Compliance with instructions for writing structured care management tools. 
The aim of this study was to assess whether clinical guidelines complied with the instructions for writing structured care management tools in a French university hospital.  A cross-sectional study of guidelines for appropriate antimicrobial agent use in the authors' institution was carried out.  A total of 221 guidelines were retrieved in 62 hospital units.  The number of guidelines by unit ranged from one to 22 and 198 guidelines (90 per cent) had been developed at the local level.  None of the guidelines fully complied with the ten criteria of the instructions.  Each guideline met, on average, 4.2 criteria (3.9-4.5).  The partial compliance rate was 75 per cent (68-80).  In two-level multivariate analysis, factors associated with partial compliance were: dissemination of guidelines after implementation of the instructions (odds ratio = 6.25 (2.41-16.21)), existence of more than one storage site for guidelines in each unit (OR = 3.26 (1.03-10.32)), and hospital unit (variance of the intercept = 1.54).