NCEC Guidelines and Audit. Dr Sarah Condell Dr Kathleen Mac Lellan May 2015

Transcription

1 NCEC Guidelines and Audit Dr Sarah Condell Dr Kathleen Mac Lellan May 2015

2 Chicken, Egg, Fish, Anemone?

3 Clinical Effectiveness: A Health Policy

4 Clinical Effectiveness The extent to which specific clinical interventions do what they are intended to do. The Right care In the Right place At the Right time With the Right information Within available resources

5 Framework for Clinical Effectiveness

6 National Clinical Effectiveness Committee (NCEC) Patient Safety First Initiative Ministerial Committee key stakeholders ToR - Prioritisation and Quality Assurance of National Clinical Guidelines and Audit Vision Suite National Clinical Guidelines Suite National Clinical Audit Standards Clinical Practice Guidance

7 National Clinical Guidelines

8 Clinical Guidelines Systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances, across the entire clinical spectrum Provide guidance and standards for improving the safety, quality and cost effectiveness of care across healthcare services in Ireland Implementation provides for a model of care that can reduce variability and improve quality of patient decisions Implementation supports services in providing consistent evidence-based healthcare

9 Endorsement National Clinical Guidelines Step 1 Step 2 Step 3 Step 4 Screening Prioritisation Quality assurance Endorsement

10 Published - National Clinical Guidelines

11 Supporting Documents

12 Supporting Management Tools

13 National Clinical Guidelines Implementation Ministerial endorsement health policy HSE governance - Accountability Frameworks, HSE Service Plan, National KPIs (implementation and impact). Regulation HIQA - National Standards for Safer Better Healthcare Professional regulators Future licensing requirements Alignment with Clinical Indemnity Scheme Health insurers Informed patients

14 Source of proposals for National Clinical Guidelines 1. Significant Patient Safety or Policy Issue From: Health system, National and International reports. Horizon scanning. Guideline Proposal Clinical/National Programmes 2. Clinical/National Programmes Full Guideline Clinical/National Programmes 3. Wider Health System (Submissions accepted annually) Guideline Proposal or Full Guideline Prioritised for the Commissioned Guideline Process Maximum 4 guidelines National Clinical Guideline Prioritisation A guideline proposal may be considered for the Commissioning process and referred to Stream 1. National Clinical Guideline Prioritisation Consideration should be given to link to Clinical and National Programmes. Guideline listed on NCEC Schedule of National Clinical Guidelines National Clinical Guideline Quality Assurance

15 Clinical Practice Guidance

16 CMO Report into Perinatal Deaths, Portlaoise Hospital (2014) Recommendation Responsible body R.19 The National Clinical Effectiveness Committee should develop standards for clinical practice guidance. NCEC Standard definitions and criteria should be developed in relation to the various forms of clinical practice guidance such as guidelines, checklists, procedures, clinical guidance, clinical protocols etc. This will ensure consistency of approach and utilisation of appropriate methodology to develop clinical practice guidance nationally. Clinical practice guidance is defined as systematically developed statements or processes to assist clinician and patient decisions about appropriate healthcare for specific clinical circumstances with the choice of clinical practice guidance model determined by evidence-based criteria and clinical requirements. Such models may include but are not limited to; local guidelines, protocols, policies, procedures, checklists and care pathways.

17 Clinical Practice Guidance Algorithms Bundles Checklists Pathways Policy Protocols Standards of care 1. SR of SRs, MAs & 1 1 primary studies 2.MAs 3.SRs & MA 4.SRs of SRs 1 Systematic evidence review SR of studies SR & Expert opinion TOTAL Paper on developing guidance incl. SRs Total

18 NCEC Next Steps

19 National Clinical Guidelines Clinical Practice Guidance Standards Establish National Clinical Audit Function National and International Partnerships Asthma Palliative care - cancer pain; constipation 2015 Cancer care breast, prostate Handover in Acute Care PEWS and NEWS update

20 National Clinical Guidelines Can be one of a number of sources for the basis of evidence-based standard setting.

21 So: Are national clinical guidelines the egg for national and local clinical audit?

22 Clinical audit Madden Report Clinical audit is a clinically-led quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and acting to improve care when standards are not met.

23 International example = NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements These are derived from the best available evidence, particularly NICE's own guidance and, where this does not exist, from other evidence sources accredited by NICE

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26 Where will future guidelines come from? NCEC Prioritisation Considerations Patient Safety Issue uncovered by audit Burden of disease high volume Evidence analysis based on audit data Economic impact high cost to service users or providers Variability in practice shown from audit data Potential for health improvement aim of audit Clinical guideline implementation

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28 Clownfish and sea anenomes (with acknowledgement to Wikipedia)

29 symbiotic mutualism or reciprocal altruism the clownfish feeds on small invertebrates that otherwise have potential to harm the sea anemone, the clownfish fertilises the sea anemone. the anemone's stinging cells, to which the clownfish is immune, protects the clownfish from predators, the clownfish emits a high pitched sound that deters butterfly fish, which would otherwise eat the anemone.

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