By integrating all the discussions above, a comprehensive flowchart with detailed implementation instructions is given in Figure 19.
This suggests that additional strategies may be required to promote use of the guidelines enhanced with user implementation instructions.
Given the implications of cost, effort, time, engagement and impact, incorporating implementation instructions and tools in guidelines to enable implementation by users emerged as the most relevant and actionable approach.
Adding implementation instructions to guidelines would help users apply the recommendations in practice: that's what brings the guideline to life and helps people put the information in practice (06).
Guidelines published in 2007 and earlier assessed with the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument scored poorly for applicability, which reflects the inclusion of implementation instructions or tools.
Considerable evidence supports the assertion that guidelines featuring implementation instructions or tools such as those recommended by Greenhalgh et al 7 and Pronovost 8 are more likely to be used.
For purposes of the initial keyword search, documents searched included white papers, green papers, draft bills, bills, acts, notices of or official amendments to acts (including regulations, proclamations, promulgations, and national instructions), and other official documents such as policy guidelines that provide implementation instructions for policy development or implementation (see Box 2).
13 The domain of applicability includes four items related to planning, undertaking and evaluating implementation facilitators and barriers of guideline implementation, resource considerations, monitoring or audit criteria, and implementation instructions or tools similar to those recommended by Greenhalgh et al 7 and Pronovost, 8 and for which there is evidence of association with guideline use.
Applicability of guidelines, which refers to the inclusion of implementation instructions and tools, did not improve subsequent to the publication of two similar meta-reviews in 2010 and 2012, respectively, which examined a total of 654 guidelines published from 1980 to 2007.
The TIE compiler is a tool that automates the implementation of instruction set extensions defined using the TIE language.
