I have been involved in the development of numerous guidelines using a range of methodologies from the pure evidence only UK NICE approach to the more pragmatic and opinion weighted Acute Disease Quality Initiative (ADQI) and Perioperative Quality Initiative (POQI). There is a massive difference in time and resources across the spectrum. I am not sure if the results are very different and how useful guidelines are that can only say "we definitely don’t know - so good luck next week when you have to make a tough choice – you’re on your own”.)
The necessary steps in setting up a fluid guideline will be discussed: the role of audits, raising awareness, form a dynamic fluid group, engage the hospital’s management, educate clinicians, appoint a fluid nurse, educate nurses, introduce fluid charts, monitor and process outcomes. The basic principle is the Act – Evaluate – Change chain.