The birth of a practice guideline — step by step

Developing a venous leg ulcer guideline

Maryanne McGuckin, DrSc Ed, MT, and her colleagues at the University of Pennsylvania School of Medicine in Philadelphia were all too aware of the lack of practice guidelines for the care of chronic wounds. They decided to do something about the deficiency and initiated the process of creating a guideline for the diagnosis and treatment of venous leg ulcers.

First, they conducted a thorough literature review on the care of venous leg ulcers. From these findings they developed a preliminary diagnostic and treatment algorithm, which evolved into a draft guideline, according to McGuckin, senior research investigator at the medical school. "Our intention from the start was to develop a practice guideline for the diagnosis and treatment of venous leg ulcers," she explains.

Next, McGuckin and her colleagues convened an interdisciplinary National Advisory Panel for the Venous Leg Ulcer Guideline. The panel comprised wound care specialists from around the United States. The resulting draft guideline produced by the panel was distributed nationally for peer review. Distribution was accomplished by publishing the guideline in multidisciplinary professional journals and presenting it at a major scientific meeting.

The advisory panel incorporated reviewers’ comments and suggestions and issued revised guidelines. Shortly, the revised guideline for the diagnosis and treatment of venous leg ulcers will be implemented in clinical trials. If found to be valid and reliable, the guideline may become the standard of care for venous leg ulcers.

McGuckin’s hope is that clinical trials will establish the guideline as a valid protocol whose procedures can be proved effective in controlled clinical situations. Eventually, the guideline could be accepted as a recognized standard of practice. Multicenter, prospective clinical trials should begin early this year.

The venous leg ulcer guideline represents part of a much-needed larger effort to standardize the diagnosis and treatment of venous leg ulcers in the United States, says McGuckin. This is because the high degree of the fragmentation of care for wound patients has resulted in costly treatments that are not backed by solid scientific evidence. "Such standards are desperately needed and will help to consolidate and coordinate the activities of the many professionals involved in the care of patients with wounds."