Shared learning database
Type and Title of Submission
Introducing a Governance framework for New Interventions and Intervention Procedures GuidelinesDescription:
In response to the Healthcare Circular - HSC 2003/011, the University Hospitals of Leicester (UHL-NHS trust) and the Medical Director established an advisory body; the New Interventional Procedures Advisory Group (NIPAG) to oversee the process and to oversee the application of NICE issued IPGs. Since it was established, NIPAG has received 47 new applications and distributed 146 IPGs. This submission describes the challenges and key learning points.Category:
GeneralDoes the submission relate to the general implementation of all NICE guidance?
YesDoes the submission relate to the implementation of a specific piece of NICE guidance?
NoFull title of NICE guidance:
-Category(s) that most closely reflects the nature of the submission:
Description of submission
Continuous innovation is key to modern healthcare. Yet, introducing new interventional procedures is linked to considerable uncertainty and, inevitably, a perceived risk. Patient safety requires that risk is assessed, communicated, and as far as possible, reduced. In response to the Healthcare Circular - HSC 2003/011, the University Hospitals of Leicester (UHL-NHS trust) established an advisory body; the New Interventional Procedures Advisory Group (NIPAG) to oversee the process, with the remit to: - act as an advisory body for clinicians when introducing new interventional procedures. - receive and review audit of compliance with the UHL-NHS trust New Interventional Procedures Policy and National Guidance. - receive and disseminate Interventional Procedure Guidance (IPG) issued by NICE and to monitor implementation across the UHL-NHS trust. Membership of NIPAG is multidisciplinary with representation from medical, nursing, clinical governance, litigation, clinical education, research & development, and management. NIPAG receives support from the Clinical Audit, Standards and Effectiveness team (CASE) and reports to the Trust Executive via the Governance and Risk Management Committee and the Medical Director.Objectives
Whilst recognising the importance of fostering innovation, the committee saw its primary objective as an advisory body that supports individual clinicians and the Clinical Directors in their role to safeguard to patient safety. In order to achieve its objectives, the committee early work focussed on raising the profile of NIPAG as an advisory body, developing stream-lined processes for decision-making, and initiatives to embed these processes within the organisational structure. The committees objectives were to: - work with clinicians to develop a mutual understanding of the issues involved with each new intervention. - raise awareness of Interventional Procedures Guidance issued by NICE. - develop processes to monitor compliance with NICE issued IPGs. The focus of early work was to draw terms of reference, procedures, and to disseminate widely using the intranet, newsletters, NIPAG conference and direct communication.Context
Historically, there was no structured framework for introducing new innovations. Much was left to individual clinicians or small teams. Neither was there a structure to oversee the implementation of nationally issued guidance. Individual clinicians may not have the necessary resources to ensure that all relevant practice areas have been adequately considered and addressed. It was important that the new committee becomes integrated into organisational culture and is not seen as an unnecessary hurdle to long established practice. The most important challenges were: 1- Maximising notification of new interventions. This remains a difficult area as new interventions are often modifications of existing procedures where the need for formal notification may not be clear cut. It was felt that a rapid turnover would facilitate clinical engagement. 2- To ensure that audit results are returned for consideration by the committee. The strategy adopted to address this relied on facilitating data acquisition by introducing a proforma with the required minimum dataset, and by introducing a process for escalating defaulting audits within the governance structure. 3- To ensure dissemination of all new IPGs and receipt of evidence of compliance. A new form was designed that contains a summary of the NICE recommendations. Responses are then reviewed by NIPAG and further information or evidence of compliance sought, where applicable, and specifically for high risk areas, or where the Clinical Director or relevant Head of Service indicated a potential difficulty with implementation. 4- Audit: NIPAG procedure required that audit data be requested from all applicants for the first 20 cases or after 6 months, whichever was sooner. The committee could request further monitoring is felt necessary. Instances include difficulty with equipment or high complication rates. Ongoing monitoring was afterwards incorporated into the relevant clinical directorate's audit programme.Methods
Since it was established, NIPAG has received 47 new applications (3 procedures have been resubmitted following a time lapse or change in personnel). Applicants received preliminary opinion within 10 days in all except two cases where there were administrative delays. All new notifications received a favourable opinion, but most required amendments to the proposal. The majority required improvements to the patient information sheet, some required additional wider team involvement such as infection control, radiation protection or pathology. Eight procedures were never started following notification and been given favourable opinion. In the majority of cases, fewer procedures were undertaken than initial projections. 146 IPGs have been distributed since NIPAG took on this responsibility. There was a poor response to the initial notifications but this has improved considerably after changes to the procedures and with more robust follow-up. The responses received following distribution of NICE IPG for 2008/9 indicated that 20 procedures are performed in the UHL-NHS trust, but 45 are not. Directorates indicated no particular problems with compliance with NICE guidance in any of the former group.Results and evaluation
We remain uncertain that all new interventions are notified to NIPAG, but we are confident that all relevant personnel are clear of the remit of the group. NIPAG is keen to receive a larger volume of notifications as we also consider this as evidence of innovative practice. There is uncertainty as to whether the number of new interventional procedures undertaken by the trust places it at a competitive advantage. Benchmarking data could be useful in monitoring performance.Key learning points
- Successful introduction of new procedures needs to be sensitive to the clinical process. A rapid response to applications and facilitation for example through the introduction of audit proformas greatly enhances compliance. - Resource implications of auditing a large number of procedures can be considerable, but the process can be facilitated through innovation and feedback. Particularly important is the need to recognise the key areas where resources need to be focussed, e.g. high risk areas. - There is a place of moving to a more proactive phase of fostering innovation in areas of perceived need. Benchmarking data would be helpful in comparing performance against that of similar size units.
View the supporting material
|Job Title:||Consultant - Senior Lecturer|
|Organisation:||University Hospitals of Leicester|
|Address:||Clinical Sciences Building, LRI|
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This page was last updated: 29 September 2009