Adapting national and international leg ulcer practice guidelines for local use: the Ontario Leg Ulcer Community Care Protocol.
BACKGROUND
Because of growing resources devoted to individuals requiring community care for leg ulcers, the authority responsible for home care in Ottawa, Ontario, Canada, established and evaluated a demonstration leg ulcer service. In an effort to provide current and evidence-based care, existing leg ulcer clinical practice guidelines were identified and appraised for quality and suitability to the new service.


METHODS
The Practice Guideline Evaluation and Adaptation Cycle guided development of a local protocol for leg ulcer care, which included: (1) systematically searching for practice guidelines, (2) appraising the quality of identified guidelines using a validated guideline appraisal instrument, (3) conducting a content analysis of guideline recommendations, (4) selecting recommendations to include in the local protocol, and (5) obtaining practitioner and external expert feedback on the proposed protocol. Updating the protocol followed a similar process.


RESULTS
Of 19 identified leg ulcer practice guidelines, 14 were not evaluated because they did not meet the criteria (ie, treatment-focused guidelines, written in English and developed after 1998). Of the 5 remaining guidelines, 3 were fairly well developed and made similar recommendations. The level of evidence supporting specific recommendations ranged from randomized clinical trial evidence to expert opinion. By comparing the methodologic quality and content of the guidelines, the Task Force reached consensus regarding recommendations appropriate for local application. Two additional guidelines were subsequently identified and incorporated into the local protocol during a scheduled update.


CONCLUSIONS
Local adaptation of international and national guidelines is feasible following facilitation of the Practice Guidelines Evaluation and Adaptation Cycle.
Graham
Ian D
ID
School of Nursing, University of Ottawa, and Ottawa Health Research Institute, Ottawa, Ontario, Canada.
Harrison
Margaret B
MB
Lorimer
Karen
K
Piercianowski
Tadeusz
T
Friedberg
Elaine
E
Buchanan
Maureen
M
Harris
Connie
C
D003153:Community Health Services / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D007391:International Cooperation; D007871:Leg Ulcer / Q000175:diagnosis* / Q000628:therapy*; D009313:National Health Programs / Q000592:standards; D009864:Ontario; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D017749:Total Quality Management