Danish Nursing Society

Improving Nursing by Clinical Guidelines and Documentation. How to organize the work?

0Inge Madsen, RN, MI0President of the Danish Nursing Society

(DASYS), Denmark

0Vicechair, Centre of Clinical Guidelines 0– The Danish National Clearinghouse

Agenda

0Introduction to DASYS0Background for establishing Centre

for Clinical Guidelines.0How do we organize the work0Status0Future

Danish Nursing Society

An Umbrella Organization

Professionel organisationNot a unionAll working as volunteersSponsored 50% by the nurses

societies and 50% self- financing

BOARD

Nursing Documentation

Nursing Reseach

Nursing Education

Nursing Center of Evidence

Organisation

How did it all start?

2004: Grassroot

2005: We want at national Clearing House at the University

2008

0Studies from the US and the Netherlands show that 30-40% of patients do not receive treatement based on evidence.

020-25% of the treatments were unnecessary or even harmful

(Grimshaw JM, Eccles MP, MJA 2004)

Why nurses do not use research

0The volume of journal and article available are enormous

0Difficulties of accessing libraries 0Lack of skills to determine the quality and validity

of research0High quality studies are published in English0Qualification to synthesise evidence into explicit

recommendation0Have the time to do all this

Practice based on evidence

0 …practice based on evidence can decrease the uncertainty - that patients and clinicians experience in a complex health care system….

0 …Clinical guidelines are one way to improve quality of care …. As they aim to reduce inappropriate variations….

Clinical guidelines

0 …‘systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances’.

0 Institute of Medicine: Guidelines for Clinical Practice: 1993

How can they matter

0 By describing appropriate care based on the best available scientific evidence and broad consensus;

0 By providing a more rational basis for referral and use of resources;

0 By providing a focus for continuing education;0 By reducing inappropriate variation in practice; 0 By Acting as focus for quality control, including audit; 0 By highlighting shortcomings of existing literature

and suggest appropriate future research.

How can they matter

0 By describing appropriate care based on the best available scientific evidence and broad consensus;

0 By providing a more rational basis for referral and use of resources;

0 By providing a focus for continuing education;0 By reducing inappropriate variation in practice; 0 By Acting as focus for quality control, including audit; 0 By highlighting shortcomings of existing literature

and suggest appropriate future research.

How can they matter

0 By describing appropriate care based on the best available scientific evidence and broad consensus;

0 By providing a more rational basis for referral and use of resources;

0 By providing a focus for continuing education;0 By reducing inappropriate variation in practice; 0 By Acting as focus for quality control, including audit; 0 By highlighting shortcomings of existing literature

and suggest appropriate future research.

How can they matter

0 By describing appropriate care based on the best available scientific evidence and broad consensus;

0 By providing a more rational basis for referral and use of resources;

0 By providing a focus for continuing education;0 By reducing inappropriate variation in practice; 0 By Acting as focus for quality control, including audit; 0 By highlighting shortcomings of existing literature

and suggest appropriate future research.

How can they matter

0 By describing appropriate care based on the best available scientific evidence and broad consensus;

0 By providing a more rational basis for referral and use of resources;

0 By providing a focus for continuing education;0 By reducing inappropriate variation in practice; 0 By Acting as focus for quality control, including audit; 0 By highlighting shortcomings of existing literature

and suggest appropriate future research.

How can they matter

0 By describing appropriate care based on the best available scientific evidence and broad consensus;

0 By providing a more rational basis for referral and use of resources;

0 By providing a focus for continuing education;0 By reducing inappropriate variation in practice; 0 By Acting as focus for quality control, including audit; 0 By highlighting shortcomings of existing literature

and suggest appropriate future research.

Do Clinical Guidelines have an impact on outcome of care?

0Grimshaw 1993 - concluded that guidelines do improve clinical practice

0Thomas 1998 – concluded some evidence excist that care driven by a guideline can be effective

0Grimshaw 2006 - 86.6% of studies observed some kind of improvements in care

0Hakkennes 2008 - the effects were small but in favour of the intervention group

Why establish a clearinghouse in Denmark??

0 Guidelines of varying quality0 Guidelines with limited evidence0 Guidelines are seldom published0 Guidelines with different recommendations

within the same nursing diagnosis0 Inexpedient use of resources

Definition

0 A Clearinghouse is an organization to which nurses send their own developed clinical guidelines for approval. Once approved the guideline can be used anywhere – the guideline is cleared

0 To cleare a clinical guideline means that the ”house” ensures the quality of the guideline on the basis of scientific evidence, consistence and relevance.

0 A Clearinghouse is an organization which collects and asseses the quality, registers and promotes evidence based guidelines to be used by nurses in any clinical setting

Overall purpose of the Clearinghouse

We will join efforts to strengthen evindence-based nursing practice and increase the quality of nursing to patients.

Knowledge CompetanceTime

& Money

Aims (1)

0 To assess the quality (professionally and methodologically) of clinical guidelines in nursing

0 To establish and maintain a database of approved clinical guidelines in nursing

0 To communicate knowledge of existing clinical guidelines

0 To collaborate nationally and internationally on the development of clinical guidelines

Aims (2)

0 To select areas for future research

0 To initiate and be part of research activities nationally and internationally

0 To initiate and be part of educational activities to strengthen the quality and development of clinical guidelines

Principles of the organisation

0 Owned by the Danish Nursing Society0 Membership financed0 Management rooted0 Decentralised focus and initiative0 Central focus through research and new areas for

systematic review0 Development of competences in Danish nursing0 An annual documentation conference is held

to develop competences, to achieve consensus and to be updated

Danish Center for Clinical Guidelines0 Nursing0 …..0 ……

0Housed by the Department of Nursing Science, University of Aarhus

0Financing: DASYS, The Danish hospitals and University Collegees and Muncipalities

0Approval calls for: Best evidence and assessment on the basis of the Agree tool.

0Subjects: The 12 areas in the Danish Nursing Minimum Data Set (NMDS).

0Clearinghouse: Skilled in scientific methods, unbiased and the Guidelines are available online, FOR FREE USE.

Secretariat

Expert-grupExpert

gruppeExpertgruppeExpert

groups

Scientific council

Danish Nursing Society

Council for clinical guidelines

Counsel

0 Chair – appointed by DASYS0 Chair - DASYS0 Chair of the Scientific Board

0 Representatives from0 National Board of Health0 Hospitals0 University collegees0 Communities

ClearingHouse

Approval

No

Yes

New revision

Peerreview

N

Peerreview

Publication at the homepage

ClinicalGuideline

Yes

Has a guideline been madeor is there an ongoing process?

Public hearing on the webside

Competences of reviewers

0 Minimum master degree0 Review at least three guidelines each year0 Pass test

Status 4 years

015 approved clinical guidelines0107 recommendations0And a membership of Joanna

Briggs Institute

So now implementations…

Is our challenge!!! !!!

Mouth rinse before heart surgery

In the literature it is clearly demonstrated that mouth rinse twice a day for two days before elective heart surgery to one day after the surgical procedure reduce the number of patients developing respiratory tract infections and postoperative pneumonia with of more than 30%. 0 Pedersen, 2012

Interdisciplinary Databases

Conclusions

0 Evidence-based clinical guidelines can: 0 Reduce the delivery of inappropriate care 0 Support the introduction of new knowledge into clinical

practice 0 Support nursing documentation and the development of

standard nursing care plans 0 Support nurses in the clinical decision process in

collaboration with the patients.

Challenges

0 .. first of all to ensure that nurses have the needed competences to develop clinical guidelines and to develop indicators that are truly sensitive for nursing care…

We should work togetherin EU…

im@dasys.dkThanks for your attention!