Standards & Guideline Proposal Form

STANDARDS & GUIDELINE PROPOSAL FORM

Provisional Title of Standards & Guideline
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Guideline Development Group Lead
Name / Job & Place of Work / Email / Contact Telephone
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Guideline Development Group Members
Name / Job & Place of Work / Email / Contact Telephone
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Guideline Scope & Purpose
What is the overall objective of the Guideline? / Click here to enter text.
What are the Clinical, Healthcare or Social questions covered by the Guideline? / Consider population, intervention, comparison, outcomes
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How did you choose the clinical questions?
Give details of why you chose this method / e.g. PICO, consensus approaches
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What population is the Guideline aimed at? / e.g. people of 18 years or older needing specialist palliative care services within the UK
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Who are the target users of the Guideline? / e.g. specialist palliative care professionals, district nurses
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Stakeholder Involvement in Guideline Development
How will you include representatives from your identified population and users in the development of the Guideline? / See guidance in Guideline Development Manual( section 2.4)
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Development Protocol
Databases to be searched / e.g. PubMed, Medline, CINAHL
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Principal search terms / e.g. MeSH headings, keywords
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Inclusion & Exclusion Criteria / e.g. inclusions: adults of 18 years of over; exclusions: not in English language or certain level of evidence. Impact on issues of equality (e.g. ethnicity, disability, sex/gender or age)
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Appraising the Evidence / e.g. use of SIGN and critical appraisal tools, two reviewer process to grade articles and how you will deal with disagreement
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Making Recommendations / e.g. use of GRADE/SIGN, agreeing on expert opinion through consensus, guidance that will help you make recommendations
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Proposed Timescale / Systematic Review / Click here to enter text.
Data Collection for an associated audit / Click here to enter text.
Presentation to CMPCNAG Meeting / Click here to enter text.
Period for Consultation and External Review / Click here to enter text.
Final Submission of Guideline / Click here to enter text.
Implementation & Applicability of Guideline
How do you plan to support implementation of the guideline? / e.g. testing audit tools and making them available, patient leaflets, publications/conferences, presentation slides
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How will you consider the cost and organisational impacts of implementing the guideline? / e.g. search for existing cost analyses, stakeholder or review consultation of guidelines
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Independence and Conflicts of Interest
Are any organisations assisting with funding the guideline? / It is anticipated that funding is not usually required
Conflicts of Interest / All members of the Guideline Development Group will need to submit a conflict of interests’ statement on submission of the completed guideline. If you are aware of a significant conflict of interest in advance of this then this should be declared below( see Appendix 6)
Details of Invited Expert
Name of Expert / Click here to enter text. /
Role/ Place of Work / Click here to enter text. /

Cheshire and Merseyside Palliative and End of Life Care Network Audit Group

Standards and Guideline Proposal Form - April 2014 1