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Welcome to - Clinical audit awareness week webinars

Join us for a chat on twitter this evening6.30-7.00pm @hqip #clinicalaudit

Find out more -www.hqip.org.uk/clinical-audit-awareness-week

Deborah O’Callaghan, Implementation Consultant – East

21st 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 NICE quality standard is a concise set of statements designed to drive and measure priority quality improvements.

A set of systematically developed recommendations to guide decisions for a particular area of care or health issue

Research studies - experimental and observational, quantitative and qualitative, process evaluations, descriptions of experience, case studies

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 NICE quality standard is a concise set of statements designed to drive and measure priority quality improvements.

A set of systematically developed recommendations to guide decisions for a particular area of care or health issue

Research studies - experimental and observational, quantitative and qualitative, process evaluations, descriptions of experience, case studies

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

Any questions?

deborah.ocallaghan@nice.org.uk