1. Danish Nursing Society Improving Nursing by Clinical Guidelines and Documentation. How to organize the work?

2. 0 Inge Madsen 0 Inge Madsen, RN, MI 0 President of the Danish Nursing Society (DASYS), Denmark 0 Vicechair, Centre of Clinical Guidelines 0 – The Danish National Clearinghouse

3. Agenda 0 Introduction to DASYS 0 Background for establishing Centre for Clinical Guidelines. 0 How do we organize the work 0 Status 0 Future

4. Danish Nursing Society An Umbrella Organization  Professionel organisation  Not a union  All working as volunteers  Sponsored 50% by the nurses societies and 50% self- financing

5. Organisation

6. How did it all start?

7. 2004: Grassroot 2005: We want at national Clearing House at the University 2008

8. 0 Studies from the US and the Netherlands show that 30-40% of patients do not receive treatement based on evidence. 0 20-25% of the treatments were unnecessary or even harmful (Grimshaw JM, Eccles MP, MJA 2004)

9. Why nurses do not use research 0 The volume of journal and article available are enormous 0 Difficulties of accessing libraries 0 Lack of skills to determine the quality and validity of research 0 High quality studies are published in English 0 Qualification to synthesise evidence into explicit recommendation 0 Have the time to do all this

10. Practice based on evidence 0 …practice based on evidence can decrease the uncertainty - that patients and clinicians experience in a complex health care system…. 0 …Clinical guidelines are one way to improve quality of care …. As they aim to reduce inappropriate variations….

11. Clinical guidelines 0 …‘systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances’. 0 Institute of Medicine: Guidelines for Clinical Practice: 1993

12. How can they matter 0 By describing appropriate care based on the best available scientific evidence and broad consensus; 0 By providing a more rational basis for referral and use of resources; 0 By providing a focus for continuing education; 0 By reducing inappropriate variation in practice; 0 By Acting as focus for quality control, including audit; 0 By highlighting shortcomings of existing literature and suggest appropriate future research.

13. How can they matter 0 By describing appropriate care based on the best available scientific evidence and broad consensus; 0 By providing a more rational basis for referral and use of resources; 0 By providing a focus for continuing education; 0 By reducing inappropriate variation in practice; 0 By Acting as focus for quality control, including audit; 0 By highlighting shortcomings of existing literature and suggest appropriate future research.

14. How can they matter 0 By describing appropriate care based on the best available scientific evidence and broad consensus; 0 By providing a more rational basis for referral and use of resources; 0 By providing a focus for continuing education; 0 By reducing inappropriate variation in practice; 0 By Acting as focus for quality control, including audit; 0 By highlighting shortcomings of existing literature and suggest appropriate future research.

15. How can they matter 0 By describing appropriate care based on the best available scientific evidence and broad consensus; 0 By providing a more rational basis for referral and use of resources; 0 By providing a focus for continuing education; 0 By reducing inappropriate variation in practice; 0 By Acting as focus for quality control, including audit; 0 By highlighting shortcomings of existing literature and suggest appropriate future research.

16. How can they matter 0 By describing appropriate care based on the best available scientific evidence and broad consensus; 0 By providing a more rational basis for referral and use of resources; 0 By providing a focus for continuing education; 0 By reducing inappropriate variation in practice; 0 By Acting as focus for quality control, including audit; 0 By highlighting shortcomings of existing literature and suggest appropriate future research.

17. How can they matter 0 By describing appropriate care based on the best available scientific evidence and broad consensus; 0 By providing a more rational basis for referral and use of resources; 0 By providing a focus for continuing education; 0 By reducing inappropriate variation in practice; 0 By Acting as focus for quality control, including audit; 0 By highlighting shortcomings of existing literature and suggest appropriate future research.

18. Do Clinical Guidelines have an impact on outcome of care? 0 Grimshaw 1993 - concluded that guidelines do improve clinical practice 0 Thomas 1998 – concluded some evidence excist that care driven by a guideline can be effective 0 Grimshaw 2006 - 86.6% of studies observed some kind of improvements in care 0 Hakkennes 2008 - the effects were small but in favour of the intervention group

19. Why establish a clearinghouse in Denmark?? 0 Guidelines of varying quality 0 Guidelines with limited evidence 0 Guidelines are seldom published 0 Guidelines with different recommendations within the same nursing diagnosis 0 Inexpedient use of resources

20. Definition 0 A Clearinghouse is an organization to which nurses send their own developed clinical guidelines for approval. Once approved the guideline can be used anywhere – the guideline is cleared 0 To cleare a clinical guideline means that the ”house” ensures the quality of the guideline on the basis of scientific evidence, consistence and relevance. 0 A Clearinghouse is an organization which collects and asseses the quality, registers and promotes evidence based guidelines to be used by nurses in any clinical setting

21. Overall purpose of the Clearinghouse We will join efforts to strengthen evindence-based nursing practice and increase the quality of nursing to patients. KnowledgeCompetance Time & Money

22. Aims (1) 0 To assess the quality (professionally and methodologically) of clinical guidelines in nursing 0 To establish and maintain a database of approved clinical guidelines in nursing 0 To communicate knowledge of existing clinical guidelines 0 To collaborate nationally and internationally on the development of clinical guidelines

23. Aims (2) 0 To select areas for future research 0 To initiate and be part of research activities nationally and internationally 0 To initiate and be part of educational activities to strengthen the quality and development of clinical guidelines

24. Principles of the organisation 0 Owned by the Danish Nursing Society 0 Membership financed 0 Management rooted 0 Decentralised focus and initiative 0 Central focus through research and new areas for systematic review 0 Development of competences in Danish nursing 0 An annual documentation conference is held to develop competences, to achieve consensus and to be updated

25. Danish Center for Clinical Guidelines 0 Nursing 0 ….. 0 ……

26. 0 Housed by the Department of Nursing Science, University of Aarhus 0 Financing: DASYS, The Danish hospitals and University Collegees and Muncipalities

27. 0 Approval calls for: Best evidence and assessment on the basis of the Agree tool. 0 Subjects: The 12 areas in the Danish Nursing Minimum Data Set (NMDS). 0 Clearinghouse: Skilled in scientific methods, unbiased and the Guidelines are available online, FOR FREE USE.

29. Secretariat Expert- grup Expert gruppe Expert gruppe Expert groups Scientific council Danish Nursing Society Council for clinical guidelines

30. Counsel 0 Chair – appointed by DASYS 0 Chair - DASYS 0 Chair of the Scientific Board 0 Representatives from 0 National Board of Health 0 Hospitals 0 University collegees 0 Communities

31. Clearing House Approval No Yes New revision Peer review N Peer review Publication at the homepage Clinical Guideline Yes Has a guideline been made or is there an ongoing process? Public hearing on the webside

32. Competences of reviewers 0 Minimum master degree 0 Review at least three guidelines each year 0 Pass test

33. Status 4 years 0 15 approved clinical guidelines 0 107 recommendations 0 And a membership of Joanna Briggs Institute

34. So now implementations… Is our challenge!!! !!!

35. Mouth rinse before heart surgery In the literature it is clearly demonstrated that mouth rinse twice a day for two days before elective heart surgery to one day after the surgical procedure reduce the number of patients developing respiratory tract infections and postoperative pneumonia with of more than 30%. 0 Pedersen, 2012

36. Interdisciplinary Databases

37. Conclusions 0 Evidence-based clinical guidelines can: 0 Reduce the delivery of inappropriate care 0 Support the introduction of new knowledge into clinical practice 0 Support nursing documentation and the development of standard nursing care plans 0 Support nurses in the clinical decision process in collaboration with the patients.

38. Challenges 0.. first of all to ensure that nurses have the needed competences to develop clinical guidelines and to develop indicators that are truly sensitive for nursing care…

39. We should work together in EU…

40. im@dasys.dk Thanks for your attention!