Research Appraisal of a Clinical Practice Guideline
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Is Clinical Practice Guideline taken seriously in this age of advanced medical technologies?
With the advent of new technologies in the health sector, the needs of health care have kept pace with the new technology. A growing patient numbers, growing dimensions of disease and emerging disease, no doubt forcing the health care professionals to run after the development of new drugs and technologies for combat. At the same time, patient safety and quality health care delivery are buzzing priority for every country and every health care organization. One of the promoting factors for achievement of patient safety and quality health care is attributed by infection control as well as prevention. According to a recent report, 200000 healthcare associated infections occur in acute health care settings in Australia (Doyle, 2011) .The number implies the graveness of the situation. The effects of these infections are – pain to patients, suffering to the patients and, prolong stay in the hospital and more costs to the patients as well as to the health care department. The suffering is not limited to the patients; it can impact upon all those who enter the hospital settings. A major part of this infection related suffering is shared by unhygienic practice like hand wash or hand hygiene. The fact looks much general, but is missed by most health care professionals due to negligence thus leading to infection and complicacies. The issue is preventable rather than unpredictable, which has led to the framing of guidelines with regard to hand hygiene, or washing of hands from different health care organizations globally. It is essential to review this guideline in order to understand its relevance in infection control and prevention. The current research report will focus upon hand hygiene guideline under the Australian guideline for prevention of control and guideline for healthcare and a critical evaluation will be carried out AGREE (II) Appraisal of Guidelines for research and evaluation. The critical evaluation will encompass 6 domains for evaluation of hand hygiene guideline. The second part of the assignment will focus upon change required in the guideline through implementation of Lewin model. The change strategy will accompany stakeholders and reviews from committees or teams in order to justify the change. The main objective of the assignment is to look into the guideline in an unbiased way in order to evaluate and frame a robust strategy having practical implementation in a clinical scenario (Owens, 2010).
As per above framework, the guidelines for hand hygiene will be evaluated on the 6 domains of AGREE (II) Appraisal of Guidelines for research and evaluation (Dans, 2010).
SCOPE AND PURPOSE
The scope and purpose of the above guideline have been stated clearly at starting saying this is intended for health care professionals and healthcare organization in order to frame a nationalized approach towards infection control and prevention. As it can be seen in their scope, readers could easily understand the guidelines are intended for health care providers and health care organizations to develop their own guidelines, processes and protocols in order to address infection control and prevention. The purpose of this guideline was not to act as reference for practice rather as a platform to build practice guidelines. The guidelines seem to have wide scope and can serve the purpose of infection control at many settings such as home based service, rural setting, home and community settings, etc. Readers and evaluators can also keep a note, the guidelines are based upon evidence based literatures especially drawn from the acute care settings and risk management strategies for infection transmission control. The merit of this guidelines lies in its acceptance of limitation such as a grading system in infection control.
The guideline development and framing process should involve stakeholders concerned with health care fields as they have varied experiences which they have gained through working with a different organization’s as well as own experience in working with different hospital settings. The stakeholder group or bunch of stakeholders who participated or contributed valuable inputs to the guideline development justifies such national level guideline development. The stakeholder forum was formed in 2008 at three places by NHMRC, which implies their seriousness in developing a nationalized guideline. The recipe was perfect for such guideline development as they include persons from health care settings, health care funders, medical device industries and government and private agencies. The inputs from such an expertise guild can definitely manifest such robust guideline which can meet any international criteria as far as Hand wash is concerned (Rosse, 2002). The developers of such guidelines didn’t mention whether they have involved any nursing manager or leaders in their stakeholder forum, as they form the end dispensers as far as the hand was as a hygienic practice is concerned. The guideline was complemented with valuable feedback from such an expertise forum along with feedback on old 2004 guidelines. Thus the guideline developed meets the criteria of stakeholder involvement, which forms an important process (Brouwers M. C., 2010).
RIGOUR/ROBUSTNESS IN DEVELOPMENT
Any guideline or regulations which has to be implemented at a nationalized scale or form the base of principles and process for nationwide health care organisation, the robustness and the vigorous process of development can be imagined (Brouwers M. C., 2010). The NHMRC guideline developed especially with regard to Hand wash and hygiene have also been developed based on same robust process. As already mentioned, every guideline requires the scope and purpose to be established first which helps in further process development (development of guidelines and process involved). The first section was focused upon to whom this guideline should be addressed. The first section pointed out the guidelines was meant for clinical staff’s, health care professionals and health care administrators in the establishment of the protocols and guidelines for acute care setting, home based health care, rural and community based health care and long term care setting To make these guidelines universal three considerations are made such as transmission of infection process, risk management strategies, and governance procedures for its implementation. The scope is evident from the content under Hand hygiene, which explains scientifically and clinically with proper reference what is hand hygiene, the types of risks involved (NHMRC, 2010). The period when hand hygiene steps should be performed, the product to be used etc. All these sections are well referenced from WHO 2009 guidelines, other internationally acclaimed guidelines and procedures. These contents clearly implies that the guidelines are meant for clinical staff’s as well as clinical administrators (Brouwers M. C., 2010).
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