Richard Baker, Director, Eli Lilly National Clinical Audit Centre, University of Leicester

1. Who developed the guidelines?

It is worth checking whether the guideline development team included experts in the field and representatives from primary healthcare.

It would also be an advantage if one or two experts in guideline development methods were included on the team.

2. When were the guidelines developed?

The guidelines should always include a date of publication, and ideally should also include an expiry date. Because research is always improving our knowledge, even the best guidelines will become dated.

3. Who funded the guidelines' development?

Those who fund guidelines may have a vested interest. Even respected colleges may have points of view influenced by the values and interests of their members. Patient groups may wish to promote interest in specific conditions or treatments. It is important to be aware of vested interests, and to check that the guidelines are based on evidence.

4. How were the guidelines developed?

The most useful guidelines are those based on evidence. They should include information about the literature searches that were carried out. However, evidence is always incomplete, and clinical judgement will also be needed.

Can you tell from the guidelines where the evidence was the basis for the recommendations, and where reliance was placed on judgement?

1. Do you need to give special thought to implementation?

It may be that performance in your practice is already good.

If so, why bother with special steps to implement new guidelines? It might be better to concentrate your efforts on something else.

2. What problems will you have to face?

Different practice teams will face different problems or obstacles in implementing guidelines for particular topics. This means that there are no universally applicable rules. Those members of the team who will have to act on the guidelines need to be asked what difficulties they think they may encounter, and what help they will need.

3. Does everyone know what is in the guidelines?

You might decide to give everyone concerned a copy of the guidelines. However, if they are long and complicated, some people will quickly lose interest.

You may need to prepare a succinct summary of the guidelines for some members of the team. An alternative approach would be to convene a meeting for all those who may be involved in using the guidelines.

4. Would reminders be helpful?

Studies have shown that reminders on consulting room computer screens are often effective. Paper reminders can also work, but remember that no method is always effective.

5. Do you need to consider audit?

If you are serious about implementation, you will need to audit performance. Because no implementation method can be relied on to work, you need information about how successful you have been. If your method has limited effect, you may want to try another approach. Audit is the system that allows you to target implementation strategies to best effect.

Guidelines in Practice, October 1998, Volume 1
© 1998 MGP Ltd
further information | subscribe