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).