NICE offer to STPs: CVD preventiontvscn.nhs.uk/wp-content/uploads/2017/10/Zoe-Girdis... · 2017. 10. 3. · Myocardial infarction: cardiac rehabilitation and prevention of further

Zoe Girdis

Regional Technical Adviser – South of England and Channel Islands

NICE offer to STPs: CVD prevention

© NICE 2017 All rights reserved

NICE support for STPs

Based on the best available evidence of what works and is cost-

effective, NICE resources can inform the development and

implementation of STP plans to:

• improve quality and safety by supporting standardisation to

evidence-based best practice for your key clinical priorities

• improve productivity

• prevent ill health

• engage patients and communities

• drive and measure quality improvement

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Local support offer

Advice

• How NICE guidance, advice and quality standards can help to address local priorities

• Signpost available metrics to support local evaluation

• Which NICE resources can support community engagement

Support

• NICE quality standards to embed good practice

• Shared learning and local education

Connecting stakeholders

• to other teams and specialist support at NICE

• with other organisations and networks working in areas of shared interest

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NICE regional and local presence

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Field Team

NICE Fellows and Scholars

Regional Technical Advisers (Medicines and Technologies)

Associate/affiliate networks (Medicines and Technologies)


Chris Connell

Associate Director [email protected]

+ 2 Implementation Facilitators

Zoe Girdis

Regional Technical Adviser

[email protected]

NICE Field Team and Technical Advisers South

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NICE CVD prevention resources

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How can NICE help you?

• NICE guidance

• NICE pathways

• Medicines advice

• Evidence summaries, key therapeutic topics

• NICE evidence search

• BNF, Clinical Knowledge Summaries

• Keeping up to date with news

• Engaging with NICE

• NICE medicines & prescribing associate programme

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An overview of NICE

Evidence-based products:

Guidance

Quality standards

Evidence summaries

Evidence alerts

Accredited evidence

Prescribing advice

Indicator sets

Dissemination and adoption

support: NICE Evidence Services

NICE website

Pathways

Apps

E-alerts

Implementation tools

Audiences:

NHS

Patients and the public

Public health

Local government

Social care

Commissioners

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NICE guidance responsibilities for health professionals

Professionals and practitioners are expected to take NICE guidance

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.

Guidelines not tramlines

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Evidence into practice Maskrey N, 2014

Research

National guidance

Local implementation

Care of Individual people

RNLI

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Best available evidence

Patient’s needs,

values and preferences

Expertise, experience, skills and

judgement

Patient-centred care

• Patients and healthcare

professionals have rights and

responsibilities as set out in the

NHS Constitution for England – all

NICE guidance is written to reflect

these

• Treatment and care should take

into account individual needs and

preferences

• Patients should have the

opportunity to make informed

decisions about their care and

treatment, in partnership with

their healthcare professionals

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Types of guidance from NICE

• Guidelines:

• Clinical

• Public health

• Social care

• Medicines practice

• Safe staffing

• Cancer service

• Quality standards

www.nice.org.uk/guidance

• Guidance:

• Technology appraisals

• Diagnostics

• Interventional procedures

• Medical technologies

• Highly specialised

technologies

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NICE Pathways

• Bring together related guidance, between and within topics

• Link other products – Quality Standards, implementation support tools etc.

• Provide a useful format – network of recommendations

• Improve digital formatting for easier access

• Easier, quicker access to the evidence

http://pathways.nice.org.uk

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© NICE 2017 All rights reserved 14


Quality Standards

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Typically 6 –

8 statements

Include

measures to

help inform

local quality

improvement

work

Define priority

areas for quality

improvement


Medicines advice https://www.nice.org.uk/guidance

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NICE evidence summaries

• Summaries of the best available evidence

to inform local NHS planning and

decision-making, for selected new

medicines, off-label use of licensed

medicines and unlicensed medicines

• Summary of published evidence (critically

appraised) but NOT formal NICE

guidance

• Topics are selected in collaboration with

the NICE topic selection process, with

advice from the NICE medicines and

prescribing associate network and

partner organisations

https://www.nice.org.uk/about/nice-communities/medicines-and-prescribing#more-evidence-summaries

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Key NICE guidelines and QS: CVD Prevention (1)

Topic

QS

Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease (CG172, November 2013)

Sept 2015

Cardiovascular disease: risk assessment and reduction, including lipid modification (CG181, September 2016)

Published

Peripheral arterial disease: diagnosis and management (CG147, August 2012) Published June 2015

Cardiovascular disease prevention (PH25, June 2010)

Cardiovascular disease: identifying and supporting people most at risk of dying early (PH15, September 2008)

Hypertension in adults: diagnosis and management (CG127, November 2016) Published

Familial hypercholesterolaemia: identification and management (CG71, July 2016)

Published

Atrial fibrillation: management (CG180, August 2014) Published

Type 2 diabetes in adults: Management (NG28, May 2017) Published


Key NICE guidelines and QS: CVD Prevention (2) Topic QS

Behaviour change: general approaches (PH6, October 2007)

Behaviour change: individual approaches (PH49, January 2014)

Community engagement: Improving health and wellbeing (NG44, March 2016) Published

Physical activity: brief advice for adults in primary care (PH44, May 2013) Published

Physical activity: exercise referral schemes (PH54, September 2014

Smoking: preventing uptake in children and young people (PH14, November 2014)

Published

Smoking: harm reduction (PH45, July 2013) Published

Smoking: Brief interventions and referrals (PH1, March 2006) Published

Stop smoking services (PH10, November 2013) Published

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Key NICE guidelines and QS: Obesity Topic QS

Preventing excess weight gain (NG7, March 2015)

BMI: preventing ill health and premature death in black, Asian and other minority ethnic groups (PH46,July 2013)

Obesity: working with local communities (PH42, June 2017 2012)

Obesity: Prevention (adults and children) (CG43March 2015) Adults Children

Maternal and child nutrition (PH11, November 2014) Published

Weight management before, during and after pregnancy (PH27, July 2010)

Weight management: lifestyle services for overweight or obese children and young people (October 2013)

Published

Weight management: lifestyle services for overweight or obese adults (PH53, May 2014)

Published

Obesity: Identification, assessment and management (CG189, November 2014) Published

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NICE Indicator menu

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NICE Return on investment tools

Key features:

• Model the effects of single, or multiple, interventions on at-risk population groups

• Estimate the overall costs against the value of non-health benefits as well as health and wellbeing improvements

• Mix and match interventions to see which package provides the best outcome

• Identify cost savings or determine if the additional benefits are worth the extra costs

• Customise the tools to include data and interventions specific to your local area

• Use the results to help support your business cases

https://www.nice.org.uk/about/what-we-do/into-practice/return-on-investment-tools

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Tools for shared decision making

• Conversation between those delivering care and those receiving

care

• Shared decision making puts people at the centre of decisions

about their own treatment and care by:

• exploring care or treatment options and their risks and benefits

• discussing choices available

• reaching a decision about care or treatment, together with their

health and social care professional

www.nice.org.uk/sdm

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Lipid modification: patient decision aid https://www.nice.org.uk/guidance/cg181/resources/

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Atrial fibrillation: patient decision aid www.nice.org.uk/guidance/cg180/resources

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Type 2 diabetes in adults: patient decision aid www.nice.org.uk/guidance/ng28/resources

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Medicines optimisation: key therapeutic topics

• Medicines optimisation: key therapeutic topics (KTTs) summarise

the evidence base on topics identified to support medicines

optimisation

• They are not formal NICE guidance

• These topics are selected and prioritised therapeutic areas where

there are potential opportunities for maintaining or improving

quality and improving value from our use of medicines

• NHS Digital lead on the development of comparators for the

therapeutic topics included in the document

www.nice.org.uk/about/what-we-do/our-programmes/nice-advice/key-therapeutic-topics

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Medicines optimisation: key therapeutic topics

• Biosimilar medicines

• Anticoagulants: including non-vitamin K antagonist oral anticoagulants (NOACs)

• Acute kidney injury (AKI): use of medicines in people with or at risk of AKI

• Lipid modifying drugs

• Asthma: medicines optimisation priorities

• Hypnotics

• Low dose antipsychotics in people with dementia

• Wound care products

https://www.nice.org.uk/about/what-we-do/our-programmes/nice-advice/key-therapeutic-topics

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• Antimicrobial stewardship: prescribing

antibiotics

• Type 2 diabetes mellitus: medicine

optimisation priorities

• Non-steroidal anti-inflammatory drugs

New topics 2017

• Multimorbidity and polypharmacy

• Psychotropic medicines in people with

learning disabilities whose behaviour

challenges

• Safer insulin prescribing

• Medicines optimisation in long-term pain


Shared-learning

• Submitting a local practice example

• What are they?

‘Shared Learning examples are real-life experiences from

organisations that have used NICE guidance to change practice,

improve care, and consider the way that health, social care and

community-based organisations, use resources’

• Details on the website

• Chris Bird able to help and support completion of examples

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Evidence into practice Maskrey N, 2014

Research

National guidance

Local implementation

Care of Individual people

RNLI

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Possible implementation issues for medicines

optimisation (N L)

• Identify local implementation priorities

• Benchmark against each topic considering:

• Existing workstreams and achievements

• Local performance metrics such as prescribing information, medicines optimisation dashboard, RightCare and HES data,

• Identify potential challenges and barriers

• Develop a plan considering the ‘options for implementation’:

• Who needs to be involved, what resources do you need, how will you raise awareness and engage stakeholders?

• What do you need to do and how will you communicate this?

• What will success look like and how will you measure it?

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NICE local practice case studies

Title Published

Improving the physical health of people with serious mental illness: A quality

improvement approach

Jan 2017

Adopting a multi-disciplinary approach to improve medicines accuracy in a general

surgical ward

Jan 2017

Refer-to-Pharmacy and Medicines Optimisation Jan 2017

Patient Led Clinical Medicines Reviews Jan 2017

Innovative ways to support smokers requiring nicotine management in a mental

health organisation

Jan 2017

Hypertension: Improving blood pressure management in primary care Jan 2017

Prudent Health Care – Pilot Study to reduce the number of inappropriate lumbar

spine x-rays requested from primary care in the Princess of Wales locality

Jan 2017

Manchester Royal Infirmary Virtual Biologics Clinic Dec 2016

Improving and maintaining medicines reconciliation on admission Nov 2016

www.nice.org.uk/about/what-we-do/into-practice/local-practice-case-studies

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Keep up to date with the latest from NICE

Subscribe to NICE News for:

- The latest news and features

- Newly published guidance and quality standards

- Current consultations

- Ways you can get involved

https://www.nice.org.uk/news/nice-newsletters-and-alerts/subscribe-to-nice-news

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Find us on Facebook


Guidelines. Not tramlines.

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Regional Technical Adviser

[email protected]

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Documents

NICE offer to STPs: CVD preventiontvscn.nhs.uk/wp-content/uploads/2017/10/Zoe-Girdis... · 2017. 10. 3. · Myocardial infarction: cardiac rehabilitation and prevention of further