Bedside Clinical Guidelines Partnership
Clinical guidelines are very difficult to produce and particularly demanding to maintain. They need to be researched, written, debated, checked, edited, formatted, proofed and disseminated.
The Bedside Clinical Guidelines Partnership provides a solution; guidelines with easily accessible point of care information to help reduce the risks associated with inconsistency of
What is the Bedside Clinical Partnership Trust?
With over 16 years experience and a current membership of over 20 acute NHS Trusts across the country, the Bedside Clinical Guidelines Partnership (BCGP) have a solid foundation in the production of point of care guidelines for clinician use at the bed-side.
Formed initially to produce guidelines for Adult Medicine care, as interest and resources have grown, the scope has extended. The BCGP now produce guidelines for all the following specialities:
- Adult Medicine
- Adult general surgery
- Adult nursing
- Emergency medicine
- Neonatal
- Obstetrics
- Paediatrics
Guidelines are written and reviewed by specialists with support from qualified, trained and experi-enced pharmacy, biochemistry, microbiology, radiology, library and publication staff. They are checked against national guidance, specialist societies and evidence reviews when available. Editors within the BCGP then peer review the material and offer challenges, comments and their own contributions. This combined expertise and experience help make the guidelines independent.
Wherever possible, recommendations made are evidence based. Where no clear evidence has been identified from published literature, the advice given represents a consensus of the expert authors and their peers and is based on their practical experience.
For ease of reference, the layout adopts a standard format, covering Recognition and assessment, Immediate treatment, Subsequent management, Monitoring treatment and Discharge and follow-up.
The use of bulleted short statements in the active tense, accompanied by bold/italic typeface to alert or caution is used.
Who does what?
The Partnership is managed by an editorial board, comprising a clinical lead consultant physician, and eight specialty editors (seven consultant grade and one senior nurse who each allocate time to review and edit the guidelines). The guidelines team also includes two fulltime developer/co-ordinators and a clinical effectiveness librarian, working to an annual reviewing and updating cycle.
How often are they updated?
- Medical, Surgical and Nursing: Every year
- Paediatric, Neonatal, Obstetric & Emergency medicine: Every two years
Why do we need guidelines
To achieve the highest standards of evidence-based practice, reduce unnecessary and costly variation in practice and to reduce risk. This is increasingly important as clinicians work shorter hours with patients being cared for by changing personnel.
Are the guidelines not a duplication of those from NICE?
No. Our guidelines are a fusion of national guidance and everyday clinical practice and experience; together in one volume per specialty. They are brief and to the point - a guide to what to do now.
Are the guidelines madatory?
The guidelines are not intended as a substitute for logical thought and must be tempered by clinical judgement in the individual patient. No guideline will apply to every patient, even where the diagnosis is clear-cut; there will always be exceptions.
The guidelines are designed to assist clinicians and help to promote consistency, but recognise that patients are individuals, possibly with co-morbidities or allergies that require alternative management. Clinicians must be free to adapt the guidelines, which are explicitly advisory, not mandatory. Divergence does not necessarily signify negligence.
What does my Trust receive for its investment?
All the present guidelines on CD-ROM in a format that can be modified by you to suit your local circumstances, followed by annual or biennial updates of each set of guidelines. A PDF version is also pro-vided to enable each Trust to put the guidelines on their intranet.
My Trust is only interested in one set of the guide-lines - can we purchase just the one we want?
We do not sell the guidelines separately; as a member you get ALL the guidelines for use within your Trust and your subscription fee helps to support the guideline process. However, it is up to individual Trusts which guidelines they use and how they tailor them to their needs.
How do we tailor the guidelines to our Trust?
The CD-ROMs include a style guide and information regarding the guidelines we suggest are reviewed for your local content. All the files use colour-coded text to help members identify where local information may be required.
However, the paediatric, neonatal and obstetric guidelines are actually quite generic as they are authored by two networks consisting of members from a number of different Trusts. We find that, unlike medicine and surgery, there aren't usually too many changes required. The main area for review is the recommended antimicrobials and most Trusts have local policies on these.
We do suggest that guidelines are reviewed by consultants/clinical nurse specialists leading for, or inter-ested in, the subspecialty guideline and amended accordingly. There may also be some differences in regional policies and pathways that may not be consistent with your Trust.
Some partner Trusts amend to their local policy and then put on to their intranet, once this has been done they find that updating is much simpler next time as they just use the changes in blue that we send year on year. However, we also know that many of our partner Trusts simply take the guide-lines as they are, accessed via their intranet with caveats regarding antimicrobial policy, advising users where local information is found.
How much does membership of the Bedside Clinical Guidelines Partnership cost?
Our annual subscription fee is currently £5,250 per annum on a recurring basis.
Does the partnership make a profit?
No. The partnership is constructed as a non-profit making group. The running costs of the secretariat (editors, pharmacists, clinical effectiveness librarian and developer/ co-ordinators) are borne equally by all partner Trusts.
Conclusion
It is our belief, on the basis of experience, that goodquality guidelines have huge potential to improve care, especially in these days of shifts, with multiple doctors involved in the care of individual patients.
However, the development of guidelines requires dedicated resources and a well defined process. It is best undertaken across a network of co-operating providers. Audit, regular review and updating are essential components of the process.
Investment in the partnership gives you bedside guidelines that bring together in one easily-accessible format, current guidance, information and best practice from all corners of the world of health-care.
Clinical guidelines are 'systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances1' They present recommendations for optimal management, informed by pub-lished evidence and broad consensus, and encourage flexible application in individual patients.
1 Field MJ, Lohr KN, eds. Clinical practice Guidelines: directions for a new program. Washington, DC: National Academy Press, 1990