Background Intravenous therapy is one of the most frequently used interventions in health care, with increasing complexity and duration of treatments. A clinical practice guideline (CPG) on this topic was developed within the framework of the Spanish programme (National Health System) aimed to provide recommendations on intravenous therapy best practice.
Objective To describe CPG development process, considering methodological issues, such as updating and adapting existing guidelines and expert inputs.
Methods Using the GRADE approach, an evidence synthesis was developed for each clinical question, including adoption or update of valid recommendations from selected guidelines. Expert panel followed methodology proposed by Jaescke et al with predefined consensus criteria to categorise recommendations.
Results After assessment with AGREE II instrument, 3 guidelines were considered highly recommended and selected for adaptation/updating. Evidence synthesis and recommendations for each 63 initial clinical question were drafted and sent to the expert panel who voted individually. Areas of disagreement were identified and discussed in a face-to-face meeting. After the second voting round 55 recommendations remained, of which 27 were rated as strong, 12 as weak and 14 as good practice recommendations. Six of them were adopted/updated from previous guidelines. In 2 cases there was no agreement in the panel and no recommendation was issued.
Discussion GRADE proved to be a useful method to develop a complex guideline, incorporating evidence from previous guidelines and expert opinion. The method was well accepted and followed by the panel and improved the elaboration of recommendations.
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