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DEVELOPING PRACTICE GUIDELINES
QMA Risk Management LLC
Practice Guidelines (AKA Clinical Guidelines, Practice Parameters, etc.)
What to strive for:
Practice Guidelines should be simple enough that you can
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:
You can find more suggestions here: GuidelinesIntroduction.htm
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:
*stimulation/massage of trunk and head
*warm or cool infant as indicated (thermoregulation)
*percussion of lungs
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 persists despite treatment
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 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”