Transcript Document
Welcome to Clinical audit awareness week webinars
Join us for a chat on twitter this evening 6.30-7.00pm @hqip #clinicalaudit Find out more www.hqip.org.uk/clinical-audit-awareness-week www.hqip.org.uk
Deborah O’Callaghan, Implementation Consultant – East 21 st October 2014
How can measuring care lead to improvement?
The importance of using robust and nationally recognised standards. Standards and guidance in the real world – using NICE’s work locally for successful measurement and improvement
Session outcomes
• Clarity of understanding about the features of NICE quality standards • Key messages about the purpose of NICE quality standards • Exploration of the potential for NICE quality standards to drive quality improvement
How to use NICE Quality Standards: Advice for providers and commissioners of health and social care
www.nice.org.uk/intopracticeguide Jane Moore and Deborah O’Callaghan
What are NICE guidance and quality standards?
A set of systematically developed recommendations to guide decisions for a particular area of care or health issue Evidence Guidance Quality Standards Research studies - experimental and observational, quantitative and qualitative, process evaluations, descriptions of experience, case studies A NICE quality standard is a concise set of statements designed to drive and measure priority quality improvements.
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Source guidance
Myocardial infarction with ST-segment elevation . NICE clinical guideline 167 (2013) Hyperglycaemia in acute coronary syndromes . NICE CG130 (2011).
Chest pain of recent onset . NICE CG95 (2010) Unstable angina and NSTEMI . NICE CG94 (2010) Cardiovascular disease outcomes strategy . Department of Health (2013) Together for health – a heart disease delivery plan . Welsh Government (2013).
The cardiac disease national service framework for Wales . Welsh Government (2009).
Source guidance
• Prevention and control of healthcare-associated infections . NICE public health guidance 36 (2011) • • Surgical site infection . NICE clinical guideline 74 (2008) Inadvertent perioperative hypothermia.
NICE CG65 (2008) • Department of Health (2013) UK five year antimicrobial resistance strategy 2013 to 2018 • Public Health England (2013) Protocol for the surveillance of surgical site infection: surgical site infection surveillance service • Department of Health Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) (2011) Antimicrobial stewardship 'Start smart – then focus'.: guidance for antimicrobial stewardship in hospitals (England)
Source guidance (cont)
• Department of Health (2010) The Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance • Department of Health (2010) Uniforms and workwear: guidance on uniform and workwear policies for NHS employers • Department of Health (2010) MRSA screening – operational guidance 3 • Department of Health (2009) National Decontamination Programme: theatre support pack • Department of Health (2008) MRSA screening – operational guidance 2
Source guidance
• Social Care Institute for Excellence (2011) IMCA and paid relevant person's representative roles in the Mental Capacity Act Deprivation of Liberty Safeguards . SCIE guide 41. • Social Care Institute for Excellence (2010) Personalisation: a rough guide . SCIE guide 47.
• Social Care Institute for Excellence (2010) Independent mental capacity advocate involvement in accommodation decisions and care reviews . SCIE guide 39. • Social Care Institute for Excellence (2010) Dignity in care . SCIE guide 15. • Social Care Institute for Excellence (2009) Practice guidance on the involvement of Independent Mental Capacity Advocates (IMCAs) in safeguarding adults . SCIE guide 32.
Source guidance
• Social Care Institute for Excellence (2009) Commissioning and monitoring of Independent Mental Capacity Advocate (IMCA) services . SCIE guide 31. • Social Care Institute for Excellence (2007) Implementing the Carers (Equal Opportunities) Act 2004 . SCIE guide 9. • NICE (2006) Dementia . NICE clinical guideline 42.
What are NICE guidance and quality standards?
A set of systematically developed recommendations to guide decisions for a particular area of care or health issue Evidence Guidance Quality Standards Research studies - experimental and observational, quantitative and qualitative, process evaluations, descriptions of experience, case studies A NICE quality standard is a concise set of statements designed
to drive and measure priority quality improvements
.
Using NICE Quality Standards NICE quality standards can highlight key areas for improvement. An initial assessment should consider for each statement within the quality standard: • whether the statement is relevant to the organisation • how the current service compares to the statement • source of information to evidence this • what actions/resources would be required in order to improve the service so that it meets the quality standard statement • an initial assessment of risk associated with not making these improvements
Sources of information to support this initial assessment could include: • Baseline assessments/actions plans for NICE clinical guidelines • new or existing service user feedback • complaints or Serious Untoward Incidents (SUIs) • audit information (including national audit data) • prescribing or activity data • views of the service/team • process maps • service user experience interviews
Locally prioritised quality improvement The initial assessment: • Can provide assurance • A positive assessment could be included in the trust’s quality account or organisation’s quality profile • An assessment indicating areas requiring quality improvement can: – inform local quality improvement work/programme planning – support discussions with commissioners • Inform the organisation’s annual audit programme (by identifying priority areas for audit) and business planning • Inform local risk management, in collaboration with the service’s commissioners
Case study 1 – Lancashire Care Foundation Trust
• Aimed to develop a robust method of using NICE quality standards across the trust • Ensuring staff are aware when a quality standard applies to their area of work so they can understand their performance in relation to it, share good practice and strive to improve if appropriate • Clinical lead completes a review of the statements • Using
existing evidence where available e.g. training records and environmental audits
Case study 2 - NHS Stockport CCG & Stockport Metropolitan Borough Council
• • Wanted to integrate quality agendas, with a systematic & evidence based approach to quality • Designed a process & set up small steering group to evaluate all QS (tested it with QS1& 30 on dementia)
Where indicated by initial assessment, set up small topic specific task & finish groups
, which identified actions required to improve, and act upon them.
• Working together led to consistent approach, combined knowledge, avoided duplication, more powerful approach to change, feeds into formal structures.
Support for commissioning – Heart Failure Services • Context and epidemiology (prevalence, emergency admission and readmission rates, case for improvement) • Resource implications (for each stage of the pathway) • Cost impact (e.g. echo waiting list) • Link to commissioning and benchmarking tool to assess the level of service needed locally and the associated costs and savings • Definitions and links to source guidance (e.g. multidisciplinary team structure) • Links to national drivers and other useful resources including patient information leaflets, exemplar CQUIN goals and ‘Es of self management’
Scrutiny and service review
NICE guidance & quality standards can provide a useful reference tool for those scrutinising services Ask services: • whether they have a systematic approach to NICE guidance and quality standards, and what it is • how they are using NICE quality standards to improve quality of care provided or commissioned • specific questions developed from quality standard statements
Case study 3 – Greater Manchester Sector Led Improvement
• NICE guidance & quality standards are pivotal to Greater Manchester's sector-led improvement approach to driving improvements in public health • Process of
self-assessment and peer review
• Local action plans are developed and reviewed regularly by LA peers to ensure that NICE guidance & quality standards are being implemented and that performance against PHOF (Public Health Outcomes Framework) measures improves in the long-term