Shared learning database

Type and Title of Submission


Implementing Best Practice taken from NICE and incorporated into the 2009 influenza clinic to aid diagnosis of Atrial Fibrillation


A comprehensive flow chart for rapid and safe reference to ensure 'Best Practice' as per NICE guidance during a fast paced annual influenza clinic incorporating a Direct Enhanced Service to diagnose Atrial Fibrillation in asymptomatic individuals aged 65 and over. (In preference to the very basic protocol supplied by the PCT which in my opinion did not reference NICE guidance fully)



Does the submission relate to the general implementation of all NICE guidance?


Does the submission relate to the implementation of a specific piece of NICE guidance?


Full title of NICE guidance:

CG36 - CG36 Atrial fibrillation: full guideline

Category(s) that most closely reflects the nature of the submission:

Implementation policy
writing a patient centred protocol

Is the submission industry-sponsored in any way?


Description of submission


To remove the barrier that NICE guidance has to be studied and discussed and procrastinated upon, instead can be simply adapted to benefit the patient experience while keeping the standards of the practice at the cutting edge of Primary Care medicine. To question handed on protocols from the PCT that are based on expediency rather than Best Practice. To demonstrate NICE guidance is a tool to be used to ensure clinical standards are cohesive and referenced..a standardised foundation of sound practice to be implemented, not just to be aware of. In four years of working in Primary Care latest NICE guidance is briefly discussed, if there is time and often there is not, at the monthly practice meeting. My aim is to automatically update all protocols with the latest guidance and this AF flow chart has proved that can be done.


1. Using and adapting the guidance in a timely fashion rather than consigning to the practice bookcase of "latest NICE publications" 2. Providing Best Practice care to the patients 3. Having all clinicians working to the framework of Shared Governance rather than opinion based practice


PBC opportunity to detect AF during the flu clinic by manual pulse palpation. Take pulse, detect irregular and greater than 110bpm, refer for follow up within 2 weeks, continue influenza clinic. This to be done by in some cases non registered HCA's who may miss a serious arrythmia.


1. Trial clinic with my NICE based protocol showed complete safety netting. 2.any patient presenting with one of the identified arrythmias was safely referred. adequate explanation of why referral necessary and what happens next

Results and evaluation

This will be fully evaluated by patient questionnaire following the flu clinic experience. To be published on the Practice Nursing web site and Independent Nurse and Practice Nurse magazine (acceptance not guaranteed but they are interested)

Key learning points

I learned to question others practice, in this case the PCT (this raised a few eyebrows but as I was quoting NICE I was very confident) Research your facts and reference carefully. Don't be put off by criticism or lose confidence. Knowledge of your subject brings confidence and confidence creates enthusiasm and enthusiasm is infectious and creates a willingness to try new things and accept change. 3 times Practice managers rejected my new approach to the partners in using NICE guidance, preferring the old way of discuss, procrastinate and consign to the library. Be persistent and demonstrate improving patient care/experience and eventually you will win. Audit your work to keep the patient at the centre of what you are doing.

View the supporting material

Contact Details

Name:Stephanie Driscoll
Job Title:Practice nurse
Organisation:Sheringham medical practice
Address:Cromer road
Postcode:NR26 8RT


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This page was last updated: 09 September 2009

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.