Nottinghamshire Healthcare NHS Trust
Nottinghamshire Healthcare NHS Trust has developed a booklet containing 'do not do' prompts for clinical practices that NICE recommend should be discontinued or not used routinely. These pocket sized booklets (6" x 4") cover twenty-one conditions that are core to our services and have been rolled out to clinicians for every-day use. Relates to guidelines: CG77, CG72, CG142, CG128, CG78, CG123, CG90, CG28, CG91, CG51, CG52, CG113, CG133, CG28, CG120, CG82, TA136, CG115, CG100, CG45.
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 make the 'do not do' prompts identified by NICE more accessible to our clinicians by putting them in a user-friendly and pocket sized format which enables the booklet to be personally carried around. All the conditions which are core to mental health and learning disability services have been selected for inclusion. The do not do prompts are listed by guideline and the guidelines appear in alphabetical order and each with a different coloured heading so that clinicians are able to locate the particular topic they are interested in quickly and easily. Each clinician has been issued with a booklet which they are able to carry around with them at all times. This is particularly useful as many of our clinicians work from different venues and do not always have access to a computer to access the NICE website.
Reasons for implementing your project
The booklets have been welcomed by clinicians both internal and external to the Trust and we have been asked to supply further copies. Rolling out the booklets has enabled us to remind clinicians of their responsibilities in terms of NICE guidance requirements as well as giving us the opportunity to highlight specific recommendations. Many times in the past, clinicians have asked us to consider producing abridged versions of NICE guidance in view of the fact that not all the recommendations are relevant to all services. Our NICE Group discussed this but felt that producing shortened versions of guidance would be difficult as our services are very varied and we also didn't want to discourage our clinicians from engaging with the full guideline and potentially miss important recommendations. Producing the do not do booklet seemed to be an excellent compromise as it enabled us to easily list those recommendations that are absolutes and therefore appropriate to all our clinicians. Many clinicians are not able to access the NICE do not do database at a time when they need to most. Many of our clinicians undertake home visits. Putting this information in an easy to use booklet which they can access at all times and carry around with them has improved some clincians knowledge of NICE guidelines. This initiative has also been an excellent awareness raising exercise.
How did you implement the project
Nottinghamshire Healthcare employs around 8,800 staff. The project has only been rolled out to the Local Services Division initially. The Trust has three divisions and the impact on services of clinical guidelines is different for each one. The original version of the booklet is therefore able to be easily adapted to suit the requirements of our other divisions. Our Divisional NICE Group had already documented which guidelines were relevant to our services; all they needed to decide was which of these should be included in the booklet. It was agreed that all those guidelines that were considered core to our particular services would be included. It was felt that a further booklet could be developed in the future to include do not dos from other guidelines such as physical healthcare.
The cost for 2,000 booklets was £4,000. We could have produced them more cheaply but wanted a high quality product that would withstand regular use without scuffing or dropping to pieces. Initially, we issued a paper version throughout the Division which clinicians reported to be really helpful. Their feedback impressed the senior management team who then found the money to develop a more durable, visually appealing and user friendly version.
We also felt that it was important to make sure that it was clear within the booklet that these were evidence-based recommendations that had been taken from the do not do database on the NICE website. We felt some individuals might have perceived these as being directives from the Trust and feel that we were overriding the clinician's responsibility for making the appropriate clinical decisions. We also didn't want clinicians to feel that we had any other agenda, e.g. an attempt to cut costs.
The impact of the project exceeded expectations. The booklets were launched by the Executive Medical Director at the Trust's Care Programme Approach Conference in January 2012. The booklets were very well received by clinicians at the Conference and we have had many requests for further copies. Although we only rolled them out within the Local Services Division, the booklets availability was advertised via the In-house magazine and the team's NICE newsletter which resulted in our receiving requests for copies from many other areas, some of which were external to the Trust. These included the British Red Cross, Podiatry Surgery, High-Secure Services, Libraries and Rehabilitation Hospitals. Commissioners and primary care colleagues were also issued with copies and have given us excellent feedback. Comments received included:
-'Thank you. Extremely useful to have in libraries and use in training'
-'Nicely produced and very handy. A really innovative idea'
-'More copies, please, we want ALL our staff to have one'.
-'A really handy tool'.
Key learning points
Put the guidelines in alphabetical order so that they are easy to find as many clinicians are not familiar with guideline reference numbers. Include photographs and bright colours to break up the text and make them more visually appealing. Don't try and include too many guidelines in the booklet as this will make it harder to use - just include those which are high impact to your services. Make sure that you have the infrastructure through which to launch the booklets e.g. Newsletter, Conference, etc.
NICE Lead (Local Services)
Nottinghamshire Healthcare NHS Trust
Is the example industry-sponsored in any way?