Royal Sussex County Hospital
To implement and monitor NICE CG65
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
To facilitate and enhance the implementation and monitoring of NICE CG65. Objectives: 1. To provide a clear appraisal of the guideline 2. To emphasise the objectives of the guideline 3. To encourage and improve audit of the guideline 4. To facilitate monitoring of the desired outcomes and therefore guideline implementation.
Reasons for implementing your project
The economic and health benefits of the preventing perioperative hypothermia were demonstrated the NICE clinical guideline 65. The guideline also defined the outcomes by which successful implementation should be measured. We felt that the key to effective implementation was to provide a simple, clear and consistent means of auditing these outcomes.
How did you implement the project
The responsibility for preventing perioperative hypothermia rests mainly with the anaesthetist. We therefore wrote an audit 'recipe' which clarified, in simple, narrative terms, the endpoints set-out by the guideline. This was then published on the Royal College of Anaesthetists website and in their audit manual. To aid data collection, we produced a document on which all the relevant information could be entered. To aid the processing of the data, we produced an excel spreadsheet which, when the information from the collection sheets is entered produces a summary of the performance in relation to the outcomes defined in the guideline eg. the percentage of patients arriving in recovery with a temperature of 36.0 degrees C or more. These documents have been linked to the recipe on the College's website To advertise this resource to as many UK anaesthetists we publicised the initiative through an editorial we wrote for the British Journal of Anaesthesia (this journal is sent out to all anaesthetists registered with the Royal College).
The 'recipe' and associated forms have been used in our Trust. It was found that inputting the data was simple and that the results were clear. In our last audit we found that, despite widespread adoption of the guidelines, 15% of our patients arrive in recovery hypothermic. As a consequence of this, we have written an algorithm outlining a more aggressive warming regime with a view to reducing the rate of hypothermia and therefore improving patients' experience and outcomes. We are currently preparing another audit to see if this has improved our performance. If this proves effective we will publish the algorithm as a further linked document on the Royal College of Anaesthetists audit website.
Key learning points
We have found that simplifying the process of data collection and processing has greatly enhanced our ability to deliver and respond to a NICE guideline. We would recommend to anyone wishing to effectively implement a guideline with clearly defined end-points to adopt.
Royal Sussex County Hospital
Is the example industry-sponsored in any way?