Clinical Practice Algorithm

The ‘Clinical Practice Algorithm’ (CPA) is an assessed piece of work which contributes 50% of the weighted marks for the module.

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The CPA is a decision making tool that is specific to your own area of practice, which explicitly describes all steps of decision making within your clinical area, from initial diagnosis to therapeutic option selection and monitoring, and everything else in between.

The creation of your CPA must be based on a full identification and critical appraisal of the literature relating to your prescribing area, including national guidelines, local guidelines and primary literature evidence.

There is no one set organisational format for the final CPA document, but it must represent a detailed and intuitive guide to ALL steps of decision making for ONE CLINICAL CONDITION within your area of expertise. In other words, the CPA should take the form of a thoroughly referenced and evidence based decision making algorithm that is also clearly understandable and usable to support each step of decision making in the care of a patient within the defined clinical condition.

Steps in the decision making process
Typically, the CPA will contain an evidence-based exploration and explanation of the following steps in the decision making process:

1. A clear and unambiguous definition of the clinical condition being treated

2. Identification of patient group to be treated. What are the inclusion and exclusion criteria would you apply? diagnostic indicatorsWould you not treat certain patient groups (in the interest of staying safely within an area of competence)? Common exclusion criteria include – specified extremes of age, a defined level of severity or stability of a disease, excluded co-morbidities that may complicate management.

3. Diagnostic process. How are you diagnosing the condition? What information do you need? This may include: Symptoms from history taking, signs from physical examination, information from blood tests, information from imaging, information from other diagnostic tests or interventions. However, your CPA should not merely list the diagnostic indicators, it should also demonstrate how these are used in order to make a positive diagnosis (or indeed rule out a diagnosis). This may include existing validated diagnostic processes – e.g. the “Two level Wells score” for PE and VTE.

4. Differential diagnoses. As well as demonstrating how diagnostic indicators inform making a working diagnosis, the CPA should clearly demonstrate your understanding of how the diagnostic process safely identifies and/or rules out common and SERIOUS differential diagnoses. This must include key RED FLAG indicators that would require urgent management/referral to another healthcare professional for management.
5. Severity rating/classification/staging. You may need to also include a section setting out how you use diagnostic indicators to inform the classification of severity of the condition that you are managing. Again, this should not just be a list of indicators, but should set out a clearly usable process for turning this information into a classification/rating of severity/staging of disease. e.g. Use of the CURB65 tool for assessing the severity and prognosis of cases of community acquired pneumonia.

6. Therapeutic options. Your CPA should set out the key therapeutic options available to you (including both pharmacological and non-pharmacological treatment options), and indicate how you would select between these, especially taking into account any severity rating/staging from point 5 above, patient factors (including age, pharmacokinetics, co-morbidities, preferences and patient beliefs), and common drug interactions, contra-indications and allergies (where contra-indications and allergies may require different treatment options, alternate treatment pathways or possible exclusion and onward specialist referral, as appropriate to the focus of the CPA).

7. Monitoring and Follow Up. For each therapeutic option you must include details of how this will be monitored to determine effectiveness and identify adverse effects. This will include: WHAT will be monitored, HOW it will be monitored, FREQUENCY of monitoring, WHO will review the monitoring. This may include information relating to the handing-over of this process to other members of the healthcare team.

All of these aspects included in the CPA will be based on a review and critical appraisal of the available evidence. This review is anticipated to include: National and/or International Guidelines, Local Guidelines, Local Formulary and Primary Literature.
The CPA will be referenced appropriately as per the UWE Harvard referencing system. There are three parts to the CPA  namely: 1. your flow diagram/decision making process; 2. your justification and 3. the UWE Harvard reference list.
Whilst there would be space within your justification part for UWE Harvard referencing, you may be short of space to reference within your flow diagram. In which instance, once you have compiled your UWE Harvard reference list in alphabetical order, for the flow diagram/decision making process ONLY, you may then  number your reference list and use the numbers within the flow diagram/decision making process part of the CPA.
We are expecting to see clear evidence that you have assessed all of the available evidence, and then critically appraised it as you use it to inform the key aspects of your CPA.
There is one, final submission of your CPA which is summatively assessed. The Blackboard site for the final submission of the complete portfolio will be open 2 weeks before the cut-off date (see your timetable for submission dates).
Essentially, your final submitted CPA will comprise of the following three parts:

1. the flow diagram/other graphical representation of decision making process;

2. 2000 word justification

3. the reference list (UWE Harvard).

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