gms | German Medical Science

Background: A great variety of protocols for bladder instillation in Dutch hospitals led to the development of an evidence based guideline. This guideline provides recommendations on the implementation of instillation with chemotherapy and immunotherapy and counseling of patients with (suspected) non-muscle invasive bladder cancer.

Context: The guideline bladder instillation is meant for all professionals involved in the implementation of bladder instillation with mitomycin and BCG and counseling of patients with urothelial carcinoma of the bladder. The guideline is also transformed into patient information material.

Description of best practice Implementation strategies are based on an estimate of the actual situation and the possible barriers that may be encountered in practice. For the implementation of the bladder instillation guideline, we use our knowledge of the local situations to choose the best strategy. – Barrier > Implementation focus > Implementation strategy – Orientation > Guideline is known > Publications, presentations, spreading guideline summaries – Insight > Guideline is used > Training, instruction on ’what’s new’ - Acceptance > Guideline is used > Promotion by key players, informing patient organizations, showing best practices – Change > Guideline is used > Adjusting hospital procedures – Adhere changes > Use of guideline is secured > Integration in protocols, education and visitation

Lessons for guideline developers, adaptors, implementers, and/or users: In a situation with substantial national differences, a new guideline can only be implemented using tailored strategies. Knowing the local situation helps to choose the strategy that fits best, in order to reach successful implementation and improved care.