Developing Effective Protocols

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Developing Effective Protocols

• Jean Robson
• Associate Adviser in CPD
• West Region

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Guideline

• A guideline is a group of systematic statements
  developed to assist decisions by practitioners
  and patients about appropriate healthcare for
  specific clinical circumstances (Field and Lohr
  1990), aiming to bridge the gap between
  evidence-based research and clinical medicine,
  and standardizing care (Heidrich et al. 2005).

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Protocol

• Draft of the terms agreed upon and signed by
  the parties, for use as the basis of a formal
  treaty".
• In practical terms what we mean is the way in
  which an organization or group seeks to ensure
  that best practice or guidance is followed within
  their organization or group.

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• So when developing a protocol we need

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• When do we need protocols?

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When do we need protocols?

• When it is important to do something
• Consequences of not doing it are significant
• We are not doing it now
• Will usually involve a number of people
• Therefore a topic where there is potential for
  CHANGE.

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• Toytown OOHs Paediatric Asthma Protocol
• All children referred by NHS 24 with wheeze
  should be seen within 15 minutes of arrival by a
  clinician.
• Assessment and treatment should be as the SIGN
  document (attached)
• All patients meeting the criteria for acute
  severe asthma should be referred to the
  paediatrician on call.
• All parents of patients discharged from the
  service, should be sent home with advice on
  indications for a return visit.
• All parents of patients discharged from the
  service, should be asked to see their own GP
  within 48 hours.

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• What should Mary P have found out before starting
  to write her protocol?

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We need to know

• Current practice
•  
• Best Practice

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Current Practice
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Best Practice

• SIGN for management and assessment
• PHEC guidance
• APLS guidance
• SIGN guidance on the immediate discharge
  document
• SIGN guidance of the referral document
• QIS standards
•  

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• What factors will increase the changes of a
  protocol being successful?

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Improving the chances of success

• INVOLVEMENT of all groups that will use it / be
  affected by it.
• Consider MOTIVATION of each group using it
• Use a FORMAT that can be used where when and by
  whom it is needed.
• In a form which is easy to use.
• Consider BARRIERS motivation, knowledge,
  skills, equipment, time, costs 

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• How will you know it is working?

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How we know it works

• Audit

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• Dont forget a review date

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• How can we help Mary P?

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• Investigate current situation
• Define best practice
• Involve representatives from all professionals
  involved
• Barriers to change addressed- knowledge, skills,
  equipment, time
• Motivated staff
• Draw up a protocol in a form that can be accessed
  when and where it was needed
• Monitoring plan agreed
• Review date agreed.

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Criteria for Effective protocol Development

• Topic chosen where there is potential for
  improvement
• Current situation is understood
• Best practice is defined
• Barriers to change are considered and each
  addressed (intellectual , training, resource)
• Motivation of all personnel involved is addressed
• Format appropriate to the situation (paper/
  electronic etc.)
• Monitoring of protocol occurs
• Date set for review of protocol contents

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Developing Effective Protocols

• Thank you for participating