Best Practice Guideline Development Methods: An Integrated Approach Based on the Registered Nurses' Association of Ontario's Methods.

Since 1999, the Registered Nurses' Association of Ontario (RNAO) has developed best practice guidelines (BPG) to promote consistency and quality of evidence-based care and improve patient, organization and health system outcomes. A distinguishing feature of RNAO's BPG development portfolio is its integration within RNAO's three-pillar BPG programme. This programme supports health service and academic organizations, Best Practice Spotlight Organizations® (BPSO®), to systematically implement, monitor and evaluate BPGs. Through formal partnerships with these organizations, the BPSO network extends the reach of the BPG programme and provides RNAO with direct feedback from end users, strengthening the relevance of future guideline editions. This article describes RNAO's integrated BPG development methods, outlining how evidence-based recommendations are made to support organizations implementing BPGs. Following extensive pre-development work to shape the purpose and scope of each guideline, an interprofessional expert panel that includes people with lived experience is appointed. Using the Grading of Recommendations, Assessment, Development and Evaluation methods, the expert panel prioritizes research questions and systematic reviews are conducted to determine strong or conditional recommendations. Good practice statements are also included and resources to support guideline implementation and evaluation are formulated including fact sheets, RNAO Clinical Pathways™ and evaluation measures. Draft guidelines undergo external review to ensure relevance and usability. To best serve the needs of organizations implementing BPGs, ongoing efforts are being made to keep RNAO's methods up-to-date and incorporate evaluation data from implementing organizations into the guideline development process.