KNH Clinical Practice Guidelines

Adaptation Methodology
Jhessie L. Abella, RN, RM, MAN, CPSO, SMRIN
Clinical Practice Guidelines

• Clinical guidelines are consensus statements developed to assist in

clinical management decisions.
• Are sponsored or supported by professional associations or
societies, public or private organizations, government agencies,
etc., and include evidence if modified to meet the population
served
• CPG’s are developed on the focus of quality, based on scientific
evidence and the assessment of likely benefits and harms of a
particular treatment
WHAT IS THE
IMPORTANCE OF
CPGs?
CPG’s guide practitioners with:

 Questions to ask and physical signs to check

 Lab and other studies to request
 Assessments of the condition
 Treatments to prescribe
 Improve healthcare decision making
HOW CAN WE
INTEGRATE
GUIDELINES IN OUR
HOSPITAL SYSTEM?
 Types of implementation tools used to integrate
guidelines into daily practice and into the patient
care system are:
 Clinical pathways/critical pathway/care maps
 Clinical protocols
 Standardized order sets
 Process flow charts
 These tools often include automatic triggers for
care according to the guidelines
DO WE HAVE
EXISTING CPGs
in the Hospital?
HOW DID WE
PRIORITIZE OUR
CLINICAL PRACTICE
GUIDELINES?
Criteria for Choosing CPG at KNH

 The prevalence of the condition and/or burden associated with the condition
 Existence of underuse, overuse or misuse of interventions
 The likelihood that the guideline will be effective in influencing practice
 The existence of relevant good quality evidence-based guidelines
 PERIPHERAL MYTHEMIA
CRITERIA STROKE POLYNEUROPATHY
NEURITIS GRAVIS

The prevalence of the condition and/or

burden associated with the condition 5 3 4 2

Existence of underuse, overuse or misuse

of interventions 5 3 4 3
The likelihood that the guideline will be
effective in influencing practice 5 4 3 4
The existence of relevant good quality
evidence-based guidelines 5 5 5 4
SUM 20 15 16 13
DEVELOPED OR
ADAPTED?
Guideline Adaptation

• Guideline adaptation is the systematic approach to the

endorsement and/or modification of a guideline(s)
produced in one cultural and organizational setting for
application in a different context. Adaptation may be
used as an alternative to de novo guideline development,
e.g., for customizing (an) existing guideline(s) to suit the
local contents
ADAPTE Guideline Adaption

 Is an international collaboration of researchers, guideline

developers, and guideline implementers who aim to
promote the development and use of CPGs through the
adaptation of existing guidelines.
 Our institutional CPG policy is solely based on this toolkit
developed by ADAPTE collaboration.
ADAPTE - a systematic approach to
guideline adaptation

Why develop a systematic approach ?

 Help ensure the quality and validity of the adapted guideline
 Enhance relevance of adapted guideline to the context of use
 Encourage confidence in and acceptance of the guidelines by
targeted users
ADAPTE PROCESS
 ADAPTE process
 Target audience
 Guideline developers, health care professionals and decision makers
 Groups from local to international level
 Manual takes into account level of experience with guideline development and available
resources

 Applications
 Groups interested in selecting 1 cpg and adapting it to the local context
 Groups wishing to identify all high quality guidelines and customize one that meets their needs
 Manual designed to be flexible

 Scope
 CPGs of any disease area
 Screening, diagnosis, treatment, supportive care, health promotion

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THE SET UP PHASE
ADAPTATION PHASE
 Adaptation Phase
Scope and Purpose Module

PIPOH
Patient population and disease
characteristics
Intervention (s) of interest
Professionals targeted by the guideline
Outcomes and endpoints to be taken into
consideration
Healthcare setting and context
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ADAPTATION PHASE
Appraisal of Guidelines Research &
Evaluation (AGREE 2 INTRUMENT)

 Was developed to address the issue of variability in guideline

quality. To that end, the AGREE instrument is a tool that assesses
the methodological rigour and transparency in which a guideline is
developed.
 Domain 1. Scope and Purpose
 Domain 2. Stakeholder Involvement
 Domain 3. Rigour of Development
 Domain 4. Clarity of Presentation
 Domain 5. Applicability
 Domain 6. Editorial Independence
ASSESSMENT PHASE
ADAPATATION PHASE
ADAPATATION PHASE
FINALIZATION PHASE