Why bother with practice guidelines?

Abstract

Practice guidelines have garnered a great deal of attention in health care. Institutions, practice lines, professional organizations, specialty groups, and even advocacy groups are producing practice guidelines and promoting their use. Practice guideline development is a timeconsuming and sometimes daunting task. Aside from being trendy, why do we bother with practice guidelines? Practice guidelines were originally proposed as a way to standardize care across geographic boundaries. After all, nursing care should not differ from Alaska to Florida. Guidelines are especially useful for common diseases, such as asthma, or common problems, such as deep-vein thrombosis. The AHCPR series of guidelines is a good example. Guidelines such as these are usually developed from review of the evidence base as well as from expert consensus. These tools are helpful in guiding overall management, enhancing safety, minimizing unnecessary tests and treatments, and promoting cost and time savings. Care can be streamlined and standardized, and we can avoid re-inventing the proverbial wheel. The most important reason we have practice guidelines is to identify the standard of care. Guidelines say, “This is how it should be done.” In turn, guidelines serve as the benchmark to which we compare our practice. Another reason practice guidelines exist is to protect overlapping interests. Identifying responsibilities and scope of practice through guidelines serves to enhance collaboration in care and promote a multidisciplinary approach to difficult problems. This is particularly important in the most challenging of neuroscience problems. In order to develop practice guidelines, it is necessary to critically analyze our practice. We ask questions about how we do what we do, whether it is enough, whether it is safe, and whether it has a scientific basis. Such critical analysis improves quality of care, which in itself is worth the effort it takes to develop a guideline. Developing consensus also promotes communication and collaboration among professionals. To make guidelines useful, we must first understand why they exist. Second, we must use them. Guidelines that are not put into everyday practice are of no benefit. Third, we must critically analyze guidelines in use and update them when necessary. Changes in treatment options, new technology, and environmental changes all may prompt us to update practice guidelines, keeping in mind the reasons we have guidelines in the first place. Next, as nursing professionals, we must share the guidelines we develop as a way of promoting excellence in care. Consider sharing your practice guidelines with our readers. Know your professional organization’s practice guidelines, become involved in developing and revising them, and propose suggestions for new guidelines. You should find practice guidelines useful and not a bother at all.