Managing Policies, Procedures and Guidelines (PPG)Toolkit

Managing policies, procedures and guidelines (PPG) Toolkit

Creating the policies, procedures and guidelines of a Trust or network is an important means for securing consistent, safe and high quality care. Practice in the creation and management of these documents can be highly variable. In many cases arrangements for sharing in particular have been haphazard and left busy healthcare practitioners scrabbling for the current version.

Library & Knowledge Services (LKS) are bringing their skills and experience to bear right through the processes around these documents – from supporting the ongoing evidence requirements to providing a hosting platform and supporting effective retrieval.

This toolkit examines some of the ways that LKS teams are working in an embedded way around PPG and provides a wide range of examples of how your service might deepen its involvement.

The evidence base for this toolkit draws on

 Research articles from a search of the HDAS databases (MEDLINE, EMBASE, CINAHL, PsycINFO, AMED, British Nursing Index, HMIC and Health Business Elite)

 Hand searches of HLG Conferences back to 2008 and proceeds of a Guidelines Study Day - What’s new and the librarian’s role on 3rd November 2015 at Glenfield Hospital, Leicester.

 A survey of NHS LKS seeking examples of good practice.

Interviews were carried out to explore the best practice volunteered by LKS. A selection of case studies are presented that cover practical approaches and, where applicable, impact of the work.

Library involvement has been explored across three themes:

1. Literature Searching

2. Hosting/process management 3. Implementation/cultural shift

Good practice shown Setting More information Literature searching Clinical librarians carry out in depth searches which support York Teaching Hospitals guideline production Question the evidence base and quality of it Leeds Community Healthcare Review the date of the evidence used NHS Trust Proof reading and correction of documents (but not yet formatting of references) Profile raising for the library service Full literature searches for all guidelines Bridgewater Community Healthcare NHS Trust Literature searching Northamptonshire Healthcare Reference checking NHS Foundation Trust Clinical Librarian sits on Controlled Document Review Group. George Eliot Hospital NHS Trust Referencing checked for: Formatting and style Accuracy of web addresses and in text references Currency of evidence Critical omissions of relevant national guidelines. Proactive literature searches sent to authors of guidelines that will University Hospitals Coventry expire in a few months. and Warwickshire NHS Trust Librarian sitting on national guideline panels on ad hoc basis. National Jewish Health, Denver Librarian Contributions to Clinical Requirements defined in advance. CO, USA Practice Guidelines. Librarian involvement in searches (and reporting it), PRISMA flow Authors Cruse, Peggy; Protzko, Shandra charts. Medical Reference Services Quarterly; Jul Agree single citation management system. 2014; vol. 33 (no. 3); p. 327-334 Approaches to full text screening varies. Scoping search can determine what level of searching is required and what topics. Librarian involvement in guideline searches. Nottingham City Hospital Marriott, R. (1999), Providing library “several recommendations: support for the development of clinical guidelines. Health Libraries Review, 16: It is important to get involved from the outset. This makes it 132–134. doi:10.1046/j.1365- easier to define what you are capable of doing to assist the project 2532.1999.00210-3.x and what is outside your capability.

Establish clearly what is required from the literature search stage of the project—which databases are to be used, which limits applied and so on. Actively seek advice on keywords and search strategies if you are not completely confident about what you are searching for.

Clarify what actions are expected following the literature search stage. Some can be anticipated, such as the provision of full-text papers, but there may be other requirements, such as maintaining a master list of authors whose papers are requested, or critically appraising the abstracts retrieved by the literature search.

Keep a detailed list of costs associated with the project and agree what will be charged for from the outset and who will pay the bill.

Keep a detailed statistical record of how many references are retrieved by the initial literature search, how many articles are then requested in hard copy and how many of these are finally used in preparation of the guidelines. These data will be useful when writing up the methodology stage of the project.

Supplementary searches may be necessary during the life of the project, both on additional keywords and to update the project, as from inception to publication could easily take 18 months-2 years.

In any project in which there are many subgroups who may want access to the same papers, encourage them to collaborate in exchanging information.” “NLM librarians developed search strategies, conducted NLM Marjorie A. Cahn Practice guidelines: a literature searches, prepared bibliographic databases, and piece of the quality puzzle Bull Med Libr provided document delivery for the first thirteen AHCPR- Assoc 82(3) July 1994 sponsored guideline panels. Since 1993, NLM has moved into a consulting role, helping panels link up with local National Network of Libraries of Medicine (NN/LM) member libraries to obtain the bulk of these services. NLM staff members also have prepared several documents useful to the development and dissemination of practice guidelines. These documents include a manual on practice guideline literature search methods, a bibliography of practice guidelines for January 1985 through December 1992, a bibliography on the techniques of meta- analysis, and a guide to sources of literature useful for health services research [9-12]. The latter three publications are available from NLM's Publications server through file transfer protocol (FTP), as well as in print format.”

Hosting/Process Management Policy intranet pages made user friendly George Eliot Hospital NHS Trust Library responsible for maintaining and archiving policy repository Birmingham Community Healthcare NHS Foundation Trust System automated through Library Management System Great Western Hospitals NHS (Heritage) including reminders Foundation Trust Librarians sit on PPG development and approval committees Blackpool Teaching Hospital A Policy Co-ordinator (to manage process and ensures all PPGs NHS Foundation Trust are kept up to date) SharePoint (intranet Document Library)

Attending the Clinical Guidelines group Northamptonshire Healthcare Improving the naming conventions of the documents. NHS Foundation Trust Raises the profile of the ‘value added’ aspects of the service and also contributes directly to an improvement in the quality of patient care.

Knowledge and Library Service (KLS) designed Cheshire and Wirral Partnership Knowledge Taxonomy Intranet website to store policies Electronic process to approve polices KLS also tag the policies. Library has responsibility for publishing corporate documents. University Hospitals Coventry and Warwickshire NHS Trust Impact in terms of the visibility of the service as a silo buster Royal Brompton & Harefield around information. NHS Foundation Trust Single search solution for OPAC, innovations database and Staff publications, which will replace current external solution, which should be lower cost for the Trust once development work is complete. Library owns and manages the system for storing and accessing Derby Teaching Hospitals NHS PPGs (this needs to be costed into business plans). Foundation Trust Hosting of PPGs on Koha means they can be accessed offsite, Using Open Source Software to Manage which also reduces FOI requests Policies and Clinical Guidelines Library uploads guideline documents to intranet and shared drive. (Presentation to Guidelines study Day Monitors expiring documents. 2015 by Trudi Wright) Documents catalogued on LMS (Koha)

Library sole publisher of documents United Lincolnshire Hospitals Supporting your trust’s guidelines and Designed process policies - Evidence search (Presentation to Guidelines study Day Incorporated into Trust policies 2015 by Richard Bridgen) Enhanced meta-data Quality assurance – Checklist / Style Final document to approver Publish Implementation/cultural shift Working with Policy leads or content specialists to developing Berkshire Healthcare NHS interactive e-learning packages linked to the policies. Foundation Trust To support sharing guidelines across organisational boundaries, encourage local authors to use Creative Commons. Clinical Librarian is a full and active member of Policies and University Hospitals of Leicester Guidelines Committee. NHS Trust Training is offered. Major project to ensure findability of Trust guidelines. Special module written for SharePoint. Clinical Librarian advises on titles to assist findability. Staff were aware of location of policies during Care Quality Commission visit. Currency of PPG now Performance indicator throughout the Trust. Clinical Outcomes and Effectiveness department now funds Clinical Librarian on a bank basis App planned in future Oxford University Hospitals NHS Engaged on the PPG committee and included in the guidance for Trust See also who to speak to. Keating, L., Carter, H., Darwent, M., Clear acceptance of the importance of good references with a KPI Bateman, S., Mackay, D. M. and of 100% acceptable references (meaning current). Pullinger, R. (2004), Partnership working in the production of clinical guidelines. Health Information & Libraries Journal, 21: 46–51. doi:10.1111/j.1740- 3324.2004.00495.x Mobile app designed with human factors expert, focus groups of Nottingham University Hospitals Improving accessibility to clinical staff, and critical incident technique. NHS Trust guidelines – NUH Guidelines app “Remember who you are designing it for and how they normally (Presentation to Guidelines study Day access guidelines” 2015 by Adrian Kwa) “Clinical input essential for successful implementation” “Consider breaking up “Do-It-All” guidelines” “Use concise and relevant guideline titles” “Beware of the wall of words” “BCGP guidelines, based on national guidance but – ‘recipe’, Bedside Clinical Guidelines Bringing consistency to clinical practice more direct and relevant to point of care Partnership 1996-2015 cross referenced to other guidelines which may have (Presentation to Guidelines study Day national guidance e.g. oxygen and COPD or not e.g. IV fluids 2015 by Naveed Mustfa) ‘recipe for all courses of a meal’ rather than a ‘single dish’ Jamie Oliver 30 minute approach ‘missing link’ between national society guidelines and practical clinical care at the point of delivery” Standard headings Monthly alerts; Librarian flags new key evidence and editors decide if early review needed. Searches. On intranet and A5 cards on trolleys and given to doctors. Usage audited Involve local opinion leaders Training in use of guidelines The Netherlands, France, the Flodgren G, Hall AM, Goulding L, Eccles Memorandum Pocket Card USA and Canada MP, Grimshaw JM, Leng GC, Shepperd S. Detail sheet with treatment recommendations Tools developed and disseminated by Printed educational materials guideline producers to promote the uptake of their guidelines. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD010669. DOI: 10.1002/14651858.CD010669.pub2. There are eight steps: Australia Turner, Tari; Harris, Claire; Green, Sally. (1) Scope the guideline. A pragmatic model for evidence-based (2) Prioritise what areas to focus on. guideline development in hospitals. (3) Search for evidence. Clinical Governance: An International (4) Appraise the evidence. Journal; Dec 2010; vol. 15 (no. 4); p. 255- (5) Draft the guideline. 265 (6) Consult with relevant colleagues. (7) Disseminate. (8) Update as necessary.