nice offer to stps: cvd preventiontvscn.nhs.uk/wp-content/uploads/2017/10/zoe-girdis... · 2017....
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Zoe Girdis
Regional Technical Adviser – South of England and Channel Islands
NICE offer to STPs: CVD prevention
© NICE 2017 All rights reserved
NICE support for STPs
Based on the best available evidence of what works and is cost-
effective, NICE resources can inform the development and
implementation of STP plans to:
• improve quality and safety by supporting standardisation to
evidence-based best practice for your key clinical priorities
• improve productivity
• prevent ill health
• engage patients and communities
• drive and measure quality improvement
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© NICE 2017 All rights reserved
Local support offer
Advice
• How NICE guidance, advice and quality standards can help to address local priorities
• Signpost available metrics to support local evaluation
• Which NICE resources can support community engagement
Support
• NICE quality standards to embed good practice
• Shared learning and local education
Connecting stakeholders
• to other teams and specialist support at NICE
• with other organisations and networks working in areas of shared interest
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NICE regional and local presence
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Field Team
NICE Fellows and Scholars
Regional Technical Advisers (Medicines and Technologies)
Associate/affiliate networks (Medicines and Technologies)
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Chris Connell
Associate Director [email protected]
+ 2 Implementation Facilitators
Zoe Girdis
Regional Technical Adviser
NICE Field Team and Technical Advisers South
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NICE CVD prevention resources
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How can NICE help you?
• NICE guidance
• NICE pathways
• Medicines advice
• Evidence summaries, key therapeutic topics
• NICE evidence search
• BNF, Clinical Knowledge Summaries
• Keeping up to date with news
• Engaging with NICE
• NICE medicines & prescribing associate programme
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© NICE 2017 All rights reserved
An overview of NICE
Evidence-based products:
Guidance
Quality standards
Evidence summaries
Evidence alerts
Accredited evidence
Prescribing advice
Indicator sets
Dissemination and adoption
support: NICE Evidence Services
NICE website
Pathways
Apps
E-alerts
Implementation tools
Audiences:
NHS
Patients and the public
Public health
Local government
Social care
Commissioners
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© NICE 2017 All rights reserved
NICE guidance responsibilities for health professionals
Professionals and practitioners are expected to take NICE guidance
fully into account, alongside the individual needs, preferences and
values of their patients or the people using their service.
It is not mandatory to apply the recommendations, and the guideline
does not override the responsibility to make decisions appropriate to
the circumstances of the individual, in consultation with them and
their families and carers or guardian.
Guidelines not tramlines
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© NICE 2017 All rights reserved
Evidence into practice Maskrey N, 2014
Research
National guidance
Local implementation
Care of Individual people
RNLI
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© NICE 2017 All rights reserved
Best available evidence
Patient’s needs,
values and preferences
Expertise, experience, skills and
judgement
Patient-centred care
• Patients and healthcare
professionals have rights and
responsibilities as set out in the
NHS Constitution for England – all
NICE guidance is written to reflect
these
• Treatment and care should take
into account individual needs and
preferences
• Patients should have the
opportunity to make informed
decisions about their care and
treatment, in partnership with
their healthcare professionals
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© NICE 2017 All rights reserved
Types of guidance from NICE
• Guidelines:
• Clinical
• Public health
• Social care
• Medicines practice
• Safe staffing
• Cancer service
• Quality standards
www.nice.org.uk/guidance
• Guidance:
• Technology appraisals
• Diagnostics
• Interventional procedures
• Medical technologies
• Highly specialised
technologies
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NICE Pathways
• Bring together related guidance, between and within topics
• Link other products – Quality Standards, implementation support tools etc.
• Provide a useful format – network of recommendations
• Improve digital formatting for easier access
• Easier, quicker access to the evidence
http://pathways.nice.org.uk
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Quality Standards
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Typically 6 –
8 statements
Include
measures to
help inform
local quality
improvement
work
Define priority
areas for quality
improvement
© NICE 2017 All rights reserved
Medicines advice https://www.nice.org.uk/guidance
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© NICE 2017 All rights reserved
NICE evidence summaries
• Summaries of the best available evidence
to inform local NHS planning and
decision-making, for selected new
medicines, off-label use of licensed
medicines and unlicensed medicines
• Summary of published evidence (critically
appraised) but NOT formal NICE
guidance
• Topics are selected in collaboration with
the NICE topic selection process, with
advice from the NICE medicines and
prescribing associate network and
partner organisations
https://www.nice.org.uk/about/nice-communities/medicines-and-prescribing#more-evidence-summaries
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Key NICE guidelines and QS: CVD Prevention (1)
Topic
QS
Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease (CG172, November 2013)
Sept 2015
Cardiovascular disease: risk assessment and reduction, including lipid modification (CG181, September 2016)
Published
Peripheral arterial disease: diagnosis and management (CG147, August 2012) Published June 2015
Cardiovascular disease prevention (PH25, June 2010)
Cardiovascular disease: identifying and supporting people most at risk of dying early (PH15, September 2008)
Hypertension in adults: diagnosis and management (CG127, November 2016) Published
Familial hypercholesterolaemia: identification and management (CG71, July 2016)
Published
Atrial fibrillation: management (CG180, August 2014) Published
Type 2 diabetes in adults: Management (NG28, May 2017) Published
© NICE 2017 All rights reserved
Key NICE guidelines and QS: CVD Prevention (2) Topic QS
Behaviour change: general approaches (PH6, October 2007)
Behaviour change: individual approaches (PH49, January 2014)
Community engagement: Improving health and wellbeing (NG44, March 2016) Published
Physical activity: brief advice for adults in primary care (PH44, May 2013) Published
Physical activity: exercise referral schemes (PH54, September 2014
Smoking: preventing uptake in children and young people (PH14, November 2014)
Published
Smoking: harm reduction (PH45, July 2013) Published
Smoking: Brief interventions and referrals (PH1, March 2006) Published
Stop smoking services (PH10, November 2013) Published
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© NICE 2017 All rights reserved
Key NICE guidelines and QS: Obesity Topic QS
Preventing excess weight gain (NG7, March 2015)
BMI: preventing ill health and premature death in black, Asian and other minority ethnic groups (PH46,July 2013)
Obesity: working with local communities (PH42, June 2017 2012)
Obesity: Prevention (adults and children) (CG43March 2015) Adults Children
Maternal and child nutrition (PH11, November 2014) Published
Weight management before, during and after pregnancy (PH27, July 2010)
Weight management: lifestyle services for overweight or obese children and young people (October 2013)
Published
Weight management: lifestyle services for overweight or obese adults (PH53, May 2014)
Published
Obesity: Identification, assessment and management (CG189, November 2014) Published
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© NICE 2017 All rights reserved
NICE Indicator menu
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NICE Return on investment tools
Key features:
• Model the effects of single, or multiple, interventions on at-risk population groups
• Estimate the overall costs against the value of non-health benefits as well as health and wellbeing improvements
• Mix and match interventions to see which package provides the best outcome
• Identify cost savings or determine if the additional benefits are worth the extra costs
• Customise the tools to include data and interventions specific to your local area
• Use the results to help support your business cases
https://www.nice.org.uk/about/what-we-do/into-practice/return-on-investment-tools
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Tools for shared decision making
• Conversation between those delivering care and those receiving
care
• Shared decision making puts people at the centre of decisions
about their own treatment and care by:
• exploring care or treatment options and their risks and benefits
• discussing choices available
• reaching a decision about care or treatment, together with their
health and social care professional
www.nice.org.uk/sdm
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Lipid modification: patient decision aid https://www.nice.org.uk/guidance/cg181/resources/
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Atrial fibrillation: patient decision aid www.nice.org.uk/guidance/cg180/resources
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Type 2 diabetes in adults: patient decision aid www.nice.org.uk/guidance/ng28/resources
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Medicines optimisation: key therapeutic topics
• Medicines optimisation: key therapeutic topics (KTTs) summarise
the evidence base on topics identified to support medicines
optimisation
• They are not formal NICE guidance
• These topics are selected and prioritised therapeutic areas where
there are potential opportunities for maintaining or improving
quality and improving value from our use of medicines
• NHS Digital lead on the development of comparators for the
therapeutic topics included in the document
www.nice.org.uk/about/what-we-do/our-programmes/nice-advice/key-therapeutic-topics
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© NICE 2017 All rights reserved
Medicines optimisation: key therapeutic topics
• Biosimilar medicines
• Anticoagulants: including non-vitamin K antagonist oral anticoagulants (NOACs)
• Acute kidney injury (AKI): use of medicines in people with or at risk of AKI
• Lipid modifying drugs
• Asthma: medicines optimisation priorities
• Hypnotics
• Low dose antipsychotics in people with dementia
• Wound care products
https://www.nice.org.uk/about/what-we-do/our-programmes/nice-advice/key-therapeutic-topics
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• Antimicrobial stewardship: prescribing
antibiotics
• Type 2 diabetes mellitus: medicine
optimisation priorities
• Non-steroidal anti-inflammatory drugs
New topics 2017
• Multimorbidity and polypharmacy
• Psychotropic medicines in people with
learning disabilities whose behaviour
challenges
• Safer insulin prescribing
• Medicines optimisation in long-term pain
© NICE 2017 All rights reserved
Shared-learning
• Submitting a local practice example
• What are they?
‘Shared Learning examples are real-life experiences from
organisations that have used NICE guidance to change practice,
improve care, and consider the way that health, social care and
community-based organisations, use resources’
• Details on the website
• Chris Bird able to help and support completion of examples
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© NICE 2017 All rights reserved
Evidence into practice Maskrey N, 2014
Research
National guidance
Local implementation
Care of Individual people
RNLI
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Possible implementation issues for medicines
optimisation (N L)
• Identify local implementation priorities
• Benchmark against each topic considering:
• Existing workstreams and achievements
• Local performance metrics such as prescribing information, medicines optimisation dashboard, RightCare and HES data,
• Identify potential challenges and barriers
• Develop a plan considering the ‘options for implementation’:
• Who needs to be involved, what resources do you need, how will you raise awareness and engage stakeholders?
• What do you need to do and how will you communicate this?
• What will success look like and how will you measure it?
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© NICE 2017 All rights reserved
NICE local practice case studies
Title Published
Improving the physical health of people with serious mental illness: A quality
improvement approach
Jan 2017
Adopting a multi-disciplinary approach to improve medicines accuracy in a general
surgical ward
Jan 2017
Refer-to-Pharmacy and Medicines Optimisation Jan 2017
Patient Led Clinical Medicines Reviews Jan 2017
Innovative ways to support smokers requiring nicotine management in a mental
health organisation
Jan 2017
Hypertension: Improving blood pressure management in primary care Jan 2017
Prudent Health Care – Pilot Study to reduce the number of inappropriate lumbar
spine x-rays requested from primary care in the Princess of Wales locality
Jan 2017
Manchester Royal Infirmary Virtual Biologics Clinic Dec 2016
Improving and maintaining medicines reconciliation on admission Nov 2016
www.nice.org.uk/about/what-we-do/into-practice/local-practice-case-studies
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© NICE 2017 All rights reserved
Keep up to date with the latest from NICE
Subscribe to NICE News for:
- The latest news and features
- Newly published guidance and quality standards
- Current consultations
- Ways you can get involved
https://www.nice.org.uk/news/nice-newsletters-and-alerts/subscribe-to-nice-news
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Guidelines. Not tramlines.
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