Clinical Guideline or Flow Chart – Therapeutic Hypothermia in Cardiac Arrest

The AGREE II tool (instrument) will be incorporated into this assessment item to assist the student’s ability to create a pre-hospital guideline. AGREE II is a very flexible tool that can be used for any disease area targeting any step in the health care continuum, including those for health promotion, public health, screening, diagnosis, treatment or interventions. The AGREE II handbook and user manual are both within the readings and also in the resources section of Interact.

Utilising the Appraisal of Guidelines for Research and Evaluation (AGREE) II document, create your own Clinical Guideline on to be used by Paramedics. Your guideline will be grounded in the evidence that you have created from your first assessment item in this subject. You will need to read the AGREE user manual and guide to gain an understanding of how this tool works and how it can be used to both critique guidelines as well as build them, based upon research evidences and best practice.

You will need to work through each area of the AGREE system, and search the evidence that you have found in order to make a final recommendation based on you findings. You should strengthen your response to each component by drawing on a wide range of resources that you have collected which acknowledge specific requirements for each component, and then use this information to create your chosen guideline.

As well as providing information to the reader about the development of your guideline against the
AGREE II criteria, you may choose to present your clinical guideline as a flow chart , table or any other relevant format . Diagrams are encouraged where appropriate to provide clear instructions to guide the clinicians.

Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. In addition, guidelines can play an important role in health policy formation and have evolved to cover topics across the health care continuum. Many ambulance service guidelines are referred to also as ‘protocols’ which are considered less flexible for the end user rather than the use of ‘guidelines’.

The potential benefits of guidelines are only as good as the quality of the guidelines themselves. Appropriate methodologies and rigorous strategies in the guideline development process are important for the successful implementation of the resulting recommendations. The quality of guidelines can be extremely variable and some often fall short of basic standards. It is interesting to note that ambulance services now feel obliged to include research and references within their guidelines, which is very different to what would have been normal practice 10 years ago. The use of evidence based practice is becoming increasingly important for validity and credibility at all levels from local to international.

The Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument was developed to address the issue of variability in guideline quality. To that end, the AGREE instrument is a tool that assesses the methodological rigour and transparency in which a guideline is developed. The original (2003) AGREE instrument has been refined, which has resulted in the new AGREE II and includes a new User’s Manual. This is available both in the readings and within the resources.

The purpose of the AGREE II, is to provide a framework to:
1.Assess the quality of guidelines;
2.Provide a methodological strategy for the development of guidelines; and
3.Inform what information and how information ought to be reported in guidelines. (Length: 2,000 -2,500 words, p9)

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