Development of local guidelines

It is intended that this guideline will be adopted after local discussion involving clinical staff and management. The Area Clinical Audit Committee should be fully involved. Local arrangements may then be made for the derivation of specific local guidelines to implement the national guideline in individual hospitals, units and practices and for securing compliance with them. This may be done by a variety of means, including patient-specific reminders, continuing education and training, and clinical audit.

SIGN consents to the copying of this guideline for the purpose of producing local guidelines for use in Scotland. For details of how to order additional copies of this or other SIGN publications, see inside back cover.

Statement of intent

This report is not intended to be construed or to serve as a standard of medical care. Standards of medical care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge and technology advance and patterns of care evolve.

These parameters of practice should be considered guidelines only. Adherence to them will not ensure a successful outcome in every case, nor should they be construed as including all proper methods of care or excluding other acceptable methods of care aimed at the same results. The ultimate judgement regarding a particular clinical procedure or treatment plan must be made by the doctor in light of the clinical data presented by the patient and the diagnostic and treatment options available.

Significant departures from the national guideline as expressed in the local guideline should be fully documented and the reasons for the differences explained. Significant departures from the local guideline should be fully documented in the patient's case notes at the time the relevant decision is taken.

A background paper on the legal implications of guidelines is available from the SIGN Secretariat.

Review of the guideline

This guideline was issued in 1999 and will be reviewed in 2001, or sooner if new evidence becomes available. Any amendments to the guideline in the interim period will be noted on the SIGN website. Comments are invited to assist the review process. All correspondence and requests for background information regarding the guideline should be sent to:

SIGN Secretariat : Royal College of Physicians, 9 Queen Street, Edinburgh EH2 1JQ

e-mail: sign@rcpe.ac.uk