British Journal of Clinical Governance

The Path.Finder NHS consortium consists of ten acute hospitals sharing a common approach to the production and dissemination of local information for primary care, including clinical practice guidelines. Ten local guidelines were studied across four clinical areas: dyspepsia, lipids, eczema, and menorrhagia. Local guideline developers largely appear to be unconvinced that investment of time and resources in “proper” guideline development is cost‐effective. At the same time, primary care professionals’ views about future NICE guidelines may have been coloured by their current much more variable experience. Successful implementation of local guidelines is unlikely to be straightforward.

Amanda Bowens

Mike Robinson

Ruth McDonald

Phil Ayres

The processes and costs of local guideline development: experiences from the Path.Finder NHS consortium

本地指南制定的过程与成本：来自Path.Finder NHS联盟的经验

Aims to provide a framework for identifying barriers to the implementation of a clinical guideline by examining a clinical effectiveness programme and a review of relevant literature. A total of 41 types of barrier were identified and categorised according to characteristics of the guideline to be introduced, the individuals who need to change behaviour and the organisation or environment in which the change is to occur. Several groups have the potential to overcome such barriers, ranging from individual clinicians to national policy makers. Multi‐level as well as multi‐faceted strategies may be required to overcome barriers to the effective implementation of clinical guidelines.

Robbie Foy

Anne Walker

Gillian Penney

Barriers to clinical guidelines: the need for concerted action

临床指南的障碍：需要协同行动

Primary care practitioners in the UK today undertake more responsibility for the management of chronic diseases than ever before, including the monitoring of medications initiated in the secondary care setting. This has not necessarily been accompanied by the introduction of guidelines or additional funding. Examining the aminosalicylate group of drugs (sulfasalazine, mesalazine, olsalazine and balsalazide), it was found that despite their potential to cause life‐threatening adverse reactions, there is no agreed protocol on the most appropriate type and frequency of monitoring. A search of the literature confirmed that there is a paucity of evidence from which to construct a guideline. An audit of one family practice suggests current levels fall short of a minimal standard. Based on the current best available evidence, a protocol is suggested for aminosalicylate monitoring. Other groups of drugs warrant similar attention in primary care, and issues regarding funding for the responsibility and cost of monitoring need addressing.

Matthew J. Ridd

Aminosalicylate monitoring in primary care: an audit and protocol

初级保健中的氨基水杨酸监测：一项审计和协议

Alan Earl‐Slater

“A‐Z of Medical Writing”

“医学写作从A到Z”

Tests the feasibility of an outreach clinical librarian service in an acute hospital setting, providing quality filtered research evidence at the point of clinical need. The design was based on a six‐month pilot with professional librarians attending clinical meetings responding to information needs raised there by providing appraised summaries of the published evidence, with full text and bibliographic material as appropriate. The main outcomes were usage statistics and clinicians’ evaluation via a 23‐question questionnaire completed each month seeking overall views of the service. Practical issues regarding the provision of the service were tested. Concludes that an outreach information service in the clinical setting can meet the clinical governance agenda of the Trust by supporting evidence‐based practice, teaching and learning and continuing professional development. Earlier models of service are adapted to make the service cost‐effective.

M. Linda

Claire J. Honeybourne

Janet Harrison

A clinical librarian can support clinical governance

临床图书馆员可支持临床治理

This paper’s objective is to develop a model for the appropriate and equitable use of disease‐modifying treatments in multiple sclerosis. The prevalence and incidence of multiple sclerosis was established in Leeds. A specialist multiple sclerosis team with two consultant neurologists and a multiple sclerosis support nurse was based at one centre. The team co‐operated with purchasers to develop a model of care. This included a referral protocol, strict prescribing criteria, counselling and education of patients, the use of patient‐centred outcome measures and training and feedback to other neurologists. A total of 217 people with multiple sclerosis were assessed from April 1997 to March 2000. Our experience suggests that a centralised multi‐district clinic developed by close collaboration between clinicians and health purchasers and operating under agreed rules is a feasible and effective model for the managed introduction of new treatments to the NHS.

Helen L. Ford

Michael Johnson

Jon Fear

A multi‐district model for the management of disease‐modifying treatments in multiple sclerosis

多发性硬化症疾病修饰治疗的多区域管理模型

Patient safety and medical error have become prominent issues following publication of Institute of Medicine reports in the USA. The USA, Australia, and now Canada have followed a national “medical error” studies path that uses language rejected by the interdisciplinary group of experts described previously in this column, and continues using methods considered seriously flawed as well as incomplete by noteworthy hospital epidemiologists. Preliminary review of British hospitals by similar methods also has been published. Proven and more cost‐effective surveillance methods are pertinent methods developed over the past several decades by hospital epidemiology and infection control professionals who have more experience, but this heritage has been ignored in recent patient safety juggernauts. It is time to question why retrospective physician chart review approaches remain in vogue with national bodies to enumerate adverse patient outcomes and attribute them with “medical error” when better alternatives exist.

David Birnbaum

William Scheckler

Beware of the patient safety juggernauts

提防患者安全巨轮

This article discusses the role of clinical risk management in the implementation of the National Service Framework for Coronary Heart Disease (NSFCHD). It considers the practical difficulties faced in meeting NSF standards, and proposes a combined, complementary approach involving primary and secondary care. While the NSF makes no explicit reference to clinical risk management, the risk manager has an important role to play in ensuring that an adverse event reporting system is in place and its role fully accepted by clinicians. From a medico‐legal standpoint, a commitment to auditing outcomes and maintaining good clinician‐patient communication is viewed as essential. It concludes that doctors’ and patients’ interests are best served by clinicians adopting a clinical risk management approach to implementing the NSFCHD.

P. Jane Cowan

Using clinical risk management processes to develop the national service framework for coronary heart disease

利用临床风险管理流程制定冠心病国家服务框架

Effective appraisal is one of the key underpinning systems to allow the practical implementation of clinical governance. Between March and July 2002, over 800 GPs have attended the national GP “Training the Appraisers” Programme, funded by the Department of Health, and run by the NHS Clinical Governance Support Team (CGST) in partnership with Edgecumbe Consulting Ltd. The one day programme, which includes practical “real life” appraisal sessions for GPs, is well on the way to meeting its remit of training 900 GP appraisers (an average of three appraisers per PCT) in 2002. Once they have completed the course, trained appraisers can begin the process of conducting the first round of appraisals in their local primary care organisations. The GP Appraisal Programme recognises the potential of an effective system of appraisal to develop over time, so that patients can be confident that their family doctor is supported in taking regular, structured steps to ensure they are identifying and fulfilling their professional development needs and thereby enhancing the delivery of high quality care.

Debbie Wall

Maurice Conlon

Ron Cullen

Aidan Halligan

Learning by doing: training general practitioners to be appraisers

边做边学：培训全科医生成为评估者

A structured sticker for examination of women in labour was introduced at Arrowe Park Hospital in 1998 to improve documentation of examination findings. This study was undertaken to assess whether the use of the sticker improved documentation of examination findings and second, compliance of sticker use. A retrospective analysis was performed on 64 cases randomised by random number generated on Arcus Quickstat from 470 women who were induced by prostaglandin during 1 January 1998 to 31 December 1998 at Arrowe Park Hospital. Women were induced by prostaglandin were chosen as the study population to obtain data from early labour. A total of 229 examinations were performed in these areas. Statistical analysis was undertaken on Arcus Quickstat, and χ 2 and Fisher’s exact tests were applied to check for statistical significance.

Sudipta Paul

David J. Rowlands

A structured examination in labour improves documentation

结构化分娩检查可改善记录

Publication Information	Publisher: Emerald Group Publishing Ltd.，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1999，Proportion of original research papers: ，Self Citation Rate:， Gold OA Rate:

British Journal of Clinical Governance

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