DEVELOPMENT OF CLINICAL STANDARDS IN SCOTLAND
9. DEVELOPMENT OF CLINICAL STANDARDS IN SCOTLAND
In Scotland, the development of Clinical Standards has been undertaken by the NHS Quality Improvement Scotland (www.nhshealthquality.org) are sub- ject to audit by means of an internal self-assessment followed by external review. This process aims to increase and promote greater public confidence in the overall standard of care (Steel, 2001).
Standards represent an agreed level of performance and this level should be determined by those who are involved in delivery or receipt of the service. The criteria attached to each standard provide more detailed and practical informa- tion on how to achieve the standard and can be described as structure, process, and outcome criteria. These standards focus on the patient journey, the care and treatment the patient receives, and relate very closely to patient outcome; are underpinned by evidence base; may be specific or generic; and are cate- gorised as being desirable or essential (Steel, 2001). An evaluation of national performance against healthcare acquired infection standards has recently been published (www.nhshealthquality.org). The methodology adopted in develop- ing these standards is worthy of greater attention and should form the core
UK Guidelines: Methodology and Standards of Care
31 principles of any future standards developmental methodology. This methodology
(Figure 2) has three distinct phases of setting and describing the standards, measuring the performance followed by recording, analysing, and disseminat- ing the findings. This model may form the “gold standard” methodology but is clearly resource intensive. Therefore, other methods of developing a consensus of recommendations based on evidence and/or good practice are also popular and valued. An example of such work is the standards of care for patients with invasive fungal infections recently published by the British Society for Medical Microbiology (Dennig et al., 2003). The Scottish Infection Standards and Strategy Group (SISS; available on the www.rcpe.ac.uk site), a broad infection specialty subgroup (microbiologists, ID physicians, genito-urinary medicine physicians, public health physicians, epidemiologists, infection con- trol nurses, and pharmacists) of the Bicollegiate Quality of Care Committee, has recognised this and other methodology and has developed good practice recommendations for optimising quality prescribing in hospitals. These rec- ommendations adopt and adapt work based on existing evidence and national strategies aimed at optimising antibiotic prescribing in hospitals (Goldman et al., 1996; Shlaes et al., 1997). They represent a mixture of good practice statements supported by verification criteria aimed at evaluating the process and organisational interventions related to hospital antibiotic prescribing. Further development and validation of “traditional” standards and introducing more “patient based” outcomes are clearly desirable and necessary in the future (Barlow et al., 2003). The SISS good practice guidance statements by no means represent the final product but form the basis of a process that will continue to evolve and adapt in line with validated standard development
Figure 2. Setting standards: The model.
32 Dilip Nathwani methodology. We hope that such standards will become an established national
tool for benchmarking the quality of antibiotic prescribing in hospitals with the objective of encouraging change where suboptimal practice is identified. This process is a key requirement of the UK Antimicrobial Resistance Strategy (see references).
Parts
» Antibiotic Policies: Theory and Practice
» THEORIES OF FACILITATING CHANGE
» OTHER APPROACHES TO GUIDELINE DEVELOPMENT
» QUALITY ASSURANCE AND DEVELOPMENT OF STANDARDS
» DEVELOPMENT OF CLINICAL STANDARDS IN SCOTLAND
» WHICH QI INTERVENTIONS HAVE BEEN STUDIED IN CAP?
» LINKING PROCESS OF CARE TO OUTCOMES IN QI
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE PROCESS OF CARE IN CAP?
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE OUTCOMES IN CAP?
» Designing and implementing a CAP intervention
» LEVEL OF AGGREGATION OF ANTIMICROBIALS
» ANTIMICROBIAL USAGE MEASURES
» Relationships based on patient-specific data
» Relationships based on aggregate usage
» ANTIBIOTIC CONSUMPTION; ALTERNATIVE UNITS OF MEASUREMENT
» ANTIBIOTIC CONSUMPTION CALCULATOR
» BENCHMARKING FOR REDUCING VANCOMYCIN USE AND VANCOMYCIN- RESISTANT ENTEROCOCCI IN US ICU S
» THE HARVARD EMERGENCY DEPARTMENT QUALITY STUDY
» ANALYSIS BY INDIVIDUAL ANTIMICROBIAL AGENT
» BENCHMARKING WITH OTHER ANTIMICROBIAL UTILISATION DATA
» STATE OF THE ART OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» AUDITING AND IMPROVING THE QUALITY OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» TYPES OF STUDIES TO OBTAIN QUALITY DATA ON A PATIENT LEVEL
» MULTIDISCIPLINARY ANTIMICROBIAL MANAGEMENT TEAMS
» THE ROLE OF THE PHARMACIST IN INFECTION MANAGEMENT
» TRAINING AND SUPPORT IN INFECTION MANAGEMENT FOR PHARMACISTS
» ANTIBIOTIC POLICY IN THE TERTIARY CARE CENTRE
» ANTIBIOTIC CONSUMPTION IN ICU S
» ANTIBIOTIC RESISTANCE IN ICU
» The impact of antibiotic policies and antibiotic consumption on antibiotic resistance
» IT and benchmarking to improve antibiotic prescribing
» COST OF HOSPITAL-ACQUIRED INFECTION
» THE COST OF ANTIMICROBIAL RESISTANCE
» Costs of screening/surveillance cultures
» Isolation, cohorting, and contact isolation
» EPIDEMIOLOGY OF INVASIVE FUNGAL INFECTIONS
» Antifungal resistance in Candida species
» Antifungal resistance cannot be transmitted by extrachromosomal DNA
» RATIONAL USE OF ANTIFUNGAL AGENTS
» THE CHANGING FACE OF VIRAL INFECTIONS AND THEIR MANAGEMENT
» PROBLEMS ASSOCIATED WITH ANTIVIRAL THERAPY
» ANTIVIRAL TREATMENT STRATEGIES
» ANTIVIRAL PROPHYLAXIS STRATEGIES
» ANTIBIOTIC CONCENTRATIONS AT TARGET SITES
» An infant with aplastic anaemia
» A long-standing E. coli infection of liver cysts
» BREAKPOINTS: A SHORT HISTORY AND OVERVIEW
» PHARMACODYNAMIC RELATIONSHIPS AND EMERGENCE OF RESISTANCE
» EVALUATION OF THE ANTIMICROBIAL RESISTANCE SURVEILLANCE DATA PUBLISHED IN THE MEDICAL LITERATURE
» PRACTICAL ASPECTS OF THE IMPLEMENTATION OF THE SURVEILLANCE PROGRAM
» Multivariate analysis methods
» Evolutionary genetic approaches
» Study of the relationship between bacterial resistance and antimicrobial consumption
» To predict the short-term evolution of resistance
» To evaluate interventions to control antibiotic resistance
» DISINFECTANTS: TYPES, ACTIONS, AND USAGES
» Evidence of bacterial resistance to biocides
» Mechanisms of bacterial resistance to biocides
» EVIDENCE OF CROSS-RESISTANCE BETWEEN BIOCIDES AND ANTIBIOTICS
» DISINFECTANT USAGE AND ANTIBIOTIC RESISTANCE
» METHODS OF LITERATURE REVIEW
» PROBLEMS WITH INTERPRETATION OF PUBLISHED STUDIES
» Distribution of educational materials
» Audit and feedback with or without other educational materials
» Educational group meetings or seminars
» Educational outreach/academic detailing
» Financial/healthcare system changes
» EFFECT OF INTERVENTIONS ON ANTIBIOTIC RESISTANCE
» DDD/1,000 INHABITANTS AND DAY (DID)
» PRESCRIPTIONS/1,000 INHABITANTS AND YEAR
» INDICATIONS FOR ANTIBIOTIC PRESCRIPTIONS
» POSSIBLE CAUSES FOR OBSERVED VARIATIONS IN ANTIBIOTIC USE
» DETERMINANTS OF ANTIBIOTIC CONSUMPTION
» COLLECTIVE AWAKENING AND PROGRESSIVE MOBILIZATION OF FRENCH PUBLIC HEALTH AUTHORITIES
» ANTIBIOTIC USE AND COST TRENDS
» IMPACT ON HEALTH BUDGETS OF ANTIBIOTIC USE
» ACCESS TO ESSENTIAL ANTIBIOTICS AT ALL LEVELS OF CARE
» EPIDEMIOLOGY OF ANTIMICROBIAL RESISTANCE
» THREAT OF ANTIMICROBIAL RESISTANCE
» ECONOMIC IMPLICATIONS OF ANTIMICROBIAL RESISTANCE
» FACTORS CONTRIBUTING TO DEVELOPMENT AND SPREAD OF RESISTANCE
» STRATEGIES FOR CONTAINMENT OF RESISTANCE IN DEVELOPING COUNTRIES
» Antibacterial resistance and policies
» Policies, guidelines, and education on antibacterial use
» Discovery, development, and commercialization in the face of policies
» Antibacterial development, labelling, and benefits
» WHAT CAN BE DONE NOW ABOUT ANTIBIOTIC RESISTANCE?
» HOW CAN THE DIAGNOSTIC LABORATORY HELP?
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