Barriers to the implementation of clinical guidelines.
Clinical guidelines in wound care have recently been formulated at the national and international level, reflecting a shift from locally derived guidelines common during the 1990s. There remains considerable uncertainty regarding the extent of implementation and monitoring of these new guidelines. This paper presents the results of a survey of members of the Tissue Viability Society that sought their views upon the guidelines in place within their workplace--how were these guidelines developed, was the impact of guidelines monitored and how and finally what barriers limited their full implementation. Of the 1500 members, 476 returned completed questionnaires (34.0% response rate). Most (n = 422, 88.4%) worked within environments that implemented clinical guidelines in some aspect of wound care, with guidance upon pressure ulcer prevention being most commonly reported (n = 351). The use of national guidelines (either in their original format or locally modified to reflect local circumstances) was relatively common--reported by 307 of the 476 respondents. Few reported that guidelines were fully implemented (n = 77; 18.3%) with lack of resources, lack of awareness of the content of the guidelines and, when aware, lack of acceptance of their recommendations being the most commonly cited reasons for the failure to implement. However, it should be noted that only 34.0% of the surveyed population responded--this may question how far the results can be considered to reflect the current status of guideline implementation in the UK given the unreported views of 66% of all those surveyed.