Final Accreditation Report

Guidance producer: Resuscitation Council (UK) Guidance product: 2010 resuscitation guidelines Date: 2 August 2012 Version: 1.4 Final Accreditation Report Page 1 of 19

Contents Introduction... 3 Accreditation recommendation... 3 Background to the guidance producer... 3 Implementation... 5 Appendix A: NICE Accreditation analysis... 6 Appendix B: Bibliography... 16 Appendix C: NICE Accreditation Advisory Committee, external advisers and NICE Accreditation team... 17 Page 2 of 19

Introduction The NICE Accreditation Scheme recognises organisations that demonstrate high standards in producing health or social care guidance. Users of the accredited guidance can therefore have high confidence in the quality of the information. Organisations may publicly display a seal of approval called an Accreditation Mark for 5 years after their processes have been accredited. The process for accrediting producers of guidance and recommendations for practice is described in the process manual on the NHS Evidence website. Accreditation recommendation NICE has accredited the process used by the Resuscitation Council (UK) to produce its 2010 resuscitation guidelines. Accreditation is valid for 5 years from July 2012 and is applicable to guidance produced using the processes described in the RC(UK) Guidelines Development Process Manual (2012). Background to the guidance producer The Resuscitation Council (UK) is a charity that aims to save lives by educating the public and healthcare professionals about resuscitation. The Resuscitation Council (UK) produces and disseminates resuscitation guidelines which undergo major revisions every 5 years. The guidelines are a national adaptation of the international Consensus on Science Treatment with Recommendations (CoSTR) produced by the International Liaison Committee on Resuscitation (ILCOR). The Resuscitation Council (UK) is a member and co-chair of the ILCOR. Summary NICE has accredited the process used by the Resuscitation Council (UK) to produce its 2010 resuscitation guidelines. Page 3 of 19

The Accreditation Advisory Committee considered that the processes used by the Resuscitation Council (UK) to produce its 2010 resuscitation guidelines complied with 24 of the 25 criteria for accreditation. The processes used to develop the 2010 resuscitation guidelines are detailed in the Resuscitation Council (UK) Guidelines Production Manual (2012). The processes are rigorous, transparent and systematic. They include both international consensus on the evidence and local adaptation for the UK, to produce a practical guide that accounts for organisational and financial barriers. The scope and purpose of the guidelines are clearly defined, and systematic methods are used to search for evidence. These methods are publically available and include inclusion and exclusion criteria and consideration of the strength of evidence. All systematic review worksheets including the search strategies are available for public consultation and enable professionals and members of the public to influence the development of recommendations. Relevant stakeholder groups and target users are involved in development, and the process considers patient views and preferences. Suggestions for improving the Resuscitation Council (UK) process to produce the 2010 resuscitation guidelines include: consistently implementing the process around clarity of recommendations by clearly demarcating all recommendations in the text of the guidelines, for example by using a bold or underlined typeface clarifying in the process manual and the guidance, the nature and extent of any adaptation from the international consensus on evidence Professor David Haslam, CBE Chair, Accreditation Advisory Committee August 2012 Page 4 of 19

Implementation Following accreditation, guidance from the accredited producer will be identified on NHS Evidence by the Accreditation Mark. The accredited guidance producer is also granted a royalty-free, worldwide licence to use the NICE Accreditation Mark in accordance with the Conditions and Terms of Use. Providing these conditions are met, a guidance producer's accreditation will last for 5 years from publication of approval on the NHS Evidence website. Accredited guidance producers must take reasonable steps to ensure the accredited processes are followed when generating the type of evidence for which they are accredited. Accredited guidance producers should have quality assurance mechanisms in place and must inform NICE Accreditation within 30 days if any significant change is made to a process. Figure 1: The Accreditation Mark Page 5 of 19

Appendix A: NICE Accreditation analysis The Accreditation Advisory Committee considered the following analysis of the guidance producer s compliance with NICE Accreditation criteria, which covers 6 discrete domains. The full analysis leading to the accreditation is shown below. Criterion Evidence for meeting the criterion Accreditation Does the guidance producer have a policy in place and adhered to that requires them to explicitly detail: Scope and purpose 1.1 Overall objective The process a requires that the scope and purpose of the guidelines are 1.2 The clinical, healthcare or social questions covered documented, and this can be seen in the guidance b. The process manual a explains how clinical and healthcare questions are developed and requires them to be clearly stated. The specific questions addressed by the guidance are published online in the systematic reviews c for public consultation and remain available. Page 6 of 19

Criterion Evidence for meeting the criterion Accreditation 1.3 Population and/or target audience to whom the guidance applies The process a requires the population and target audience to be described, and this can be seen in the guidance b. The target audience is very broad, including all UK healthcare professionals and members of the public who may ever need to provide resuscitation, and those who provide training. The target population is anyone of any age requiring resuscitation. 1.4 Guidance includes clear recommendations in reference to specific clinical, healthcare or social circumstances. The process a requires the recommendations to be easy to find and implement, including the use of algorithms where appropriate. Recommendations are given in relation to specific clinical or healthcare circumstances such as the patient s condition and their response to different interventions b. Does the guidance producer have a policy in place and adhered to that means it includes: Stakeholder involvement 2.1 Individuals from all relevant stakeholder groups, including patient groups, in developing guidance The process a involves all major stakeholder groups in developing the guidance, including a wide variety of healthcare professionals, first aid trainers and lay people. Page 7 of 19

Criterion Evidence for meeting the criterion Accreditation 2.2 Patient and service user representatives and seeks patient views and preferences in developing guidance There are processes a to include the views and preferences of patients and lay people in developing guidance. Literature relating to the patient experience is included in the systematic reviews c, and all reviews are subject to public consultation. A lay panel advises the group that translates the international consensus into the 2010 resuscitation guidelines which is reviewed by the Resuscitation Council (UK) Executive Committee that includes a lay member. Equality issues are also considered. 2.3 Representative intended users in developing guidance. The target audience for the 2010 resuscitation guidelines is very broad, including healthcare professionals, resuscitation trainers, and members of the public who might need to undertake resuscitation. The breadth of organisations involved in developing the international consensus on evidence d, the public consultation on the evidence, and the breadth of membership of the Resuscitation Council (UK) Executive Council, all helps to ensure that individuals from all these groups are represented. Rigour of Does the guidance producer have a clear policy in place that: Page 8 of 19

Criterion Evidence for meeting the criterion Accreditation development 3.1 Requires the guidance producer to use systematic methods to search for evidence and provide details of the search strategy 3.2 Requires the guidance producers to state the criteria and reasons for inclusion or exclusion of evidence identified by the evidence review 3.3 Describes the strengths and limitations of the body of evidence and acknowledges any areas of uncertainty The process a requires a systematic and transparent search for evidence at the international evidence synthesis stage. All systematic review worksheets c including the search strategies are published online for public consultation, and remain available after the consultation has ended. The process a specifies inclusion and exclusion criteria for studies, and that these criteria should be stated in the systematic review worksheets c which are publicly available. The process a requires that the strength of the evidence is clearly identified. The systematic review sheets c available online detail the level of evidence, the methodological quality and whether the evidence supports, opposes or is equivocal towards the clinical hypothesis in question. Page 9 of 19

Criterion Evidence for meeting the criterion Accreditation 3.4 Describes the method used to arrive at recommendations (for example, a voting system or formal consensus techniques like Delphi consensus) The process a for reaching recommendations is described in both the process manual and the guidance. Systematic reviews c are published online for public consultation, and recommendations are drafted and agreed by international taskforces based on these reviews. The recommendations are then reviewed by an international editorial board. Recommendations are voted on and modified until a majority consensus is achieved. The international recommendations are preserved in the guidance b with adaptation to take into account implementation issues specific to the UK. 3.5 Requires the guidance producers to consider the health benefits against the side effects and risks in formulating recommendations 3.6 Describes the processes of external peer review The process a states that risks and benefits should be considered in developing recommendations. These are communicated both in the publicly available systematic reviews c and in the guidance b where appropriate. The recommendations are subject to external review at 2 points; both through the public consultation on the systematic reviews c, and the peer review of the international recommendations prior to publication in the journal Circulation. The international recommendations remain unchanged in the UK guidance b, which explain how to implement the recommendations in a UK context. Therefore external peer review at the international stage is appropriate and sufficient to meet this criterion. Page 10 of 19

Criterion Evidence for meeting the criterion Accreditation 3.7 Describes the process of updating guidance and maintaining and improving guidance quality The process a describes how guidance is reviewed and updated. There is a scheduled update every 5 years including the full evidence search and assessment procedure; and an unscheduled update process for interim updates. Evidence of implementation was found in the guidance b and on the hosting website e. Does the guidance producer ensure that: Clarity and presentation 4.1 Recommendations are specific, unambiguous and clearly identifiable The process a requires that recommendations are clear and easily identifiable. Examination of the guidance b shows that the majority of recommendations, particularly those aimed at lay people, are clear and readily identifiable. Some recommendations are located in the text and would benefit from clearer demarcation. For this reason, this criterion is not fully met. Not fully met 4.2 Different options for the management of the condition or options for intervention are clearly presented Where options for treatment or intervention exist they are covered by the processes a governing the presentation of recommendations, requiring that they are clear and easily identifiable. Frequently, options are presented in an algorithm format which helps to reduce ambiguity and improve -making when time is short. Page 11 of 19

Criterion Evidence for meeting the criterion Accreditation 4.3 The date of search, the date of publication or last update and the proposed date for review are clearly stated The process a requires that the date of publication is documented, and this can be seen in the guidance. The systematic review worksheets c require the dates of searches to be documented, and these remain publicly available after consultation. 4.4 The content of the guidance is suitable for the specified target audience. If patients or service users are part of this audience, the language should be appropriate. The specified target audience for the 2010 resuscitation guidelines is very broad, including healthcare professionals, resuscitation trainers and the general public. The process a requires that recommendations are clear and easily identifiable, and that any changes to the previous version are stated up-front. Together, these steps help to ensure a wide range of people can quickly find the information they need. The language used is appropriate to the different audiences, with technical terms avoided in the basic life support section (which is of most interest to the public), and specialist terms used where necessary in the advanced sections for professionals. Does the guidance producer routinely consider: Applicability 5.1 Publishing support tools to aid implementation of guidance An extensive collection of support tools are provided, including training materials, different formats, a smartphone application and lists of relevant equipment f. Page 12 of 19

Criterion Evidence for meeting the criterion Accreditation 5.2 Discussion of potential organisational and financial barriers in applying its recommendations The process a requires that potential barriers to implementation should be considered. Examination of the guidance b shows that there is consideration of organisational barriers to effective resuscitation in hospitals, and consideration of training needs. Financial barriers are less commonly discussed in the guidance, but the systematic reviews c include evidence of cost effectiveness. 5.3 Review criteria for monitoring and/or audit purposes within each product. The process a requires that the guidance includes a section on auditable outcome measures. In collaboration with the Intensive Care National Audit and Research Centre, the guidance producer has established the National Cardiac Arrest Audit (NCAA) to assess outcomes from in-hospital cardiac arrest. The guidance b states that all in-hospital cardiac arrests should be reviewed and audited through the NCAA, and it has been confirmed that this is underway. Editorial Does the guidance producer: Page 13 of 19

Criterion Evidence for meeting the criterion Accreditation independence 6.1 Ensure editorial independence from the funding body The process manual a provides a statement of editorial independence that describes the charitable status of the Resuscitation Council (UK) and that its main source of income is providing training courses. It is stated that the guidance producer has no financial relationships with the industry and that the guideline project group is completely independent from any commercial organisation and is solely responsible for the content of the Resuscitation Council (UK) guidelines. 6.2 Demonstrate transparency about the funding mechanisms for its guidance The process manual a and the guidance b describe the charitable status of the Resuscitation Council (UK). It has been confirmed that the work of ILCOR is funded by the member organisations and that the Resuscitation Council (UK) is funded primarily by running training courses. The annual accounts of the Resuscitation Council (UK) are available online through the charity commission g. 6.3 Record and state any potential conflicts of interest of individuals involved in developing the recommendations The process a requires individuals involved in development of the guidance at every stage to declare any conflicts of interest. Page 14 of 19

Criterion Evidence for meeting the criterion Accreditation 6.4 Take account of any potential for bias in the conclusions or recommendations of the guidance. The guidance is the result of a transparent and systematic process a involving an international, multidisciplinary group. Local adaptation is transparent and all individuals involved in developing recommendations are required to declare conflicts of interest. The source of funding is described, and the process accounts for the possibility of bias. Documents submitted: a Resuscitation Council (UK) process manual (2012) b 2010 resuscitation guidelines (2010) c List of all systematic reviews with links to worksheets d Consensus on Science with Treatment Recommendations (2010) e Guidelines, medical information and reports page of the Resuscitation Council (UK) website f Tools to support guidance g Resuscitation Council (UK) page on the charity commission website Page 15 of 19

Appendix B: Bibliography Appendix B lists the additional information taken into account in the analysis and considered by the Accreditation Advisory Committee. Document name Description Location AccreditationForm_RC UK_Mar2012.doc BLS-023B.pdf S606-38.pdf Circulation-2010- Appendix Evidence- Based_Worksheets- Circulation-2010- Morley-S283-90.pdf Accreditation application form Supplied Example of systematic review http://circ.ahajournals.org/site/c2010/bls- 023B.pdf List of systematic reviews with links to worksheets CoSTR 2010 evidence evaluation process COIform.doc Conflict of interests form Supplied Conflict of interests declaration.pdf Constitution.pdf CoSTR 2010_2010.pdf GL2010.pdf Guidance on conflicts of interest.pdf RCUK_Guidelines_Dev elopment_process_ma nual.pdf Standards.pdf Completed RC(UK) declarations of interest Constitution of the RC(UK) as a charitable trust Consensus on Science with Treatment Recommendations 2010 RC(UK) resuscitation guidelines 2010 Guidance on conflicts of interest RC(UK) process manual CPR standards for clinical practice and training http://circ.ahajournals.org/content/122/16_s uppl_2/s606.full.pdf+html http://circ.ahajournals.org/content/122/16_s uppl_2/s283.full.pdf+html Supplied Supplied http://www.cprguidelines.eu/2010/costr 2010.php Supplied http://www.resus.org.uk/pages/guidcoid.pdf Supplied www.resus.org.uk/pages/standard.pdf Page 16 of 19

Appendix C: NICE Accreditation Advisory Committee, external advisers and NICE Accreditation team NICE Accreditation Advisory Committee The NICE Accreditation Advisory Committee operates as a standing advisory committee of the Board of the National Institute for Health and Clinical Excellence (NICE). The Committee provides advice to NICE on a framework for accrediting sources of evidence that should be recognised as trusted sources of information for the NHS. The Chair of the Committee is appointed by NICE Board and the meetings are conducted by the chair or in his/her absence the vice chair. The current Chair is David Haslam. A full list of the Accreditation Advisory Committee membership is available on the NICE website. Members are appointed for a period of 3 years. This may be extended by mutual agreement for a further 3 years, up to a maximum term of office of 10 years. The s of the Committee are arrived at by a consensus of the members present. The quorum is set at 50% of committee membership. The Committee submits its recommendations to the NICE Publications executive which acts under delegated powers of the NICE Board in considering and approving its recommendations. Committee members are asked to declare any interests in the guidance producer to be accredited. If it is considered that there is a conflict of interest, the member(s) is excluded from participating further in the discussions. Committee members who took part in the discussions for this accreditation are listed below. Title Name Surname Role Organisation Mr Jim Blair Consultant Nurse Learning Disabilities Professor Ann Caress Professor of Nursing/Director of postgraduate research St. George's Healthcare NHS Trust University of Manchester Page 17 of 19

programmes Ailsa Donnelly Lay member Joyce Epstein Lay Member Professor David Haslam National Clinical Adviser Professor Monica Lakhanpaul Professor of Integrated Community Child Health Ms Ruth Liley Assistant Director of Quality Improvement Professor Stuart Logan Cerebra Professor of Paediatric Epidemiology Care Quality Commission Institute of Child Health Marie Curie Cancer Care Peninsula College of Medicine & Dentistry Dr Edward Ng General Practitioner Ley Hill Surgery Dr Donal O'Donoghue National Clinical Director for Kidney Care & Consultant Renal Physician Dr Carl Parker Primary Care Medical Advisor Dr Karen Ritchie Head of Knowledge Management Salford Royal NHS Foundation Trust North Tees and Hartlepool Foundation Trust Healthcare Improvement Scotland Dr Peter Smith Vice President National Association of Primary Care Dr Mark Strong MRC Fellow Section of Public Health, ScHARR Ms Gill Swash Head of Knowledge NHS Western Cheshire Page 18 of 19

and Library Services External Advisers for Resuscitation Council (UK) 2010 resuscitation guidelines accreditation application Mr Aung Soe, Consultant Neonatologist, Centre for Evidence Based Medicine, Medway NHS Foundation Trust, UK Janine Tallet, Practice Development and Quality Lead, Bradford District Care Trust, UK Dr Lorna Thompson, Programme Manager, Scottish Intercollegiate Guidelines Network, UK NICE Accreditation team for Resuscitation Council (UK) 2010 resuscitation guidelines accreditation application James Stone, Accreditation Technical Analyst, NHS Evidence, National Institute for Health and Clinical Excellence, Manchester, UK Stephanie Birtles, Accreditation Technical Analyst, NHS Evidence, National Institute for Health and Clinical Excellence, Manchester, UK Page 19 of 19