The implementation of venous leg ulcer guidelines: process analysis of theintervention used in a multi-centre, pragmatic, randomized, controlled trial

The production and implementation of clinical practice guidelines is curren tly a high political priority and a rapidly developing field within healthc are 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 q uality 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 thr ee collaborating universities in the Northern and Yorkshire Region of the U K 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 g eneral 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 pr ocesses 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 issue s that must be addressed if the process is to succeed. These findings provide some lessons for successful implementation of clinic al guidelines in general. Recommendations for nursing policy makers, manage rs, practitioners and researchers are included.