FP32-6 Development and implementation of Clinical Practice Guidelines in Pediatric Endocrinology: Challenges and opportunities

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP32-Health Outcomes & Quality Improvement
Monday, June 17, 2013: 10:45 AM-11:15 AM
Presentation Start Time: 11:10 AM
Room 301 (Moscone Center)

Poster Board MON-282
Sarar Mohamed*1, Nasir Al-Juryyan2, Amir Babiker2, Shaikh Mohamed Iqbal2, Mohamed El Faki Osman2 and Abdelrahman Al-Nemri2
1King Saud University, Riyadh 11461, Saudi Arabi, Saudi Arabia, 2King Saud University
Development and implementation of Clinical Practice Guidelines in Pediatric Endocrinology: Challenges and opportunities


Sarar Mohamed, Nasir Al Juryyan, Amir Babiker, Shaikh Iqbal ,Mohamed Elfaki,   Abdelrahman Al-Nemri

Department of Pediatrics, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia


Background: Clinical Practice Guidelines (CPG) are systematically developed statements to assist practitioner and patient taking informed and evidence based decision. There is an enormous need for CPG in Pediatric Endocrinology in order to deliver a high quality service.  

Objectives: We aim to review our experience in synthesis and implementation of CPG in our Pediatric Endocrinology Unit taking Diabetic ketoacidosis (DKA) as an example to highlight the challenges and outcome of CPG.

Methods: A departmental steering committee was formed in January 2010 to develop CPG. Topics for CPG were selected on the basis of high risk high volume, according to the most recent patient census. DKA was selected as a priority CPG topic.  We used Resource Toolkit developed by ADAPTE collaboration (International Collaboration of guideline Developer) for development of CPG. CPGs were selected and appraised according to AGREE format (Appraisal of Guidelines for Research and Evaluation). We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to evaluate the strength of recommendations and the quality of evidence. Four existing CPGs on DKA were appraised. National Institute for Clinical Excellence (NICE) guidelines for management of DKA was selected for adoption as it scored high on the list. Minor changes in NICE guideline were done to suit our setting. All stakeholders including endocrinologists, intensivists, emergency physicians, nurses and dieticians were involved in the development of DKA guidelines.  

Results: An audit was conducted after two years of implementation of CPG for DKA. Results showed that CPG enhanced the quality of care and improved patient outcome. It reduced  variations in practice. Adherence to CPG was good. Pediatric intensive care stay was significantly reduced and no mortality reported.  Challenges observed include convincing medical staff to change their practice and adhere to CPG with all extra paper work and commitments in light of a busy service. Continuing education of first line medical staff was found to be the best approach.  Commitment and motivation of staff was crucial for success of CPG implementation.

Conclusion: This paper highlights the process of development and implementation of CPG in Pediatric Endocrinology setting and reports the challenges, outcome and  impact of CPG in delivering evidence based service.

 Disclosure: Authors have no conflict of interest to declare

Nothing to Disclose: SM, NA, AB, SMI, MEFO, AA

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

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