Expert Advice: EBP Resources: Online Clinical Practice Guidelines

One of the questions I’ve been asked recently is around finding free online resources for evidence-based practice (EBP). (Of course, I think you are already on the best website for clarifying your questions and really understanding how to be an evidence-based practitioner!)

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I have been obsessed with finding good evidence-based practice resources ever since I first started teaching EBP. Along the way, I’ve found excellent websites and other resources for faculty, practicing nurses, and for students. I’ll talk about other resources, such as mobile apps and textbooks, in future posts.

To keep the information manageable, this post will introduce you to some of my favorite online websites to find and access Clinical Practice Guidelines (CPGs). The websites will be especially helpful to those of you who are looking for credible information for school assignments or for organizational projects. I’ll annotate each site to give you an idea of what you can find. So Mary from Grundy, Virginia — I hope this blog post helps you in your quest to provide evidence-based nursing care!

Finding the Best Evidence: Start at the Top!
Mary was interested in online evidence-based resources for both school and work-related projects. The best advice I can give is to always look for the highest level of evidence you can find to answer your clinical questions.

Always start your search looking for the highest level of evidence you can find to answer your clinical questions!

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You will hear EBP practitioners talk about levels of evidence (LOE). These are basically frameworks that use shorthand to identify the quality of the evidence, in terms of the rigor of the methodology. The highest levels of evidence will be systems, followed by summaries, synopses of syntheses, syntheses, synopses of studies, and original, single studies (DiCenso, Bayley, & Haynes, 2009).

Levels of Evidence: The 6S Pyramid
Levels of Evidence: The 6S Pyramid

As Systems are only accessible to the employees of the institution where the clinical decision support system resides, we’ll move on to Summaries that can be accessed online.

Summary Resources: Online Clinical Practice Guidelines
Summaries include clinical guidelines or textbooks that are updated on a regular basis. I’ll talk about textbooks in a future post.

Clinical practice guidelines are supposed to be just that, guidelines! They are to be used with your clinical expertise — your judgment as to whether your patient will benefit from the practice recommendations — and with your patient’s input. They should be based on rigorously conducted systematic reviews.

Here are some helpful online clinical practice guideline websites:

Best Practice Guidelines – one of the most helpful websites I found is the website of the Registered Nurses Association of Ontario (RNAO). At the time of this post, there are 50 guidelines in a searchable database. The guidelines are extremely well-researched and helpful for nursing practice from peds to geriatrics and everything in between. They also have guidelines to help you establish Healthy Work Environments. You can download their best practice guidelines for free or pay for a hard copy. Guidelines are translated into Japanese, French, Spanish, German, Chinese, and Italian.
CPG Infobase is from the Canadian Medical Association. There are about 1200 CPGs that have been either developed or vetted Canadian medical or health organizations. Patient resource handouts and other resources are available with the CPGs. The CPGs are free to access. Some resources are membership benefits – so unless you want to join the CMA, they’re not accessible.
Evidence-Based Medicine Guidelines is an easy-to-use site – just type in your search terms for EBM guidelines, evidence summaries, and more for primary care practice for many medical conditions. You can also access Cochrane Reviews from this site.
The Guideline Advantage is a resource from the American Cancer Society, American Diabetes Association, and the American Heart Association/American Stroke Association. This link takes you to an index of guidelines and practice recommendations from these professional organizations.
Joanna Briggs Institute – “The Joanna Briggs Institute (JBI) is the international not-for-profit, research and development Centre within the Faculty of Health Sciences and Medical at the University of Adelaide, South Australia.” The site has excellent Best Practice Information Sheets.
National Center for Complementary and Integrative Health (NCCIH) features clinical practice guidelines on a variety of clinical specialties.
National Guideline Clearinghouse – run by AHRQ, this website solicits clinical practice guidelines from a “medical specialty association; relevant professional society; public or private organization; government agency at the Federal, State, or local level; or health care organization or plan” that meet six criteria. All accepted clinical practice guidelines have to be based on a systematic review. This site provides guidelines summaries of clinical specialty topics, guideline syntheses that compare and contrast guidelines that focus on similar topics, and expert commentaries.
NICE Clinical Guidelines – The National Institute for Health and Clinical Evidence (NICE) is located in the United Kingdom and provides “national guidance and advice to improve health and social care.” The NICE pathways provide interactive flowcharts from which to access information of interest, resources such as cost templates and process and methods guidance. The NICE guidelines cover general areas of Conditions and diseases; Health protection; Lifestyle and wellbeing; Population groups; Service delivery, organisation and staffing; and Settings. Quality standards, including measuring tools, and searchable evidence databases are also available.
VA/DoD Clinical Practice Guidelines – The Veteran’s Administration (VA)/Department of Defense (DoD) has developed clinical practice guidelines “to improve care by reducing variation in practice and systematizing “best practices.” The guidelines were vetted by the VA/DoD Evidence-Based Practice Work Group and are intended to be used in conjunction with the clinician’s best judgment and the patient’s input.
There are many other sources of clinical practice guidelines. Professional organizations typically develop CPGs on clinical topics specific to their members’ priorities (e.g., respiratory therapy, physical therapy, pharmacology, etc.).

The key to vetting CPGs is to look for the process the authors or organization used to develop their practice recommendations. Transparency is what it’s all about! You want to be able to believe the CPG as the best evidence available, so you want the authors to spell out the process they used to vet the evidence and develop the statements. I’ll get into how to appraise a clinical practice guideline in a future post.

DiCenso, A., Bayley, L., & Haynes, R. B. (2009). Accessing pre-appraised evidence: Finetuning the 5S model into a 6S model. Evidence-Based Nursing, 12(4), 99-101. doi:10.1136/ebn.12.4.99-b

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