Implementing NICE within a Learning Disability service: A service wide journey

Aim: To improve service wide, registered and unregistered, multi-disciplinary staff engagement in the routine use of NICE guidance to evaluate and improve clinical care delivery.

Objectives:

• To educate staff on the use of NICE guidance in clinical practice.
• To empower register and unregistered staff to review current clinical practice against evidence-based guidance.
• To provide a regular forum for staff to debate and share learning around the review of guidance against own practice.
• To actively engage frontline, multi-disciplinary registered and unregistered staff in NICE relevance assessments and NICE baseline assessments.
• Using the outcomes from relevance and baseline assessments to engage frontline staff in the co-production of action plans to improve compliance.
• To establish systems and process that supports the development of a positive culture around the implementation of NICE guidance.
• To ensure that our clinical pathways are reviewed and developed in line with NICE guidance.

A CQC Key Lines of Enquiry (KLOE) self-assessment highlighted gaps across the learning disability service, particularly with relation to staff understanding and awareness of NICE guidance and the routine use of NICE guidance by staff to review, evaluate and improve current practice.

No process or opportunity existed within the service for staff to come together to share, debate or communicate any experiences around the use of NICE within care delivery.

The LYPFT Learning Disability service consists of 450 staff, across 23 sites and 4 key service arms, these being:

• Community & health facilitation teams
• Inpatient and health respite services
• Specialised supported living services
• User Involvement Team / Services In addition to unregistered staff, the service has 8 different professions that work together to form integrated teams.

The service provides health interventions across three core areas, these include:

1). Adults with learning disabilities who have behaviours that challenge services

2). Adults with learning disabilities that have mental health needs

3). Adults with learning disabilities that have complex, multiple impairments / physical health needs.

The size and diversity of the staff / professions and services, as well as the range of clinical needs that the service meets, pose specific challenges in regards to ensuring service wide implementation and routine use of NICE guidelines by all staff within care delivery.

The service lead received a tutorial from the Trust NICE lead to; increase understanding of Trust NICE review & implementation process & “current state” of staff involvement in NICE relevance / baseline assessments & staff understanding / use of NICE guidance in clinical practice.

The service lead worked with professional leadership colleagues to plan, prepare and deliver a service wide clinical learning event on NICE guidance, the aims of which were to:

• Explore how NICE guidelines help to ensure that we deliver high quality, safe and effective care to the people that use our services.
• Increase awareness and understating of the Trust ‘s systems and processes for assessing / embedding NICE guidelines within the organisation.
• Hear case study examples of how learning disability (LD) staff have used NICE guidance to improve their practice.
• Discuss ideas for how to engage frontline staff in the NICE relevance and baseline assessment process.

At the learning event the concept of a NICE Guidelines Working Group was introduced. Representatives from each profession, un-registered staff & operational management were requested to attend the group. The group meets bi-monthly.

The aims of the group are to:

• Receive new and updated NICE guidance, assess them for relevance to the service, and report findings back to the trust.
• Co-ordinate and identify the right people to complete NICE baseline assessments.
• Complete baseline assessments and develop proposals for action plans to ensure compliance.
• Communicate and share the work of the group with team colleagues.
• Ensure clinical pathways are developed in accordance with NICE guidance recommendations.

A challenge of the work has been in developing a culture of shared collective leadership and ensuring that group members prepare for and communicate the outcomes of the group to colleagues. A key solution to this was for the service lead to meet with group members to discuss the terms of reference for the group and members roles and responsibilities.

Staff engagement and ownership of the group was strengthened through regularly celebrating achievements and service improvements that had occurred as a result of the groups’ work. This helped to communicate the importance of the work and helped to raise the value of the group and the work of its members.

Key outcomes include:

• New and updated NICE relevance assessments are completed multi-disciplinary by frontline clinicians.
• NICE baseline assessments are completed by staff with a clinical interest in the area and involve relevant professionals.
• Informs practice guidance is discussed within professional meetings /forums and discussion outcomes are documented and shared with others at the NICE group to maximise learning.
• Unregistered staff have used sexual health guideline to review the service “Keeping Safe” intervention tool kit to ensure that the programme is in line with evidenced base practice.
• To support decision making in regards to informing practice, group members have worked with the trust NICE lead to develop a guidance resource for staff.
• Through the group, gaps in awareness of service provision relating to relevant guidelines has been identified – this has led to increased accuracy in guidance declared as relevant to the service.
• Staff report increased awareness and confidence in understanding and using NICE within clinical care.
• Service clinical pathways have been developed and reviewed again NICE guidance, providing evidence and assurance that the service is providing evidence-based care.
• Group members have shared their experiences and learning from their involvement in the group with university undergraduates at a city-wide event focusing on, “how to use research in practice”.
• An informs practice discussion resulted in different professions, from different arms of the service, working together to share learning and review their practice. This led to a special interest group presentation on the guideline and its recommendations.
• The group has been identified with the trust as a best practice example for how to support frontline clinicians to embed NICE guidance within practice and has been identified within the trust quality accounts.
• Clinical resources have been developed to support staff in practice, an examples of this include; easy read "Taking your antibiotic tablets" service user information leaflet and "Guidance for wound management" information leaflet with illustrations to support staff to assess wounds and take appropriate action.
• The work of the group and its journey has been shared at trust-wide forums.

Create an opportunity for frontline staff to hear and experience (through interactive group activities) how NICE can ensure / improve the quality, safety and effectiveness of care that is received by the service user and their carers. Peer to peer learning greatly supported the motivation and engagement of staff. Clear terms of reference which detail roles and responsibilities.

Celebrating achievements, practice improvements and shared learning. Embedding the working group within service Governance structures / frameworks. Identifying the clinical interests of staff to ensure that these staff are involved in baseline assessments. Support the work of the group to be used in other forums such as special interest groups or professional meetings.