Developing guideline-based quality indicators: assessing gaps in pain management practice

In this article, the authors discuss a multiphase approach for developing quality indicators based on pain practice guidelines, and the challenges associated with the process. The presentation is based on previously published reporting standards for guideline-based quality indicators.

The following steps of the indicator development process were undertaken: topic selection; guideline selection; extraction of recommendations; quality indicator selection and practice test.

Eleven practice guidelines were reviewed for quality, and three high-quality guidelines were compared for pertinent recommendations. From these three guidelines, 12 recommendations were extracted and judged appropriate to examine the practice gap for nursing students and clinicians on an oncology and palliative care unit. Quality indicators were then identified by a consensus process, resulting in 24 discrete indicators that were included in the practice test.

Quality indicators can be used to examine gaps in pain management practice, and to evaluate change after guideline implementation. However, their development can be challenging, and guideline developers could facilitate uptake of guidelines by including clear, relevant quality indicators as part of guideline creation and presentation.