Appraising a Guideline Before Adopting It

In practice

A guideline on pressure injury prevention is proposed for adoption. Who developed it is asked first, because institutional auspices and editorial independence bear on everything that follows; the panel is multidisciplinary and its funding is declared. Is it based on a systematic review, or on assembled opinion. This one cites a review, and the review is checked to exist rather than taken on trust. Is it current within five years — it is four years old, which passes, though the field's own literature has moved since. Recommendations are then read one at a time, because a guideline is not a single object with a single quality. The two-hourly repositioning recommendation carries a strong grade, while the specialty mattress recommendation carries a weak one. A weak grade is not a defect. It means the panel judged the balance of benefits and harms to be close, or the evidence uncertain, and a weak recommendation demands more conversation with the patient rather than less. Strong is also not the same as high priority: a strongly supported recommendation about a rare complication may matter less on this unit than a weakly supported one about something seen daily. Applicability and flexibility are checked against local practice, and the distance from current practice is measured, because that distance is the implementation work.