the strength of the published evidence. This was complemented by an extensive analysis of
existing practices in acute care services in Ireland, to identify evidence of good practices and
issues and challenges in conducting clinical handover, including the barriers and facilitators in
achieving an effective clinical handover. This analysis involved: a national survey of the acute
care hospitals in Ireland; non-participant observation of clinical handover events; and focus
group discussions and interviews with a purposive sample of health professionals and other
key informants, including representatives of service users. In addition, a national survey was
administered to the deans and heads of all training schools for health professions in Ireland,
with the aim of eliciting the extent and quality of education and training in clinical handover
and related topics, like clinical risk management. The full report of this analysis is presented in
Appendix 6.
All available evidence was reviewed following the systematic review of literature and analysis
of current clinical handover practices nationally. As outlined in Section 1.9 below, evidence
was graded according to the Scottish Intercollegiate Guidelines Network (SIGN) methodology
checklists for quality of evidence (Scottish Intercollegiate Guidelines Network (SIGN) 2011).
We used the pre-requisite quality assurance criteria for the Irish context (Appendix 7) contained
in the National Quality Assurance Criteria for National Clinical Guidelines (HIQA and NCEC
2015), to ensure that the expected benefit of the guideline was clearly established for the Irish
healthcare setting. Once the guideline was developed, we also applied the National Quality
Assurance Criteria (HIQA and NCEC 2015) to appraise the guideline for research and evaluation.
The appraisal was based on the AGREE II grading tool (Appendix 8) to support the GDG in its
decisions and also to support the National Clinical Effectiveness Committee’s assessments and
decision-making, regarding the recommendation contained in the guideline (HIQA and NCEC
2015).
The GDG discussed each recommendation in detail and each recommendation was included
by unanimous or consensus agreement among the Group. The GDG consulted with a large
number of stakeholders including the National Clinical Effectiveness Committee (NCEC).
Following receipt of feedback the guideline was revised with agreement of the GDG, as
appropriate.
The guideline was developed specifically for use in acute care services in the Irish context,
but may also be of relevance to other services that do not currently have a policy or clinical
guidelines on clinical handover.
The literature review was registered on the PROSPERO international database, a database of
prospectively registered systematic reviews in health and social care. Key features from the
review protocol are recorded and maintained as a permanent record. Registration allows those
commissioning or planning reviews to identify whether there are any reviews already underway
that address their topic of interest. This enables comparison of reported review methods with
what is planned in the current review and helps avoid unintended and economically wasteful
duplication of effort.
1.7 Grading of recommendations
All decisions regarding the quality of evidence and the strength of recommendations were
based on summaries of evidence from the literature review and the evidence was weighted
according to the SIGN (2011) grading criteria. The basis for level of evidence and grade of
recommendation are summarised in tables 1.8.1 and 1.8.2.
Where existing guidance was the only source used to guide a guideline statement/
recommendation, this is specified. Where each guideline statement/recommendation is
the strength of the published evidence. This was complemented by an extensive analysis ofexisting practices in acute care services in Ireland, to identify evidence of good practices andissues and challenges in conducting clinical handover, including the barriers and facilitators inachieving an effective clinical handover. This analysis involved: a national survey of the acutecare hospitals in Ireland; non-participant observation of clinical handover events; and focusgroup discussions and interviews with a purposive sample of health professionals and otherkey informants, including representatives of service users. In addition, a national survey wasadministered to the deans and heads of all training schools for health professions in Ireland,with the aim of eliciting the extent and quality of education and training in clinical handoverand related topics, like clinical risk management. The full report of this analysis is presented inAppendix 6.All available evidence was reviewed following the systematic review of literature and analysisof current clinical handover practices nationally. As outlined in Section 1.9 below, evidencewas graded according to the Scottish Intercollegiate Guidelines Network (SIGN) methodologychecklists for quality of evidence (Scottish Intercollegiate Guidelines Network (SIGN) 2011).We used the pre-requisite quality assurance criteria for the Irish context (Appendix 7) containedin the National Quality Assurance Criteria for National Clinical Guidelines (HIQA and NCEC2015), to ensure that the expected benefit of the guideline was clearly established for the Irishhealthcare setting. Once the guideline was developed, we also applied the National QualityAssurance Criteria (HIQA and NCEC 2015) to appraise the guideline for research and evaluation.The appraisal was based on the AGREE II grading tool (Appendix 8) to support the GDG in itsdecisions and also to support the National Clinical Effectiveness Committee’s assessments anddecision-making, regarding the recommendation contained in the guideline (HIQA and NCEC2015).The GDG discussed each recommendation in detail and each recommendation was includedby unanimous or consensus agreement among the Group. The GDG consulted with a largenumber of stakeholders including the National Clinical Effectiveness Committee (NCEC).Following receipt of feedback the guideline was revised with agreement of the GDG, asappropriate.The guideline was developed specifically for use in acute care services in the Irish context,but may also be of relevance to other services that do not currently have a policy or clinicalguidelines on clinical handover.The literature review was registered on the PROSPERO international database, a database ofprospectively registered systematic reviews in health and social care. Key features from thereview protocol are recorded and maintained as a permanent record. Registration allows thosecommissioning or planning reviews to identify whether there are any reviews already underwaythat address their topic of interest. This enables comparison of reported review methods withwhat is planned in the current review and helps avoid unintended and economically wastefulduplication of effort.1.7 Grading of recommendationsAll decisions regarding the quality of evidence and the strength of recommendations werebased on summaries of evidence from the literature review and the evidence was weightedaccording to the SIGN (2011) grading criteria. The basis for level of evidence and grade ofrecommendation are summarised in tables 1.8.1 and 1.8.2.Where existing guidance was the only source used to guide a guideline statement/recommendation, this is specified. Where each guideline statement/recommendation is
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