Table 1 Guideline implementability framework

Adaptability

The guideline is available in a variety of versions for different users or purposes

Sources

Internet, peer reviewed journal

Versions

Full text, summary, print, digital

Users

Tailored for patients or caregivers

Useability

Content is organized to enhancethe ease with which the guideline can be used

Navigation

Table of contents

Evidence

Narrative, tabulated or both

Recommendations

Narrative, graphic (algorithms) or both; Recommendation summary (single list in full or summary version rather than dispersed)

Validity

Evidence is summarized and presented such that its quantity and quality are apparent

Number of references

Total number of distinct references to evidence upon which recommendations are based

Evidence graded

A system is used to categorize quality of evidence supporting each recommendation

Number of recommendations

Total number of distinct recommendations

Applicability

Information is provided to help interpret and apply guidelines for individual patients

Clinical considerations

Information such as indications, criteria, risk factors, drug dosing that facilitates application of the recommendations explicitly highlighted as tips or practical issues using sub-titles or text boxes, or summarized in tables and referred to in recommendations or narrative

Communicability

Resources for providers or patients to inform, educate, support and involve patients

Inform, educate, support

Informational, educational or supportive resources for patients/caregivers, or contact information (phone, fax, email or URL) for such resources

Decision making

Questions or tools for clinicians to facilitate discussion with patients, or decision aids to support patient involvement

Relevance

The focus or purpose of the guideline is explicitly stated

Objective

Explicitly stated purpose of guideline (clinical, education, policy, quality improvement)

Stakeholders

Specify who would deliver (individuals, teams, departments, institutions, managers, policy makers, internal/external agents) and receive the services (specify type of patients)

Needs

Identification of stakeholder needs, perspectives, interests or values

Accommodation

Anticipated changes, resources and competencies required to adapt and accommodate guideline utilization are identified

Technical

Equipment or technology needed, or the way services should be organized

Regulatory

Industrial standards for equipment or technology, or policy regarding their use

Human resources

Type and number of health professionals needed to deliver recommended services

Professional

Education, training or competencies needed by clinicians/staff to deliver recommendations

Workflow

Anticipated changes in workflow or processes during/after adoption of recommendations

Costs

Direct or productivity costs incurred by acquiring resources or training to accommodate guidelines, or as a result of service reductions during transition from old to new processes

Implementation

Processes for planning and applying local strategies to promote guideline utilization are described

Identify barriers

Individual, organizational, or system barriers that could challenge adoption, or instructions for local needs assessment of guideline users

Tailor guideline

Instructions, tools or templates to tailor guideline/recommendations for local context

Integrated tools

Point-of-care templates/forms (clinical assessment, standard orders) to integrate guidelines within care delivery processes

Promote utilization

Possible mechanisms by which to promote guideline utilization

Evaluation

Processes for evaluating guideline implementation and utilization are described

Implementation

Methods for evaluating the implementation process

Utilization

Audit tools or performance measures/quality indicators to assess the organization, delivery and outcomes of guideline recommended care