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Table 1 Summary of results

From: Antimicrobial stewardship: a qualitative study of the development of national guidelines for antibiotic use in hospitals

Domains (cf. AGREE II)

Archival data – examples of findings

Interview data – examples of quotas

Normative conditions addressed

Scope and Purpose

Guideline rationale:

Growing AMR

Guideline purpose:

Responsible use of antibiotics in hospitals

Guideline target:

Health professionals in hospital settings

Guideline initiative:

Political and health professional

Development responsibility: Norwegian Directorate of Health

“I don’t think there has been some great discussion about whether (antibiotic) guidelines are needed. There are always some who think it’s nonsense, but we know that summarizing what’s out there is good, so that one doesn’t have an unfortunate practice compared to the evidence-base”.

“I think everyone needs the guidelines, because the specialists are not necessarily on duty and they are not always available (...) and even to us (the specialists), well it is a large area, having the guidelines as a pillar, not least, it is important”.

“Why should we change practice when the local guideline works well? The national (guideline) is important but I wouldn’t accept everything at face value, to put it simple”.

Guideline relevance

Stakeholder Involvement

Development process: Project organizing

- Steering group

- Guideline development group

- Expert groups

Stakeholder representation:

- Health authorities

- Norwegian Medicine Agency

- Norwegian Institute of Public Health

- National Advisory Unit for Antibiotic Use in Hospitals

- Antibiotic Centre for Primary Care

- Norwegian Federation of Organizations of Disabled People

- a.o.

Expert involvement:

>80 health professionals

“I believe that the process was very good because the guidelines were anchored in a wide academic environment, that is, in several disciplines. These are guidelines that all hospital doctors (….) should be aware of. And it was important that representatives, influential representatives that is, from each discipline were included, representatives appointed by the different specialist associations.”

“When people are a part of the process they experience a sense of ownership. And these people are influential people at the different hospitals”.

“When so many people from infectious disease medicine and micro-biology are involved in the development of the guidelines, they (the guidelines) get a totally different impact and credibility (...). If people disagree at least they know that many and mostly well trained people have approved the outcome.”

“I think that there is a greater risk that one can come up with guidelines that are not being used if you don’t do it this way (…). It is the spirit of dugnad”.

Relevance of evidence, reasons and their foundations

Transparency of decision-making process

Rigor of Development

GRADE methodology for some recommendations

Systematic literature reviews using PICO

Various data sources

Recommendations based on specific criteria

Formalized strategy for implementation and update

Update responsible: National Advisory Unit for Antibiotic Use in Hospitals

“The new guidelines have a clear advantage in that they to a greater extent are evidence-based, with references, and (are the outcome of) a transparent process. The authority of the new guidelines is great, I think”.

“It’s definitely a need to have a “live” guideline”.

“It is the fresh produce really. Infectious disease medicine changes quickly”.

Relevance of evidence, reasons and their foundations

Transparency of decision-making process

Revisability of guidelines

Clarity of presentation

Recommendations presented as strongly or conditionally recommended

Tables summary of recommendations

“I don’t think it’s good if there are changes that make our work more cumbersome, but changes that make the work easier (…) then I’m all in”.

Transparency of recommendations


Electronic publication

Standard and short version

“In everyday life you want everything to be easily available (…). I want a leaflet to have in my pocket”.

“Everyone has a smart phone now (…). And with an app, well that would be great”.


Editorial independence

Guideline developed by the Norwegian Directorate of Health

“If there is something that is published on the Web by the Norwegian Directorate of Health, you think it’s updated, the latest, it is that which applies”.

Guideline relevance