NICE gateway - stories from nurses who have been involved

Those who have participated in the NICE work programme have found it informative, educative and feel that they have made a difference to nursing practice. To be involved in NICE topics, contact: caroline.rapu@rcn.org.uk. You can view current topics and recent examples of member involvement with NICE guidance.

Here are stories from nurses who have taken part.

Dr Nicola Thomas

Implementing NICE guidance in nursing practice - The ENABLE project: Reducing the variability of management of kidney disease in primary care using a care bundle approach  (based on NICE guidance Chronic Kidney Disease, CG073)

By Dr Nicola Thomas (Renal Nurse Consulting)

The overall aim of this project is to improve the management of people with kidney disease in primary care, using a Quality Improvement (QI) intervention called a care bundle. The Project is funded by The Health Foundation and the Project team is managed by Kidney Research UK.

For more information about the project, see: The ENABLE project: Reducing the variability of management of kidney disease in primary care using a care bundle approach  (based on NICE guidance Chronic Kidney Disease, CG073)  (Word 45KB)

Sue Bacon   

Implementing NICE VTE Guidelines: The ‘Highs and Lows’

By Sue Bacon, Clinical Nurse Specialist, Scarborough Hospital

Background

There has been a huge media interest in DVT; mainly surrounding the so-called ‘economy class syndrome’ and airlines were being sued. Victims of deep vein thrombosis demanded that there should be EU action to prevent DVT and consequently DVT became a much talked about issue.

John Smith MP raised the issue in Parliament and the Department of Health asked the Health Select Committee to investigate the problem. A report was produced in 2005 by the Committee. This was the first time in history that all the recommendations of the Health Select Committee have been taken up by the DoH. NICE was commissioned to produce guidelines for patients admitted to hospital by April 2007 and a Venous thromboembolism (VTE) working party was asked to produce some guidance for the CMO by July 2006 for the population NOT covered by NICE. NICE VTE guidelines were published in April 2007.

Involvement through the RCN

As a member of the RCN, with knowledge, interest and a specialist in DVT, I was asked to participate in this work and to feedback my views on the draft documents right at the beginning of the consultation process.

As a clinical nurse specialist I was able to approach various consultants, colleagues and patients regarding the proposed guidelines. I reported back to the RCN who then collated all the information from other RCN members involved in the consultation and the RCN submitted a formal response to NICE consultation on behalf of members.

‘Highs’

The NICE VTE guidance was welcomed as it was hoped that it would remove the controversy that existed between the different consultants and specialties and thus reduce the continual dialogue that surrounded the use of aspirin, foot pumps and LMWH. The guidance raised awareness of the issue of thromboprophylaxis and it was easily assessable to all health care professionals (HCPs). The guidance helps HCPs to deliver high quality care and conform to clinical governance. Since publication of the guidance there was an increase in the uptake of thromboprophylaxis in our trust.

‘Lows’

Most of the consultants are happy with the guidance but some doctors felt that their clinical decision and individual approach to their patient care has been removed from them. Orthopaedic consultants appear to disagree with the guidance and the British Orthopaedic Association has written to NICE with their concerns.

Further, the advice from NICE to offer and fit all patients with thigh length anti-embolic stockings has met some resistance.  In our trust we have agreed through the thrombosis committee and with the backing of the vascular surgeons, that we will fit below knee socks as standard. We are currently discussing funding process for the recommendation for extended prophylaxis.

Implementation of VTE guideline in Scarborough

  • Education: The clinical nurse specialist in DVT facilitates the care for the patients with a suspected or proven DVT and also educates all HCPs re thromboprophylaxis
  • Governance: We have formed a thrombosis committee looking at all aspects of thrombosis, both prevention and management
  • Risk assessment and clinical practice: VTE has been incorporated into the new nursing documentation, including the thromboprophylaxis recommendations. The VTE risk is assessed by the admitting nurse and the result transcribed onto a VTE risk assessment sticker that has been added to the current drug chart, in order to inform the doctor of the VTE risk and thus enable appropriate prescription of LMWH if required.
  • Protocols: Patients who have a plaster cast fitted should have a risk assessment prior to fitting the cast and the development of a simple protocol is in hand
  • Patient safety: A patient alert has been added to the patient information system so that when a patient with a history of VTE is admitted the ward clerk is able to print out the alert and inform the doctor immediately
  • CPD: All HCPs are receiving education and awareness of VTE but this has still to be improved
  • Promotion: We hope to print some new patient information leaflets which will, hopefully, alert the patient to reduce the risk of VTE
  • Joined up work: We hope to print a thrombosis newsletter which could be linked to the VERITY website and perhaps include audits from across the trust and maybe link in with information from other trusts
  • Wish list: We wish to extend the DVT service to at least two nurses in order to implement the above and to also improve the care given to the DVT patients, a challenge… but we have to aim high!

To summarise…

In the main the NICE VTE guidance has increased awareness of the problem of thromboprophylaxis and improved patient care.

Norman Young

I work as a lecturer practitioner in mental health nursing at Cardiff University and Cardiff and Vale NHS Trust. Having worked in acute psychiatry and in the community, I specialised in cognitive behaviour therapy prior to being employed by Cardiff University.

As member of the Mental Health Forum in the RCN I was asked to provide comments on the NICE technological appraisal for Computerised Cognitive Behavioural Therapy for Anxiety and Depression. This work was challenging not only for its technical content but also in ensuring that the role of nurses is properly reviewed. This work provided me with an insight into NICE work programmes and the stakeholder process. It complemented a number of other technological appraisals and clinical guidelines, and provided the basis for my involvement in implementation of NICE guidance.

This case study illustrates how the work of NICE has been channelled through my clinical academic role and resulted in real improvements in health care delivery. In order to adequately implement clinical guidelines published by NICE we needed the right number of people, doing the right thing at the right time. The publication of the NICE guidance on Core Interventions for Schizophrenia in 2002 highlighted the need for local improvements in service delivery and education. A work plan was developed which included the development of two degree programmes aimed at raising the number of mental health practitioners capable of delivering NICE guidance.
 
While aware that training alone is insufficient for successful implementation, the work plan therefore included the development of effective leaders, service redesign in inpatient mental health, and the development of local clinical governance groups to steer developments and monitor progress.

This work has begun to embed the NICE guidance in the routine work. In 2005 a multi-agency project to develop a clinical pathway for those who experience psychosis (schizophrenia and manic depression) was initiated. With increasing numbers of people in place to deliver the interventions outlined in the NICE guidance we are now beginning to have the right people in the right place at the right time. Future work will focus on compliance and the variance associated with the integrated care pathway.

Jane Houghton

I work as a Nurse Consultant, Paediatric Ambulatory Care at the Lancashire Teaching Hospital NHS Foundation Trust. In 2002, I worked on behalf of the RCN as a guideline development group member for the NICE guideline: Type 1 Diabetes In Children, Young People and Adults. I was lucky enough to be one of the two nurses asked to represent the RCN from the children and young people perspective of this guideline. This was developed by the National Collaborating Centre (NCC) for Women’s and Children’s Health, where meetings were held every couple of months.

The group was multidisciplinary, including two diabetes charities and NICE staff. The scope for the guideline shaped guideline development through to recommendations for clinical practice. NICE guidelines are not about service delivery models but recommend appropriate treatment and care of people with specific diseases and conditions.

Guideline development included finalising the scope; formulating the care pathway and guideline questions; breaking the questions down; systematically searching for evidence; developing recommendations for clinical practice. Most of the researching and writing was undertaken by the NCC. The document was made available for stakeholder comments at several stages. Feedback provided was addressed. This work took two years, with the two guideline subgroups meeting just once.

Every meeting was hard work, with lots of reading prior to the meeting. The meetings however were always really enjoyable and members of the group were treated as equals, with respect for each discipline. In October 2003, as a territorial army nurse, I was mobilised and sent to Iraq. Whilst there, NICE continued to send me all the papers for the meetings, and passed on my comments. This was so important to me to feel part of the outside world. I returned home in time for the launch of the final document in June 2004, at the Royal College of Paediatrics and Child Health. Press was invited and with the other nurse I gave interviews regarding the content of the guideline. We felt like celebrities, having our photos published in the Nursing Standard. I have since written articles about the guideline for several nursing journals, as well as presented at several conferences.

NICE guidance in this area is in widespread use, with some of the recommendations changing practice. It has been very rewarding to see the guidelines implemented across the country. NICE was certainly NICE by name and nature!