Managing and Implementing Protocols

25 Pages·2012·1 MB·English

by  Gillian Brunier

Managing and
implementing protocols
Gillian Brunier RN(EC), MScN, CNeph(C),
Nurse Practitioner Nephrology,
Sunnybrook Health Sciences Centre, Toronto, Ontario,
Canada
Objectives

1. Differentiate between protocols and practice
guidelines
2. Discuss how to establish protocols
3. Review how to evaluate protocols
What is a medical protocol?

 a detailed written set of instructions
to guide the care of a patient or to
assist the practitioner in the
performance of a procedure.

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh
Edition. © 2003 by Saunders, an imprint of Elsevier, Inc.
Similarities between clinical
practice guidelines and protocols
 Protocols:
 Guidelines:
◦ Guide decisions
◦ Guide decisions
◦ Based on current
◦ Based on current
evidence-based
evidence-based
management
management
strategies
strategies

Kohr, L. & Hravnak, M. (2001). Clinical

practice guidelines and protocols guide

decisions. AACN News, 18(3).
Differences between clinical
practice guidelines and protocols
 Guidelines:  Protocols:
◦ Are flexible ◦ Are more rigid
◦ Are easily modified to ◦ Define a specific
patient needs management plan
◦ Can be adapted ◦ Leave little room for
within a large variety adjustment
of settings
◦ Reflect regional or
institutional practices

Kohr, L. & Hravnak, M. (2001). Clinical practice
guidelines and protocols guide decisions.
AACN News, 18(3).
Treatment protocol
 For treating (or preventing) a particular
ailment
◦ Peritonitis
◦ PD catheter exit-site infection
More on the topic… a caveat
 Evidence-based clinical guidance documents are
heterogeneous, as is the terminology utilized to
describe and/or label them.

 The phrases "guideline," "protocol," "practice
parameter," "pathway," "standard," etc., are used
in many different contexts by different guideline
developers.

(National Guideline Clearinghouse www.guideline.gov/faq.aspx)
How to establish a protocol
 e.g. Insertion of a PD catheter
◦ Form a multi-disciplinary group
◦ Review the literature:
 published clinical guidelines
 published best practices
◦ Write up a protocol
◦ Obtain approval
◦ Implement the protocol
◦ Evaluate the protocol
◦ Plan for updating

Brunier, G. et al. (2010). A change to radiological peritoneal dialysis catheter insertion: Three-
month outcomes. PDI, 30, 528-533.
Resources
Organization Latest Title Website
update
University Health 2012 UHN Division of www.nephrology.utoronto.ca
Network, Division nephrology:
of Nephrology Housestaff/NP www.ukidney.com/
(Toronto, Canada) guidebook
Canadian Society 2011 CSN Clinical www.csnscn.ca
of Nephrology Practice
(CSN) Guidelines
International 2010 1. Peritoneal www.pdiconnect.com/cgi/reprint
Society of dialysis related /30/4/393
Peritoneal Dialysis infections
(ISPD) 2. Peritoneal
access
The Renal 2009/10 1. Peritoneal www.renal.org/clinical/Guideline
Association (UK) dialysis sSection/Guidelines.aspx
2. Peritoneal
access
NKF KDOQI (US) 2006 Peritoneal dialysis www.kidney.org/professionals/k
adequacy doqi/guideline/
Grading of evidence
Ia systematic review or meta-analysis of RCTs*
Ib at least one RCT*
IIa at least one well-designed controlled study without
randomisation
IIb at least one well-designed quasi-experimental study,
such as a cohort study
III well-designed non-experimental descriptive studies, such
as comparative studies, correlation studies, case-control
studies and case series.
IV expert committee reports, opinions and/or clinical
experience of respected authorities
* RCT = Randomized Controlled Trial
From: www.patient.co.uk/doctor/Different-Levels-of-Evidence-%28Critical Reading%29.htm