Policies And Procedures

Practice Guidelines

Postpartum Evaluation Form

Disclosure and Resolution

QI/RM Statements

Abandonment

HIPAA

RCWs/WACs

Cord Blood

MTS/CLIA

DEVELOPING PRACTICE GUIDELINES

QMA Risk Management LLC
Victoria Grace 1/24/2012
v3

Practice Guidelines (AKA Clinical Guidelines, Practice Parameters, etc.)

What to strive for:

Practice Guidelines should be simple enough that you can
write each one from memory and be accurate every time.

Characteristics of Effective Risk Management Practice Guidelines:
  • Brief, with focus on the most salient points – should be able to fit two on a page
  • Descriptive phrases in outline or bulleted form
  • Non-limiting; allows actions based on clinical judgment
  • Descriptive of your midwifery management – not a goal but an actuality
  • Acts as a guide; useful to the midwife 
  • Language allows flexibility
  • Consistent with the midwife’s own practice style
  • Management options are within midwife’s scope of practice
  • Researched
  • Evidence based
  • Up-to-date
  • All revisions dated
  • Out-dated copies kept on file
  • Midwife or practice name (address optional) on every page; number pages

Important: If a practice guideline is not within the current scope of midwifery practice, follow the MAWS or ACNM process for new/unconventional practice and have reasoning supported by research and references.

When a practice guideline is not followed exactly then the deviation or omission and the reasoning behind it must be documented clearly and thoroughly in the chart notes.

 

Key areas to include in a practice guideline:

Clinical Definition: Briefly describe the clinical signs and symptoms that indicate this condition warrants attention or management.

Midwifery Management: Describe succinctly the most important midwifery management points - use headings.

MD/DO Consultation/Referral: Describe the parameters (signs and symptoms) used to determine when to consult, refer or transfer care.

 

Writing an Introduction Statement for your Practice Guidelines Manual

Use it to tell health care providers and other potential readers, i.e. state agencies and attorneys, how you use your manual and how they are to interact with it.  This is your opportunity to speak of your commitment to the midwifery model of care and to the women in your practice.  This is also where you can explain that all women receive education, engage in discussion of conditions requiring midwifery management, have their questions answered, and receive informed consent as the situation allows (or similar wording) instead of stating that in each and every practice guideline. You can find more suggestions here: GuidelinesIntroduction.htm

.

 Example Guideline

Neonatal Respiratory Distress

Clinical Definition: Briefly describe the signs and symptoms indicating this condition warrants attention or management.

Neonate exhibits persistent tachypnea, cyanosis, grunting, nasal flaring, retractions.

Midwifery Management: Describe succinctly the most important management points.

Midwifery Management may include:

*clear airway

*stimulation/massage of trunk and head

*blow-by oxygen

*warm or cool infant as indicated (thermoregulation)

*percussion of lungs

*PPV

MD/DO Consultation/Referral: Describe the parameters used to determine when to consult and/or refer or transfer.

Consult or transfer if:

*s/s of infection present

*condition deteriorates

*condition persists despite treatment

Avoid:

  • Differential diagnosis (D/D) and rule out (R/O) use in both Practice Guidelines and charting unless prepared to do all the necessary assessments and tests to specifically rule out each condition listed every time, documenting it thoroughly in the chart.  Even if tests are positive for the very first condition on the list you must still rule out all others on a R/O list.

  • Listing all risk factors, all possible signs and symptoms, etiology, all possible tests and treatments, etc.  NOTE: If you already have practice guidelines written in a more involved style it is not necessary to discard them.  Keep this information clearly labeled as a Reference Guide and place it on the shelf, not in the Practice Guideline manual. 

  • Too much description. Consolidate specific treatment options into general categories.
    Use instead: “appropriate lab tests” “comfort measures”   “appropriate medications” “nutrition counseling” etc.

  • Numbering or listing midwifery management in a specific order unless always done in that order no matter what.
    Use instead:
    not necessarily in this order” “according to clinical judgment”

Some language that may be helpful:

“as appropriate”
“as clinical judgment indicates”
“as time allows”
“if birth not imminent”
“evaluation may include”
“management may include”

Choose the appropriate strength of your statement:

“all clients will”
“recommended”
“suggested”
“offered” 
...
etc.