Clinical Practice Guideline Template
Recommendations of a Clinical Practice Guideline
What group or groups produced the guideline?
What does the guideline address? Clinical questions, conditions, interventions?
Did the panel use existing SRs or did it conduct its own?
What clinical outcomes was the guideline designed to achieve?
What are the main recommendations?
What system was used to grade the recommendations?
Was the panel made up of people with the necessary expertise? Yes No Not clear
Are the goals for developing the guideline explicit and clear? Yes No Not clear
*Does the guideline production process include all the widely
recognized steps? Yes No Not clear
*Were the SRs used of high quality? Yes No Not clear
Are differences in evidence for subpopulations recognized? Yes No Not clear
*Is the evidence supporting each
recommendation graded or stated as adequate to strong? Yes No Not clear
Is the guideline current? (based on
issue date and date of most recent evidence included) Yes No Not clear
Are the recommendations credible? Yes All Yes Some No
Are essential elements of any recommended action or intervention clearly stated? Yes No Not clear
*Is the magnitude of benefit associated with each recommendation clinically important? Yes No Not clear
*Is the panel’s certainty or confidence in each recommendation clear? Yes No Not clear
Were patient concerns, values, and risks addressed? Yes No Not clear
Were downsides or costs of each recommendation addressed? Yes No Not clear
Was the guideline reviewed by outside experts and a member of the public or field tested? Yes No Not clear
Are the recommendations clinically significant? Yes All Yes Some No
Does the guideline address a problem, weakness, or decision we are examining in our setting? Yes No
Did the research evidence involve patients similar to ours, and was the setting similar to ours? Yes No Some
What changes, additions, training, or purchases would be needed to implement and sustain a clinical protocol based on these conclusions? Specify.
*Is what we will have to do to implement the new protocol realistically achievable by us (resources, capability, commitment)? Yes No Not clear
Which departments and/or providers will be affected by a change? Specify.
*How will we know if our patients are benefiting from our new protocol? Specify.
Are the recommendations applicable to our situation? Yes All Yes Some No
Should we proceed to design a protocol based on these recommendations? Implement All Implement Some No
* = Important criteria
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