Practice guidelines and measurement: State-of-the-science

Background: Restructuring of the health care system has exposed widespread evidence of practice variability and has highlighted the benefits associated with nurses embracing interdisciplinary, best practice solutions to health care delivery. Clinical practice guidelines have emerged as a valuable interdisciplinary evidenced-based tool. Purpose: This article explores the state of the science of guideline measurement and evaluates the strengths and weaknesses of measurement approaches. Method: A computerized search of Cumulative Index of Nursing and Allied Health Literature, Health and Psyckosocial Instruments, Medline, and PubMed for the search term "practice guidelines" was combined with the following keywords: attitudes, adherence, effect, impact, instrument, and measurement. Discussion: Measurement issues identified in this analysis are related to the manner in which guidelines are written and the lack of a standard methodology for measurement. Conclusions: The challenge remains to establish sound measures of adherence and impact while controlling for confounding variables. Questions remain as to the format of practice guidelines to best grant autonomy while offering recommendations that are clear and measurable.