The aim of this assignment is to critique an evidence based guideline that is currently being utilised within the clinical area of the author. The chosen guideline is ‘the management of postpartum haemorrhage (PPH)’ (see appendix 1). The author will base the critique of these guidelines using the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE, 2001) (see appendix 2), which provides a framework for assessing the quality of clinical practice guidelines (AGREE, 2001). However, other supporting and opposing literature will be included.
Over the past decade clinical guidelines have become an everyday part of practice (Woolf et al, 1999), and are defined by West and Newton (1997) as-
“systematically developed statements which are used to assist both clinicians and patients in making decisions regarding appropriate treatment for certain conditions” (P. 414).
Guidelines can reduce variations in practice, and promote the delivery of high quality evidence based health care (Thomson, 1995, West and Newton, 1997, and Rycroft-Malone, 2001). However, although guidelines should be evidence based, several authors have found that there is increasing concern regarding the reliability, effectiveness and quality of them (Grimshaw and Russell, 1993, Thomas et al, 1998, and Muir Gray, 2001). Ensuring guidelines are used in the clinical area also has the potential to reduce litigation, which is high within the National Health Service (Tingle, 1998). Conversely, they may also be used in litigation against individual health care professionals who will be held professionally accountable (Johnson, 2002). In addition Feder (1994) states that clinicians find them inconvenient and time-consuming, and that they may encourage ineffective or wasteful interventions. Concerns have also been raised that guidelines de-skill professionals, reducing their capacity to think for themselves and reduce their clinical judgement (Shekelle et al, 1999). In contrast, a...