Harrogate and District NHS Foundation Trust
An initiative to produce a comprehensive database framework using MS Access to record the Trust's progress against NICE guidance.
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Aims and objectives
The purpose of this initiative was to produce a comprehensive database framework using MS Access to record the Trust's progress against NICE guidance. It was intended that the database would be used to hold information ranging from identifying lead clinicians, supporting evidence to state compliance and summary information relating to implementation and NICE information releases. Ultimately the database would be an easily accessible service to those wishing to ascertain the Trust's governance structures in relation to NICE guidance, to support Standards for Better Health but also to highlight practical areas where best practice improvements were needed. 1. To devise a framework which can continually be updated with new information pertaining to NICE guidance, making ease of access and ease of reference key. Importantly this meant ensuring that all relevant subfields were included in the database outline to ensure a sufficient level of detail. 2. To devise a method of being able to attach evidence of compliance (audits, clinical statements, formularies etc) to the relevant category of NICE guidance and to ensure that this evidence is easily accessible and transferable within the database as a sealed entity. 3. To devise a means of reporting the outputs from the database so that summaries of information and compliance statements can easily be drawn from it and converted into documents that are readily available to Trust colleagues' primarily to support compliance, progress and historical trends.
Reasons for implementing your project
Prior to the intervention and old database had been established but not updated since 2003 and this did not fulfil the expected governance requirements. A baseline assessment was conducted of what key pieces of information NICE produces for each guideline that would need including (dates, labels, names), what key requirements the Healthcare Commission might expect in terms of monitoring (compliance, evidence) and what information was useful to the Trust in terms of tracking progress (lead clinicians, when information sent/received, clinical opinion on the guidance). The database was intended to be maintained and operated by the NICE Manager but with the ability to be presented to the NICE and Medicines Management Group and Trust Board.
How did you implement the project
1. The framework was devised through trial and error (and multiple draft versions) to ensure that each of the distinct fields that needed to be related were, and to make sure that the multi-page layout of the database flowed successfully. Amendments were made as new fields were recognized to be needed, although even now the database is operational there remains the flexibility to alter the layout and key structures. 2. The database is now fully operational. Every piece of NICE guidance issued (all CGs, TAs, IPGS, PHI, PHOs, IPGs) has a section devoted to it with corresponding pages that link to the guidance within HDFT and the provision of evidence to support a statement of compliance. There are also instances of consultations, announced guidance and scoping documents being recorded on the database which are easily transformed into published guidance when necessary. Evidence is attached to all guidance where this exists via a method of hyper linking the database content to folders contained within the overall database grouping, maintaining the transferability of the data. 3. Queries have been set up and given a dedicated page of the database for all the most common requests (by department, by type, by compliance level, by date, by audit). This has resulted in a series of quick-reporting mechanisms to provide necessary NICE information at the touch of a button.
Monitoring of the database is done primarily via the daily use of the software by the NICE Manager and any needs are quickly identified and met. On a more strategic level, presentations of the database to the NICE and Medicines Management Group and to all Trust bodies has confirmed the acceptance of the database as a viable tool for the collation and reporting of NICE guidance information.
Key learning points
Don't be afraid to experiment with new types of database and if necessary start again when initial versions do not work out. It is important to ensure that before the time consuming operation of inputting data takes place that the system feels as though structurally it is sound and will not need a large scale overhaul. Take the project in steps, focusing on TAs first then CGs, then IPGs etc otherwise it is easy to get lost in inputting the data. Finally, make sure back-up copies exist otherwise a lot of work can easily go missing!
Harrogate and District NHS Foundation Trust
Is the example industry-sponsored in any way?