Shared learning database

West Yorkshire Critical Care Network
Published date:
April 2009

The implementation of the Acutely Ill Patient in Hospital NICE guidance (CG50) across 5 Acute Trusts, the universities and medical school in West Yorkshire. This involved a pre and post audit using national guidance. Engaging all key stakeholders, the Acutely Ill Competency Framework was piloted in all 5 Acute Trusts in West Yorkshire and as a result recommendations were made.

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 aim of the project was to implement the Acutely Ill Patients in Hospital (NICE: 2007 - CG 50) into all 5 Acute Trusts in West Yorkshire to ensure equity of care for all patients admitted into a secondary facility irrespective of postcode. 1) An objective was to gain support from Senior level managers, clinicians, universities and local medical schools to inform them of the essence of the NICE guidance and the implications to their organisations. 2) To ensure that the recommendations within the document were devolved to all acute Trusts within WYCCN. 3) A further objective was to work with the national competency framework associated with the CG50 NICE guidance and its implementation across all Acute Trust NHS employees with West Yorkshire.

Reasons for implementing your project

The WYCCN appointed secondment clinical educators across the 5 Acute Trusts (1 per Trust). A pre-audit informed them where their organisation sat against the NICE guidance (CG50). The pre-audit highlighted that the standard of observations across all 5 Acute Trusts did not comply with the NICE guidance (CG50). Appropriate organisational recommendations and implementation plans were made at this stage.

How did you implement the project

1) There was enthusiasm from Senior Management, Clinicians, universities and medical schools across West Yorkshire to be involved in this work. 2) The clinical educators were able to disseminate the information within the NICE guidance (CG50) to high level managment and clinical meetings which gave support to the work being undertaken. 3) From this, support was given to the use of the competences on a pilot site within each Acute Trust for future implementation organisation wide. 4) The Universities and Medical schools are also keen to build in the recommendations and competences of the document into future courses of study. 5) Barriers the Educators came across were around the implementation of the Early Warning Score and call out algorithm in areas not using it. A further barrier was around the number of competences staff needed to achieve. This was made easier by putting into a simple format which mirrored the guidance. A 3rd barrier was getting medical support. 6)Each Acute Trust Educator completed their pre-audit, based on the national audit tool (NICE), and formulated reports and presentations for key senior management meetings. This report highlighted areas for improvement where the key recommendations of the NICE guidance (CG50) were not being met. The reports also made recommendations for individual organisations to improve areas where needed. 7) The Educators then identified one or two clinical areas within their organisation to implement the competencies as a pilot. 8) Currently Educators are carrying out post audits (12 months after pre-audits) to identify areas of improvement following senior management / clinician meetings. This will also identify improvements particularly in areas where competences have been piloted. Prior to the publication of the NICE guidance (CG 50) there was national evidence from NPSA & NCEPOD reports that patients admitted to acute hospitals were receiving sub-optimal care.

Key findings

The progress of the Educators was monitored by monthly meetings with WYCCN management as well as open contact in between. Evidence of success of the project to date is that in some organisations wider use of early warning scores has been implemented and new observation policies developed. In one Trust a new colour coded observation chart has been developed and shared using the same 'Low', 'Medium' and 'High' risk patients methodology as in the national guidance. The results of the post audits will be published within individual organisations final reports and shared with the WYCCN. The impact of the project on patients will be shown in these reports. It is anticipated that our aim to ensure improved adult patient care across West Yorkshire will be evident.

Key learning points

1) It is essential to obtain Chief Executive and Chief Nurse sign up to the implementation of the guidance organisational wide. This will endorse the work for the Educators at Senior Management / Clinician level. 2) A 'driver' within organisations is key to ensure the guidance is embedded into practice. The use of a clinical educator for this is a good model. 3) It is essential that the Educator is a good communicator and able to link with Directors, Matrons and Management in all areas. 4) The WYCCN offered 2 roadshows prior to the project which gave a taster of the contents of the guidance and where organisations need to be to achieve the recommendations within them. 5) A link with universities / medical schools was felt to be important to ensure that future cohorts of nursing and medical staff are aware of and prepared to implement the NICE guidance on commencement within Acute Trusts. 6) The Educators need to avoid the minute details within clinical areas, but need to engage at senior levels to ensure that these key people become the drivers for change as they are the key motivators within their clinical areas.

Contact details

Margaret Clark
Network Manager
West Yorkshire Critical Care Network

Is the example industry-sponsored in any way?