How to write a local guideline
Guidelines are ‘systematically
developed statements to assist
practitioner and patient decisions
about appropriate healthcare for
specific clinical circumstances’ [1]. The
purpose of a local guideline is to help
healthcare professionals with regard
to the specific patients, services and
infrastructure present in a department,
hospital or trust. Writing a guideline
can be an opportunity to review your
current situation, define best practice
and help the whole team deliver high
quality care.
What is the problem?
Clearly identify a clinical problem of relevance to your patients.
It may be an area of clinical practice with significant variation
that would benefit from standardisation, an area of developing
practice with limited local knowledge or experience, or the
adaptation of existing national guidance to fit your specific
service provision. You should carefully consider the scope of
your guideline:
- Which patients / procedures / clinical situations are
included?
- Are there circumstances when the guideline should not be
used?
- Avoid making your guideline too broad (when it might
become cumbersome to use) or too narrow (thereby
forcing people to look at several guidelines when one
would suffice).
Who is going to use your guideline?
Identify your target audience and make it as relevant as possible
to this group. Obtain input from other stakeholders (e.g. from
different clinical areas or departments) that may be affected by
it or who are required for implementation. Collaborating with
other users when developing a guideline will avoid unforeseen
problems, provide opportunity for sense-checking and give
collaborators a sense of ownership – invaluable when the time
comes for dissemination and implementation.
How does this guideline help?
Your guideline must assist its intended users in addressing
the problem(s) identified. Its design should match the clinical
situation in which it will be used. Guidelines for emergency use should be pared down to easily readable essential information
[2]. Those concerning less urgent situations will benefit from
more detail to explain the reasoning behind recommendations
[3]. Consider what information you and other users will find
helpful.
Guidelines should be written so that recommended actions
can easily be followed by all users. This requires clear, concise
and straightforward language supplying an appropriate level
of content and detail. Try to avoid acronyms, abbreviations and
jargon; if you must use them, define what they mean. Avoid
ambiguity; readers should not have any questions that are
unanswered by the guideline. Reference existing guidelines and
policy, and avoid overlap or contradiction. Your institution may
have a guideline on how to write guidelines, which is sure to
help.
Implementation
Consider whether you need to trial any aspects of the guideline
before general use; feedback from users can significantly
improve your design. Present and publish in a manner that
is easily accessible and can be readily updated. Include
appropriate search terms so it can be found when needed.
Your guideline may need to be approved by your institution’s
guidelines committee before it can be used in practice. Ensure
that everyone who might use the guideline is aware of it;
present it at as many meetings to as many groups that might
need to know.
What patient, staff and organisational benefits do you hope to
achieve by implementing your guideline? Decide which process
and outcome metrics can be (easily) measured to assess its
impact, and how frequently these should be evaluated. There
may be departments within your organisation able to help
with the data collection and analysis. Consider how soon the
guideline needs updating and identify someone responsible for
doing so.
Sam Marcangelo
Trust Grade Anaesthetist
Ben Goodman
Consultant Anaesthetist
The Newcastle upon Tyne Hospitals NHS Foundation Trust
References
- Field MJ, Lohr KN, eds. Clinical practice guidelines:
directions for a new program. Washington, DC: National
Academy Press; 1990
- Meek T. The AAGBI Quick Reference Handbook.
Anaesthesia News 2018; 366: 5-6
- Association of Anaesthetists of Great Britain and Ireland.
Peri-operative management of the surgical patient with
diabetes 2015.
Anaesthesia 2015; 70: 1427-1440