Press Release

NICE 2001/012 Issued 23 April 2001

NICE has today issued the first of its clinical guidelines to the NHS in England and Wales. The Institute's clinical guidelines are derived from detailed guidelines that have been produced by clinical and patient organisations working in multidisciplinary teams.

The guideline on Pressure Ulcer Risk Assessment and Prevention provides advice on best practice for clinicians and patients and their carers to help people avoid getting a pressure ulcer (often referred to as bed sores). The Institute's recommendations are derived from a detailed guideline entitled "Pressure Ulcer Risk Assessment and Prevention" which was originally commissioned by the Department of Health from the Royal College of Nursing.

The guideline on Prophylaxis for Patients who have Experienced a Myocardial Infarction: Drug Treatment, Cardiac Rehabilitation and Dietary Manipulation makes recommendations for patients who have survived a heart attack with the aim of decreasing subsequent early deaths. These recommendations are derived from a detailed guideline which was originally commissioned by the Department of Health from the Centre for Health Services Research, University of Newcastle upon Tyne and the Medicines Evaluation Group, Centre for Health Economics, University of York.

Andrew Dillon, Chief Executive of NICE said, "Our guidance takes the key recommendations from each of these detailed guidelines and presents them in a concise form for health professionals and for patients and carers. The recommendations have been developed by health professionals, patients and experts working within the NHS. The Institute is confident that they reflect best practice for the care of patients in the NHS in England and Wales"

Ends

Notes for Editors

Background

1. Clinical Guidelines are produced to help health professionals and patients make the right decisions about health care in specific clinical circumstances. Research has shown that if properly developed, communicated and implemented, guidelines can improve patient care. Clinical guidelines sit alongside, and do not replace, the knowledge and skills of experienced health professionals.
2. Full details of the Institute's guidelines development process and principles
3. Copies of these guidelines and supporting documentation will be available on the NICE web site (www.nice.org.uk) from 12pm (lunchtime) on Monday 23 April 2001.
4. The Institute's guidance contains details of
• Who the guidance has been sent to (inside front cover)
• Implementation advice (Section 5)
• Membership of the Guidelines Development Group (Appendix A)
• Membership of the Institute's Guidelines Advisory Committee (Appendix B)
• Information for Patients (Appendix C)
Prophylaxis for patients who have experienced a myocardial infarction
5. The Institute's full guidance is published on the NICE web site (www.nice.org.uk) and is derived from the guideline entitled "Prophylaxis for patients who have experienced a myocardial infarction: drug treatment, cardiac rehabilitation and dietary manipulation." The guideline was commissioned by the Department of Health from the Centre for Health Services Research, University of Newcastle upon Tyne and the Medicines Evaluation Group, Centre for Health Economics, University of York. It is available on the Institute's website (www.nice.org.uk) and the National Electronic Library for Health's website (www.nelh.nhs.uk).
6. The guideline identifies where specific drugs (statins, beta-blockers, ACE inhibitors, antiplatelet agents, calcium channel blockers, potassium channel activators), cardiac rehabilitation, and diet should be used in people who have experienced an MI. It provides specific advice for those patients who have had a heart attack and have heart failure and for patients with diabetes.
7. This guideline is published as part of a range of clinical resources to support the Coronary Heart Disease National Service Framework. Its implementation should take place as part of the health improvement plans for each local health economy.
8. Local health communities will need to review existing service provision against this guidance. This review should result in an implementation strategy which will identify the resources required to implement fully the recommendations set out in Section 2 of the guidance, the people and processes involved and the timeline over which full implementation is envisaged. Relevant local clinical guidelines and protocols should be reviewed in light of this guidance and revised accordingly.
9. Recommendations for drug treatment assume clinicians will take account of both patient tolerability and compliance, and the indications, contra-indications and cautions as listed in the British National Formulary (BNF) or Summary of Product Characteristics.
Pressure Ulcer Risk Assessment and Prevention
10. The Institute's full guidance is published on the NICE web site (www.nice.org.uk) and is derived from the guideline entitled "Pressure Ulcer Risk Assessment and Prevention" which was commissioned by the Department of Health from the Royal College of Nursing (RCN). It is available on the Institute's website (www.nice.org.uk), the National Electronic Library for Health's website (www.nelh.nhs.uk), and the RCN's website (www.rcn.org.uk).
11. The guideline on Pressure Ulcers aims to reduce the occurrence of pressure ulcers by providing health care professionals with guidance on the early identification of patients at risk of developing pressure ulcers, the provision of preventive interventions, and by identifying practice that may be harmful or ineffective. The guideline does not cover the epidemiology of pressure ulcers or make recommendations for wound care and/or the surgical management of pressure damage.
12. This guideline does not include treatment of existing pressure ulcers. However in cases where a patient has a pressure ulcer, it will be useful in preventing pressure ulcers on other areas of the body.
13. The guideline developers were not in a position to undertake a full assessment of the cost effectiveness of pressure relieving devices and there are, therefore, no recommendations on their use in this document. In view of the importance of assessing the cost-effectiveness of pressure redistributing devices, the Institute will commission the Nursing and Supportive Care Collaborating Centre to update this aspect of the guideline using the Institute's methodology.
General Information
14. The National Institute for Clinical Excellence (NICE) is a part of the NHS. Part of its work is the development of clinical guidelines. The Institute produces guidance for both the NHS and patients on best practice in the treatment of specific clinical areas and is developed with groups that represent patients/carers and healthcare professionals.
15. The guidelines published today are part of the Institute's Inherited Clinical Guidelines work programme. They were commissioned by the Department of Health before the Institute was formed in April 1999 and have followed closely the development brief that was agreed at the time of commissioning. The developers have worked with the Institute to ensure, in the time available, that the guideline has been subjected to validation and to consultation with stakeholders. However it has not been possible to subject them to the full guideline development process that the Institute has now adopted.
16. Health professionals are expected to take the Institute's guidance fully into account when exercising their clinical judgement for individual patients. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.