How to write a local guideline | Association of Anaesthetists

How to write a local guideline

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.


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


  1. Field MJ, Lohr KN, eds. Clinical practice guidelines: directions for a new program. Washington, DC: National Academy Press; 1990 
  2. Meek T. The AAGBI Quick Reference Handbook. Anaesthesia News 2018; 366: 5-6 
  3. Association of Anaesthetists of Great Britain and Ireland. Peri-operative management of the surgical patient with diabetes 2015. Anaesthesia 2015; 70: 1427-1440