They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:

Transcription

1 bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see: NICE Pathway last updated: 04 October 2017 This document contains a single flowchart and uses numbering to link the boxes to the associated recommendations. Page 1 of 10

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3 1 Recommendations about training No additional information 2 Training for healthcare professionals No additional information 3 Training in advice and care for women who may become pregnant, are pregnant or breastfeeding Training in nutrition and breastfeeding Professional bodies should ensure health professionals have the appropriate knowledge and skills to give advice on the following: the nutritional needs of women and the importance of a balanced diet before, during and after pregnancy (including the need for suitable folic acid supplements) the rationale for recommending certain dietary supplements (for example, vitamin D) to pregnant and breastfeeding women the nutritional needs of infants and young children breastfeeding management, using UNICEF's Baby Friendly Initiative training as a minimum standard. strategies for changing people's eating behaviour, particularly by offering practical, foodbased advice As part of their continuing professional development, train midwives, health visitors and support workers in breastfeeding management, using UNICEF's Baby Friendly Initiative training as a minimum standard. As part of their continuing professional development, train health professionals, including doctors, dietitians and pharmacists, to promote and support breastfeeding, using UNICEF's Baby Friendly Initiative training as a minimum standard. Ensure health professionals who provide information and advice to breastfeeding mothers have the required knowledge and skills. For training and professional development on vitamin D, see what NICE says on vitamin D. Page 3 of 10

4 Training in weight management Ensure health professionals, healthcare assistants and support workers have the skills to advise on the health benefits of weight management and risks of being overweight or obese before, during and after pregnancy, or after successive pregnancies. Ensure they can advise women on their nutritional needs before, during and after pregnancy and can explain why it is important to have a balanced diet and to be moderately physically active. Ensure they have behaviour change knowledge, skills and competencies. This includes being able to help people to identify how their behaviour is affecting their health, draw up an action plan, make the changes and maintain them. (See what NICE says on behaviour change.) Ensure they have the communication techniques needed to broach the subject of weight management in a sensitive manner. They should be able to give women practical advice on how to improve their diet and become more physically active. They should be able to tailor this advice to individual needs and know when to refer them for specialist care and support. Ensure they have the knowledge and skills to help dispel common myths. This includes myths about what to eat and what not to eat during pregnancy and about weight loss in relation to breastfeeding. Ensure they have knowledge, skills and competencies in group facilitation, are aware of the needs of minority ethnic groups and have knowledge of local services. Ensure their training is regularly monitored and updated. Prescribing to breastfeeding women Ensure health professionals and pharmacists who prescribe or dispense drugs to a breastfeeding mother consult supplementary sources (for example, the Drugs and Lactation Database [LactMed] ) or seek guidance from the UK Drugs in Lactation Advisory Service. For information about prescribing to women with mental health disorders who are breastfeeding, see what NICE says on antenatal and postnatal mental health. Quality standards The following quality statement is relevant to this part of the interactive flowchart. Postnatal care quality standard 5. Breastfeeding Page 4 of 10

5 4 Training in weighing and measuring infants Commissioners and managers should ensure health professionals receive training on weighing and measuring infants. This should include: how to use equipment, how to document and interpret the data, and how to help parents and carers understand the results and implications. Ensure support staff are trained to weigh infants and young children and to record the data accurately in the child health record held by the parents. 5 Training for support workers, link workers and breastfeeding peer supporters Support workers Ensure support workers receive training in breastfeeding management from someone with the relevant skills and experience before they start working with breastfeeding mothers. Ensure all those who work in maternity and children's services, including receptionists, volunteers and ancillary staff, are made fully aware of the importance of breastfeeding and help to promote a supportive environment. Link workers and breastfeeding peer supporters NHS trusts should train link workers who speak the mother's first language to provide information and support on breastfeeding, use of infant formula, weaning and healthy eating. Where link workers are not available, ensure women whose first language is not English have access to interpreting services and information in a format and language they can understand. NHS trusts should encourage women from minority ethnic communities whose first language is not English to train as breastfeeding peer supporters. Provide local, easily accessible breastfeeding peer support programmes and ensure peer supporters are part of a multidisciplinary team. Ensure peer supporters: attend a recognised, externally accredited training course in breastfeeding peer support contact new mothers directly within 48 hours of their transfer home (or within 48 hours of a Page 5 of 10

6 home birth) offer mothers ongoing support according to their individual needs. This could be delivered face-to-face, via telephone or through local groups can consult a health professional and are provided with ongoing support gain appropriate child protection clearance. Consider training peer supporters and link workers to help mothers, parents and carers follow professional advice on feeding infants aged 6 months and over. The advice should promote an increasingly varied diet using food of different textures in appropriate amounts (in addition to milk), in response to the baby's needs. Page 6 of 10

7 Glossary Diet in this interactive flowchart, the term 'diet' refers to the habitual eating patterns of individuals and groups of people who are not slimming or eating to manage or treat a medical condition Follow-on formula under UK law, follow-on formula may provide the liquid component of a progressively varied diet for healthy infants aged over 6 months Healthy eating there is no standard definition. However it is widely accepted that 'healthy eating' means following a diet which is low in fat (particularly saturated fat), sugar and salt, and high in fruit, vegetables and fibre-rich starchy foods. More details are available from NHS Choices Hydrolysed infant formula infant formula containing protein which has been broken down (hydrolysed) either partially or more extensively. Hydrolysed infant formula is more expensive than other infant formula and is usually available on prescription Infant formula under UK law, infant formula is the term used to describe a food intended to satisfy, by itself, the nutritional needs of infants during the first months of life. The Department of Health advises that infant formula may be used on its own for the first 6 months Low birth weight low birth weight is defined by the World Health Organization as less than 2500 grams Neural tube defect the neural tube in the fetus develops into the brain and spinal cord. Neural tube defects occur when the brain, skull and/or the spinal cord and its protective spinal column do not develop properly within the first 4 weeks after conception. The most common neural tube defects are anencephaly (which results in stillbirth or death soon after delivery) and spina bifida (which may Page 7 of 10

8 lead to a range of physical disabilities including partial or total paralysis) Weaning weaning or 'complementary feeding' is the transition from an exclusively milk-based diet to a diet based on solid foods Sources Weight management before, during and after pregnancy (2010) NICE guideline PH27 (2008 updated 2014) NICE guideline PH11 Your responsibility Guidelines The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline 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. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Page 8 of 10

9 Technology appraisals The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Medical technologies guidance, diagnostics guidance and interventional procedures guidance The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties. Page 9 of 10

10 Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Page 10 of 10