline implementation on patient outcomes should be part of every healthcare organization’s quality improvement monitoring.
EBP can be successfully implemented only if all healthcare team members support the EBP model that guides practice in their organization and understand how to apply it to their practice.
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Book Code: AUS3024
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