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 guideline production / York Teaching Hospitals /
Question the evidence base and quality of it
Review the date of the evidence used
Proof reading and correction of documents (but not yet formatting of references)
Profile raising for the library service / Leeds Community Healthcare NHS Trust /
Full literature searches for all guidelines / Bridgewater Community Healthcare NHS Trust /
Literature searching
Reference checking / Northamptonshire Healthcare NHS Foundation Trust /
Clinical Librarian sits on Controlled Document Review Group.
Referencing checked for:
Formatting and style
Accuracy of web addresses and in text references
Currency of evidence
Critical omissions of relevant national guidelines. / George Eliot Hospital NHS Trust /
Proactive literature searches sent to authors of guidelines that will expire in a few months. / University Hospitals Coventry and Warwickshire NHS Trust /
Librarian sitting on national guideline panels on ad hoc basis. Requirements defined in advance.
Librarian involvement in searches (and reporting it), PRISMA flow charts.
Agree single citation management system.
Approaches to full text screening varies. Scoping search can determine what level of searching is required and what topics. / National Jewish Health, Denver CO, USA / Librarian Contributions to Clinical Practice Guidelines.
Authors Cruse, Peggy; Protzko, Shandra
Medical Reference Services Quarterly; Jul 2014; vol. 33 (no. 3); p. 327-334
Librarian involvement in guideline searches.
“several recommendations:
It is important to get involved from the outset. This makes it easier to define what you are capable of doing to assist the project 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.” / Nottingham City Hospital / Marriott, R. (1999), Providing library support for the development of clinical guidelines. Health Libraries Review, 16: 132–134. doi:10.1046/j.1365-2532.1999.00210-3.x
“NLM librarians developed search strategies, conducted literature searches, prepared bibliographic databases, and provided document delivery for the first thirteen AHCPR-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.” / NLM / Marjorie A. CahnPractice guidelines: a piece of the quality puzzle Bull Med Libr Assoc 82(3) July 1994
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 (Heritage) including reminders / Great Western Hospitals NHS Foundation Trust /
Librarians sit on PPG development and approval committees
A Policy Co-ordinator (to manage process and ensures all PPGs are kept up to date)
SharePoint (intranet Document Library) / Blackpool Teaching Hospital NHS Foundation Trust /
Attending the Clinical Guidelines group
Improving the naming conventions of the documents.
Raises the profile of the ‘value added’ aspects of the service and also contributes directly to an improvement in the quality of patient care. / Northamptonshire Healthcare NHS Foundation Trust /
Knowledge and Library Service (KLS) designed
Knowledge Taxonomy
Intranet website to store policies
Electronic process to approve polices
KLS also tag the policies. / Cheshire and Wirral Partnership /
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 around information.
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. / Royal Brompton & Harefield NHS Foundation Trust /
Library owns and manages the system for storing and accessing PPGs (this needs to be costed into business plans).
Hosting of PPGs on Koha means they can be accessed offsite, which also reduces FOI requests
Library uploads guideline documents to intranet and shared drive. Monitors expiring documents.
Documents catalogued on LMS (Koha) / Derby Teaching Hospitals NHS Foundation Trust /
Using Open Source Software to Manage Policies and Clinical Guidelines
(Presentation to Guidelines study Day 2015 by Trudi Wright)
Library sole publisher of documents
Designed process
Evidence search
Incorporated into Trust policies
Enhanced meta-data
Quality assurance – Checklist / Style
Final document to approver
Publish / United Lincolnshire Hospitals / Supporting your trust’s guidelines and policies-
(Presentation to Guidelines study Day 2015 by Richard Bridgen)
Implementation/cultural shift
Working with Policy leads or content specialists to developing interactive e-learning packages linked to the policies.
To support sharing guidelines across organisational boundaries, encourage local authors to use Creative Commons. / Berkshire Healthcare NHS Foundation Trust /
Clinical Librarian is a full and active member of Policies and Guidelines Committee.
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 / University Hospitals of Leicester NHS Trust /
App planned in future
Engaged on the PPG committee and included in the guidance for who to speak to.
Clear acceptance of the importance of good references with a KPI of 100% acceptable references (meaning current). / Oxford University Hospitals NHS Trust /
See also
Keating, L., Carter, H., Darwent, M., Bateman, S., Mackay, D. M. and 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 staff, and critical incident technique.
“Remember who you are designing it for and how they normally access guidelines”
“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” / Nottingham University Hospitals NHS Trust / Improving accessibility to clinical guidelines – NUH Guidelines app
(Presentation to Guidelines study Day 2015 by Adrian Kwa)
“BCGP guidelines, based on national guidance but – ‘recipe’, more direct and relevant to point of care
cross referenced to other guidelines which may have
national guidance e.g. oxygen and COPD or not e.g. IV fluids
‘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 / Bedside Clinical Guidelines Partnership / Bringing consistency to clinical practice 1996-2015
(Presentation to Guidelines study Day 2015 by Naveed Mustfa)
Training in use of guidelines
Memorandum Pocket Card
Detail sheet with treatment recommendations
Printed educational materials / The Netherlands, France, the USA and Canada / Flodgren G, Hall AM, Goulding L, Eccles MP, Grimshaw JM, Leng GC, Shepperd S. Tools developed and disseminated by 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:
(1) Scope the guideline.
(2) Prioritise what areas to focus on.
(3) Search for evidence.
(4) Appraise the evidence.
(5) Draft the guideline.
(6) Consult with relevant colleagues.
(7) Disseminate.
(8) Update as necessary. / Australia / Turner, Tari; Harris, Claire; Green, Sally.A pragmatic model for evidence-based guideline development in hospitals.
Clinical Governance: An International Journal; Dec 2010; vol. 15 (no. 4); p. 255-265