I have been in post as a Trust Lead for NICE implementation for 15 months and have supported the review of over 600 NICE publications. From the outset it was clear that NICE guidance was reviewed unilaterally and signed off by one person within the organisation, there was little evidence of compliance and few gaps from assessments that were fully addressed. The role has allowed me to work through all guidance since 2010 and several publications prior to that date and ensure there is a multidisciplinary review, appropriate discussion and plans for implementation and evidence of compliance.
This project has taken 12 months to become fully developed and to ensure there is improved engagement from clinical colleagues, non-clinical staff and execs/non-execs.
Example
Aims and objectives
The aims of the project were:
- Revisit and review existing publications
- Develop a robust management process for all publications
- Use an electronic management system - Develop scheduled reports for all Divisions and specialties on NICE progress
- Ensure Divisions reported NICE progress at Clinical Audit and Effectiveness Committee noting exceptions.
- Engage with NICE as an organisation and sign up to be stakeholders for certain publications
- Engage with wider clinical teams including AHP's, nurses, nurse specialists, midwifes etc. and not just senior medical staff to support the review of guidance - seek out support at Exec level and nominate senior member of staff to lead on NICE at Trust level (deputy Medical director)
- Each Division to nominate a Divisional NICE guideline lead (medical and nursing/midwifery/AHP) to help drive forward reviews and harness enthusiasm - automated reminders/escalations when reviews are overdue
- Letters of thanks to staff involved in reviews for their portfolios/revalidation
- Stronger links with communities/stakeholders/external organisations to support the review of NICE across the healthcare pathway and not just acute care.
- Support the inclusion of NICE guidance in business and service planning noting any future guidance that may impact, both positively and negatively on resources.
The objectives of the project have been to make NICE guidance much easier to review, and to actively engage support from staff who now see NICE as supporting the improvement of patient safety and experience.
Reasons for implementing your project
Prior to the project starting the clinical audit department sent any new NICE guidance to the Medical Director who identified a lead and the guidance was subsequently sent to them for review. They reviewed the guidance and either responded as compliant or not.
Baseline assessments were often carried out in isolation of other key stakeholders. The change was needed to ensure that all NICE guidance was fully reviewed with a team of experts and actions were identified and progressed within Divisions. In addition there was a drive to use an electronic system for managing NICE guidance and making the process easier for staff leaving them time to focus on the actual review and implementation.
How did you implement the project
The steps used to put NICE guidance into practice are clearly outlined in our policies and procedures; each NICE publication has a NICE Guideline lead allocated - this person drives forward the review, monitoring, identification of actions and dissemination of information to relevant staff.
The design of the project was such that each guideline was reviewed individually either by revisiting it or starting from scratch, all guidance was uploaded onto Ulysses Safeguard via their Alert module which then automatically alerted guideline leads of new guidance.
There were some initial problems from the outset with staff engagement and defining and sharing the process with the wider organisation. No services were discontinued and, other than the funding of a NICE lead for the Trust the project did not incur any additional costs.
Key findings
The project has had a significant impact on the efficient management of NICE and the assurance that each Division/NICE Guideline Lead provides with regard to implementation.
Whilst it is difficult to measure the improvements in terms of cost there has been a steady improvement in the assurances provided that guidance has been implemented. Progress is monitored via divisions reports and the monitoring of evidence either from audit, patient experience etc. to denote compliance. The results exceeded expectations - divisions are now actively engaged in the process.
Key learning points
From my experience, I would advise that they work through the project slowly and methodically and identify some key people to support the project from the outset. This will allow for a greater sustained success rather than a quick win. Try and use an electronic management system which makes it easier to highlight when guidance is overdue for review.