• Helen O'Neal, Alison Gray, and Angela Thompson.
• John Farman Intensive Care Unit, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK. helen.oneal@addenbrookes.nhs.uk
• Nurs Crit Care. 2008 May 1; 13 (3): 169-77.

Background And AimsBetween 2002-2005 the Trust undertook an action research project to evaluate a corporate practice development strategy. During this period clinicians became practitioner-researchers utilising a variety of methods to evaluate the influence of practice development. One aspect of this focused upon evaluation of evidence based guidelines. This article concentrates upon this process and the learning from this within critical care.MethodWithin critical care it was recognised that the standard of guidelines and protocols varied in terms of the amount of evidence used to underpin decision making. A group was set up to evaluate and appraise these using a structured format such as the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument.FindingsThe initial evaluation (cycle 1) highlighted learning associated with the process of using the instrument within critical care, as well as where the quality of the guidelines could be improved. The second cycle of evaluation demonstrated that implementation of the action plans as a consequence of cycle 1 resulted in an improvement in the quality of the guidelines. It also resulted in streamlining the process of undertaking guideline appraisal across a Trust.Discussion And ConclusionsAction resulting from analysis of the findings of cycle 1 led to a cultural change in which the structure of a tool such as the AGREE instrument could be beneficial in the development of future guidelines. This has been sustained both within critical care and Trust wide with various initiatives such as the establishment of critical care multidisciplinary guideline development groups and a Trust wide electronic library management system.

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