title: The implementation of venous leg ulcer guidelines: process analysis of the intervention used in a multi-centre, pragmatic, randomized, controlled trial.
abstract: The production and implementation of clinical practice guidelines is currently a high political priority and a rapidly developing field within healthcare in the United Kingdom (UK). Their purpose is to provide clinicians with a synthesis of the best available external evidence and operationalize the implementation of evidence-based practice. Despite indications that clinical guidelines can make a difference to the quality of patient care, there is some evidence that practitioners struggle with their application. The aim of this paper is to report one element of a trial undertaken by three collaborating universities in the Northern and Yorkshire Region of the UK health service during 1997-1998. The objective was to understand what makes guidelines acceptable and usable, or otherwise, to health professionals. The findings reported in this paper describe the process of care in those general practices that elected to implement guidelines for the management of patients with venous leg ulcers. We conclude that planning for training, resource and quality improvement processes must be built into a team's guidelines implementation procedures. A preliminary needs analysis of the contextual 'hurdles and levers' within each primary healthcare team is also necessary to identify individual issues that must be addressed if the process is to succeed. These findings provide some lessons for successful implementation of clinical guidelines in general. Recommendations for nursing policy makers, managers, practitioners and researchers are included.
authors.affiliation: Centre for Research in Primary Care, University of Leeds, UK. j.marshall@leeds.ac.uk
authors.forename: J L
authors.initials: JL
authors.lastname: Marshall
authors.forename: P
authors.initials: P
authors.lastname: Mead
authors.forename: K
authors.initials: K
authors.lastname: Jones
authors.forename: E
authors.initials: E
authors.lastname: Kaba
authors.forename: A P
authors.initials: AP
authors.lastname: Roberts
mesh_terms: D001291:Attitude of Health Personnel; D001458:Bandages; D004739:England; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000193:education / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006285:Health Planning / Q000458:organization & administration; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D008485:Medical Audit; D020380:Needs Assessment / Q000458:organization & administration; D009722:Nurse Practitioners / Q000193:education / Q000592:standards* / Q000706:statistics & numerical data; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011637:Public Health Nursing / Q000193:education / Q000592:standards* / Q000706:statistics & numerical data; D017749:Total Quality Management / Q000458:organization & administration; D014463:Ultrasonography; D014647:Varicose Ulcer / Q000000981:diagnostic imaging* / Q000628:therapy*