Guideline Central Blog

In a bit of a deviation from the norm, rather than inform our readers of specific guideline recommendations, we wanted to provide a stepped approach for various best practices on how you can implement guidelines or specific guideline recommendations within your organization. As most know, the publication of a new guideline does not equate to instant behavioral or process changes. It often takes a great deal of time, and a focused guideline implementation campaign or initiative to effectively translate best practice recommendations into real world clinical decisions, and ultimately, improved patient outcomes. 

Key takeaways and best practices for implementing clinical practice guidelines in your institution:

• Step 1 – Identify the guideline recommendation(s) that you wish to implement
  1. Identify all available guidelines on the given topic(s) – you can use a credible guideline repository website like Guideline Central to save yourself a bit of time. 
  2. If there are multiple, understand how they are similar, how they are different, and the potential reasons for each
  3. Determine which guideline(s) and recommendation(s) to focus on
  4. You may prioritize recommendations that are most likely to result in improved client outcomes, as well as those that are supported by the best possible evidence.
  5. Consider:
     1. What are the potential benefits for patients?
     2. What are the potential cost savings?
     3. What resources might be required?
• Step 2 – Measure current practice at your institution
  1. What is the current gap between the recommendation(s) you are attempting to implement and the current clinical practice at your organization?
  2. Measure this gap and/or conduct an audit using existing data,
  3. Identify the initial time period for which you would like to compare historical practice data with any potential change after implementation efforts begin.
  4. Most people describe adherence in terms of the percentage of occasions in which the care provided was consistent with the care recommended in guidelines. You may also want to look at data which provides information on variations in care. For example, does care differ on the weekend?
• Step 3 – Identify potential barriers (and enablers) to implementing the recommendation
  1. What are some of the barriers that may impact or hinder guideline implementation? A list of common barriers for individuals is outlined below
  2. What are some of the facilitators or enablers that may support guideline implementation?
• Step 4 – Determine interventions to mitigate the identified barriers.
  1. What steps can be taken to mitigate or reduce potential barriers, 
  2. What are steps that can be taken to promote potential facilitators? 
  3. What are the direct and indirect or opportunity costs associated with these interventions?
  4. What are the potential direct or indirect benefits associated with these interventions? 
  5. Who needs to be involved, and who needs to approve of these strategies and interventions? 
  6. What sort of resources can you use to make guideline implementation efficient and effective? A list of guideline implementation tools is outlined below/
• Step 5 – Implement the strategies to improve adherence to the selected recommendation(s)
  1. After identifying potential barriers, facilitators, and strategies to maximize effectiveness of the interventions, you can begin to put your improvement efforts into place.
  2. TIp – Consider localization of the guidelines to increase likelihood of adherence. For example, if guidelines recommend SGLT2Is, and you have a preferred medication on formulary, integrate that into your implementation strategy to make it more relevant and actionable for your organization. 
• Step 6 – Measure and evaluate change
  1. Collect data on a regular, ongoing basis as you implement your interventions. 
  2. Compare pre and post intervention data to understand the increase in adherence.
  3. Examine how the change (hopefully increase) in adherence to the recommendations affected quality and patient outcomes. Also consider the financial implications of the increased adherence. Did costs decrease? Did reimbursement increase? Did time spent decrease? Etc.
  4. Make sure to share your findings with your colleagues and leadership – especially if they are positive. Organizational buy-in is a major factor in guideline implementation, and the more of your organization is on board, the more support and resources you will have to continue your efforts.
  5. Put a plan in place to continue tracking and evaluating your efforts over a long period of time to help understand whether the change/improvement was temporary or not.
• Step 7 – Repeat
  1. Based on the data you collected and your key takeaways on what did/did not work as expected, begin to plan the next intervention(s) for the specific guideline, or even the next guideline implementation initiative. 

Common Barriers to Clinical Guideline Adherence:

• Lack of awareness (“I didn’t know that was a guideline!”)
• Lack of familiarity (“I don’t know what’s inside the guideline”)
• Lack of access (“I know the guideline exists, but cannot get to it in order to reference the recommendations in my workflow”)
• Lack of clarity (“I don’t understand the recommendation, or the recommendation is too weak, conditional or otherwise not actionable”)
• Lack of resources (“I want to implement the recommendation, but I do not have sufficient time or resources to implement the recommendation(s) in the guideline”)
• Lack of specificity (“I know the general recommendation, but it does not address my patient’s specific situation and/or comorbid conditions”)
• Lack of collaboration (“I want to implement the recommendation, but to do so would require the action of one or more colleagues, and they are unwilling or unable to do their part”)
• Lack of agreement regarding the guidelines (“I’m not too sure it’s going to improve my patient’s outcome”)

Clinical Guideline Derivatives and Guideline Implementation Tools to Consider:

• Guideline database and library
• Mobile app access to guidelines and guideline recommendations
• Provider Pocket Guides and Summary of Recommendations
• Patient Pocket Guides and Plan Language Summaries
• Provider Summary of Recommendations
• Quizzes & learning activities, unaccredited or accredited
• Slide Sets
• Infographic / Visual Abstract
• Webinar or Videos
• Interactive Calculators or Algorithms
• Checklists/Reminders
• Posters/Wall Charts
• Performance Improvement Measures
• Quality Improvement Training Programs
• Clinical Cases / Case Studies
• Computable Guidelines for Integration into EHRs

*Guideline Central currently develops all of the derivative tools outlined in the list above, so if you need assistance with one or more, feel free to reach out via our contact form.

In future posts we will dig deeper into each of the steps above, and provide additional tips and suggestions for planning and executing your own guidelines implementation initiatives.