Caring For Australians with Renal Impairment (CARI) Guidelines - Australia/New Zealand

Website: http://www.cari.org.au/ 

Guideline Development Process:
Development of a guideline occurs in five stages:

1. Scoping and tasking - identification of topics and writing allocation
2. Literature searching and writing of draft

• Levels of evidence according to the NHMRC classification (6 tiers)
• Focus on guidelines that are clearly evidence-based (i.e. evidence from randomised controlled trials)
• At least 3 face to face meetings for Guideline Group members to assist with meeting deadlines.

3. External peer review/consumer and nephrology community comment
4. Steering Committee approval/request for changes to revised draft
5. Editing and publication of guideline in Nephrology/uploading to CARI website

Evidence Review:
The CARI Guidelines are strictly evidence-based - that is, they are drawn from the published literature, which is carefully assessed for its level of certainty. Only when the conclusions in a particular area are based on a high degree of certainty is the guideline ratified. Recommendations are based on Level I or II evidence according to the NHMRC evidence classification system; Level I refers to "evidence obtained from a systematic review of all relevant randomised controlled trials" and Level II refers to "evidence obtained from at least one properly designed randomised controlled trial."

Implementation Activities:
In 2004, the first stage of an Iron implementation project was commenced. This involved performing a clinical audit of 6 renal centres for their practices and procedures regarding Iron levels for their patients and comparison of these results against the CARI guideline on Haemoglobin Targets. In 2005, the second stage of this project was begun. This stage involves bringing practice in line with the CARI guideline; three of the six renal units that were audited regarding their Iron Management processes are working with the CARI Implementation Team to help bring about agreed practice changes.

CARI obtained a seeding grant in 2005 from the National Institute of Clinical Studies (NICS) which enabled a consultation process to be held with representatives of all sectors of the organ donation process. As a result, the organ donation process was mapped and barriers to increasing donation rates were documented. The next stage will involve the implementation of this project over a 2-year period.