Putting this guideline into practice
NICE has produced tools and resources to help you put this guideline into practice.
Some issues were highlighted that might need specific thought when implementing the recommendations. These were raised during the development of this guideline. They are:
Education of health and social care staff and support workers – there are national minimum standards for these groups (see national minimum standards and core curriculum for immunisation training for registered healthcare practitioners, the Royal College of Nursing's Immunisation knowledge and skills competence assessment tool, and Immunisation training of healthcare support workers: national minimum standards and core curriculum). Health Education England's eLearning for Healthcare platform has produced an interactive flu immunisation eLearning programme. A national flu programme training slide set is available from Public Health England. The Royal Pharmaceutical Society provides a seasonal influenza hub with information and educational resources accessible to its members. These resources could be used in implementing this guideline.
Support from national bodies, professional groups and royal colleges – organisations such as the British Medical Association (BMA), Royal College of Nursing and the Royal Pharmaceutical Society encourage their members and others to accept the flu vaccination. This includes advice that the BMA provides for occupational health providers: see the BMA's influenza immunisation for employees. See also: the General Medical Council's guidance on good medical practice, the Nursing and Midwifery Council Code, advice from the General Pharmaceutical Council, the Health and Care Professions Council's Standards of conduct and the Royal College of Nursing's guidance and resources on flu vaccination. This support and drive to increase flu vaccination could provide a useful lever for action in implementing this guideline.
Existing national targets – there are a number of national targets including public health outcomes frameworks (3.03, 4.03, 4.07, 4.08) relating to population flu vaccination uptake. These targets could be used to establish the case when seeking to commission, develop and implement interventions recommended in this guideline.
Existing incentive-based payment mechanisms to organisations to increase uptake – there are a number of incentives in primary and secondary care to increase flu vaccination, including Quality and Outcomes Framework, or QOF (secondary prevention of coronary heart disease [CHD007]; diabetes mellitus [DM018]; chronic obstructive pulmonary disease [COPD007]; and stroke and transient ischaemic attack [STIA009]) and Commissioning for Quality and Innovation, or CQUIN (improving the uptake of flu vaccinations for front-line clinical staff [CQUIN 1c]). Framing proposals to increase flu vaccination in terms of the achievement of indicator criteria, as well as stating the impact on mortality and morbidity, may positively influence development and implementation of interventions recommended in this guideline.
Existing examples of best practice guidance for increasing flu vaccination uptake – GPs have Flu vaccine for children: best practice guide for GPs and for healthcare workers, NHS Employers have good practice guides and case studies from former flu fighter award winners as well as planning, communications and reviewing campaign guides.
Existing resources to support targeting, tailoring and information provision for eligible groups, including template letters, posters and easy read leaflets, can be found at Public Health England's resource centre webpages for the Stay Well This Winter campaign, and on the annual flu letter webpage.
Putting recommendations into practice can take time. How long may vary from guideline to guideline, and depends on how much change in practice or services is needed. Implementing change is most effective when aligned with local priorities.
Changes should be implemented as soon as possible, unless there is a good reason for not doing so (for example, if it would be better value for money if a package of recommendations were all implemented at once).
Different organisations may need different approaches to implementation, depending on their size and function. Sometimes individual practitioners may be able to respond to recommendations to improve their practice more quickly than large organisations.
Here are some pointers to help organisations put NICE guidelines into practice:
1. Raise awareness through routine communication channels, such as email or newsletters, regular meetings, internal staff briefings and other communications with all relevant partner organisations. Identify things staff can include in their own practice straight away.
2. Identify a lead with an interest in the topic to champion the guideline and motivate others to support its use and make service changes, and to find out any significant issues locally.
3. Carry out a baseline assessment against the recommendations to find out whether there are gaps in current service provision.
4. Think about what data you need to measure improvement and plan how you will collect it. You may want to work with other health and social care organisations and specialist groups to compare current practice with the recommendations. This may also help identify local issues that will slow or prevent implementation.
5. Develop an action plan, with the steps needed to put the guideline into practice, and make sure it is ready as soon as possible. Big, complex changes may take longer to implement, but some may be quick and easy to do. An action plan will help in both cases.
6. For very big changes include milestones and a business case, which will set out additional costs, savings and possible areas for disinvestment. A small project group could develop the action plan. The group might include the guideline champion, a senior organisational sponsor, staff involved in the associated services, finance and information professionals.
7. Implement the action plan with oversight from the lead and the project group. Big projects may also need project management support.
8. Review and monitor how well the guideline is being implemented through the project group. Share progress with those involved in making improvements, as well as relevant boards and local partners.
NICE provides a comprehensive programme of support and resources to maximise uptake and use of evidence and guidance. See our into practice pages for more information.
Also see Leng G, Moore V, Abraham S, editors (2014) Achieving high quality care – practical experience from NICE. Chichester: Wiley.