national clinical effectiveness committee

National Clinical Effectiveness CommitteeThird Annual Report 2015

NATIONALCLINICALEFFECTI ENESSCOMMITTEE

www.health.gov.ie/patient-safety/[email protected]

Table of Contents

Introduction to Clinical Effectiveness 3

National Clinical Effectiveness Committee (NCEC) 5

NCEC Updated Terms of Reference 2015 5

Chairperson’s Statement 6

Introduction from Director of Patient Safety and Clinical Effectiveness 7

Figure 1: NCEC outputs: 2015 at a glance 8

Activities Report 9 1. National Clinical Effectiveness Committee 9 2. Developments in NCEC National Clinical Guidelines 13 3. Monitoring and Implementation of NCEC National Clinical Guidelines 14 4. National Clinical Audit 17 5. Standards for Clinical Practice Guidance 17 6. Information Technology – Early Warning Systems and Clinical Handover 18 7. Education and Training 19 8. NCEC Symposium 20 9. Communications 21 10. Clinical Effectiveness informing policy, strategy and legislation 26

NCEC Priorities 2016 27

Appendix 1NCEC Guideline Endorsement Process 28

Appendix 2NCEC Membership and Meeting Attendance 2015 29

Appendix 3 Department of Health Clinical Effectiveness Support 31

Appendix 4 NCEC Annual Symposium Programme 2015 32

Appendix 5 Guidelines in Development, December 2015 33

Appendix 6 National Clinical Guidelines 34

Appendix 7 Abbreviations 35

List of tables

Table 1 NCEC Committee 9Table 2 NCEC Sub-groups 10Table 3 Research and Literature review projects 12Table 4 Key Performance Indicators for National Clinical Guidelines 15Table 5 Training Sessions 2015 19Table 6 Abbreviations 35

List of figures

Figure 1 NCEC outputs: 2015 at a glance 8Figure 2 New NCEC/HIQA Publication 11Figure 3 NCG No 6 14Figure 4 Development of Standards for Clinical Practice Guidance 18Figure 5 3rd NCEC Annual Symposium 21Figure 6 NCEC Guidelines on international websites 22Figure 7 NCEC Website (1) 23Figure 8 NCEC Website (2) 24Figure 9 Website Pageviews 24Figure 10 Irish health magazine and newspaper coverage 25Figure 11 Twitter coverage on Annual Symposium 25

3National Clinical Effectiveness Committee Annual Report 2015

What is Clinical Effectiveness?Clinical effectiveness is a collection of activities and tools, based on research and measurement that are used to improve the quality of healthcare. The activities include, but are not limited to, guidelines, audit, research and evaluation.

What is the aim of Clinical Effectiveness?Clinical effectiveness aims to ensure that healthcare practice is based on the best available data and evidence of effectiveness. It is a key component for improving patient safety and quality health service delivery.

How does Clinical Effectiveness work?Clinical effectiveness uses information gathered from national and international research and audit to identify what practices are safe, effective and efficient. It brings this information together to draw conclusions that help healthcare practitioners and their patients to make decisions about what is best for the Irish healthcare system and its individual users.

Is Ireland the only country developing Clinical Effectiveness?No, other countries such as the UK and Australia are developing Clinical Effectiveness for their national health systems through agencies such as the UK’s National Institute for Health and Care Excellence (NICE) and Australian Commission on Safety and Quality in Healthcare.

How is Ireland developing Clinical Effectiveness?Ireland is developing Clinical Effectiveness through the National Clinical Effectiveness Committee (NCEC) that the Minister of Health set up in 2010. The NCEC role is to recommend guidelines and audit to the Minister for Health to become National Clinical Guidelines and National Clinical Audit for implementation in Irish healthcare. Currently, it does this by:

• Prioritising clinical guidelines that are important to national policy and the Irish health system.• Assessing clinical guidelines against criteria to judge that they have been developed in the

best possible way. This assures that National Clinical Guidelines are based on best available evidence, have involved key people, including patients, in their development and have examined the cost involved in implementation.

Clinical guidelines that successfully go through these steps are recommended to the Minister for Health through the Chief Medical Officer for endorsement and publication as National Clinical Guidelines. A similar process is in development for clinical audit.

What do National Clinical Guidelines do?NCEC National Clinical Guidelines are defined as “systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and service users’ decisions about appropriate healthcare for specific clinical circumstances across the entire clinical system”. The implementation of clinical guidelines can improve health outcomes for patients, reduce variation in practice and improve the quality of clinical decisions that patients and healthcare staff have to make. National Clinical Guidelines will inform patients about the care they should be receiving and assist them to make healthcare choices based on best available information. National Clinical Guidelines can be used to set the standards for measurement in clinical audit.

Introduction to Clinical Effectiveness

4 Annual Report 2015 National Clinical Effectiveness Committee

What does National Clinical Audit do?NCEC National Clinical Audit is defined as “a cyclical process that aims to improve patient care and outcomes by systematic, structured review and evaluation of clinical care against explicit clinical standards conducted on a national basis”. Clinical audit is an internationally recognised process that requires action to be taken where the audit identifies quality improvement is necessary. When in place, the results of NCEC National Clinical Audits can inform patients of the structures, process and outcomes of healthcare and show them where improvements are being made.

What are National Standards for Clinical Practice Guidance?These Standards help healthcare staff develop quality clinical practice guidance by using an agreed approach nationally.

Further information is available on the website http://health.gov.ie/patient-safety/ncec/


National Clinical Effectiveness Committee (NCEC)

The National Clinical Effectiveness Committee (NCEC) was established as part of the Patient Safety First Initiative. The NCEC’s mission is to provide a framework for national endorsement of clinical guidelines and audit to optimise patient and service user care. The NCEC has a remit to establish and implement processes for the prioritisation and quality assurance of clinical guidelines and clinical audit so as to recommend them to the Minister for Health to become part of a suite of National Clinical Guidelines and National Clinical Audit. The NCEC publishes an annual report of its activities, of which this is the third.

The aim of the National Clinical Guidelines is to provide guidance and standards for improving the quality, safety and cost effectiveness of healthcare in Ireland. The implementation of these National Clinical Guidelines will support the provision of evidence based and consistent care across Irish healthcare services. The NCEC process for endorsement of National Clinical Guidelines involves a number of steps as outlined in Appendix 1. The oversight of the national clinical effectiveness agenda is provided by the National Clinical Effectiveness Committee (NCEC) (Appendix 2) which is supported by the Clinical Effectiveness Unit (CEU, Department of Health) (Appendix 3) and sub-groups, with each sub-group reflecting a work stream of the committee. The NCEC is a partnership between key stakeholders in patient safety and clinical effectiveness.

NCEC Updated Terms of Reference 2015

1. Provide strategic leadership for the national clinical effectiveness agenda.

2. Contribute to national patient safety and quality improvement agendas.

3. Publish standards for clinical practice guidance.

4. Publish guidance for National Clinical Guidelines and National Clinical Audit.

5. Prioritise and quality assure National Clinical Guidelines and National Clinical Audit.

6. Commission National Clinical Guidelines and National Clinical Audit.

7. Align National Clinical Guidelines and National Clinical Audit with implementation levers.

8. Report periodically on the implementation and impact of National Clinical Guidelines and the performance of National Clinical Audit.

9. Establish sub-committees for NCEC work-streams.

10. Publish an Annual Report.


Chairperson’s Statement

This is the third annual report of the NCEC and 2015 again represented a year with significant achievements. During the first half, the Minister for Health re-constituted the Committee with many new members. The Committee now consists of 20 members, representing the health service, educational bodies, regulation, the Department of Health, insurers, research, and with two patient representatives. As Chair, I look forward to working with them to provide strategic leadership for clinical effectiveness. In addition, at the latter end of 2015 three sub-groups have been established, namely, Clinical Guidelines under the chairmanship of Professor Devane of NUIG and a previous member of the NCEC, Clinical Audit under the chairmanship of Mr. Ian Callanan of St Vincent’s Hospital Group, and a previous member of the NCEC, and Education under the chairmanship of Professor Dermot Malone of the Forum of Postgraduate Training Bodies. During the year, eight guidelines were endorsed by the Minister to add to the six endorsed in previous years. These include guidelines on cancer, asthma, palliative care, clinical handover and the Irish paediatric early warning system.

This year also saw the development and ratification of Prioritisation and Quality Assurance Criteria for National Clinical Audit which involved very constructive engagement with key national stakeholders. The Third National Clinical Effectiveness Symposium took place in Dublin Castle in late November and was attended by approximately 150 delegates and covered such issues as research and the patient perspective. In 2016 this will be combined with the National Safety Patient Conference which will take place over 2 days. The NCEC web pages were re-designed and are now more user friendly. They highlight news such as public consultations and other important information.

I would like to record my sincere thanks and appreciation to all members (past and present) of the NCEC for their commitment and hard work, all those involved in guideline development and audit, and the staff of the Clinical Effectiveness Unit in the Department of Health for their outstanding professionalism and dedication. Notwithstanding the achievements and successes of 2015, more work needs to be undertaken to maximise patient safety and to embed a culture of the highest quality of care in all aspects of healthcare delivery

_____________________________

Professor Hilary Humphreys, Chairman NCEC

24th February 2016


Introduction from the Director of Patient Safety and Clinical Effectiveness

This has been a very productive and important year for the national clinical effectiveness agenda. Eight new guidelines were published. In addition, twelve guidelines in development and one guideline update were supported and research was conducted to support the establishment of NCEC’s audit function was completed.

Clinical effectiveness capacity has expanded with the addition of two new Clinical Effectiveness Officers to the team in the Department of Health. This year all Guideline Development Groups were offered an officer to act as liaison with NCEC and to provide support and direction for the guideline work. An updated framework for guideline development was published in tandem with revised guideline prioritisation criteria.

HIQA and NCEC partnered to publish enhanced quality assurance criteria for guidelines. We are grateful to HIQA for their continued support for the economic and budget impact aspects of guidelines. In addition HIQA in July published Guidance on Budget Impact Analysis of Health Technologies in Ireland. This was created primarily to support clinical guideline developers who must provide analysis of the budget impact of their recommendations.

The NCEC website has been updated with additional resources and templates, and an enhanced training programme provided for guideline developers. Standards for Clinical Practice Guidance were published to provide an evidence-based methodology for the development of guidance such as clinical policies, procedures, protocols and guidelines.

The Clinical Effectiveness Unit is now fully integrated with the overall policy work of the Department of Health. This means that emerging strategies such as the Maternity Strategy and the Cancer Strategy will have distinct sections outlining the vision for clinical effectiveness and specific recommendations for NCEC guidelines and audit.

Clinical effectiveness will become a work stream of the new National Patient Safety Office (NPSO) planned for the Department in 2016. The NPSO will provide a programme of patient safety measures and the reach and impact of clinical effectiveness will be enhanced through synergies across the various patient safety initiatives of the NPSO.

_____________________________

Dr Kathleen Mac LellanDirector of Clinical Effectiveness


NCEC outputs: 2015 at a glance

Figure 1: NCEC Outputs: 2015 at a glance

Newwebpages

Update: NCEC Framework for Endorsement of NCGs

NCEC Preliminary Prioritisation Process for NCGs

Cochrane Conference

GDG Training

NOCA Conference

NCEC Member

Orientation

Guidelines International

Network Conference

GDG Training

Launch NCGs:Cancer

Pain and Constipation in Palliative Care

NCEC Framework for Endorsement of NCA

Launch NCGs:Breast Cancer and Prostate

Cancer

HIQA/NCEC Quality Assurance Criteria for NCGs

Launch NICE Accreditation of NCG: Sepsis

Public Consultations:Clinical Practice Guidance

StandardsPrioritisation and QA Criteria for

Clinical Audit

NCEC Prioritisation and Quality Assurance Criteria for NCA

NCEC Clinical Practice Guidance

Standards

3rd National Clinical

Effectiveness Symposium

Launch NCGs:PEWS,

Clinical Handover,GTD,

Acute Adult Asthma Attack


5 NCEC Meetings


1. National Clinical Effectiveness Committee

Membership representation and terms of reference of the NCEC were reviewed by the Minister for Health in early 2015. The new terms of reference take into account the evolving models for health service delivery and provide for effective and efficient management of the business of the NCEC.Changes in the reconstitution included a reduction in numbers of committee members, some overlap of membership for continuity and the addition of patient representatives to the committee. The new committee (Table 1) coincided with the updated Terms of Reference (see page 3).

Table 1: NCEC committee

NCEC Membership (by November 2015)

Chairman Professor Hilary Humphreys

Regulation

Health Information and Quality Authority Dr Máirin Ryan

Mental Health Commission Ms Rosemary Smyth

Health and Social Care Regulatory Forum Dr Jayne Crowe

Health Products Regulatory Authority Dr Elaine Breslin

State Claims Agency Dr Dubhfeasa Slattery

Education

Forum of Postgraduate Training Bodies Prof Dermot Malone

Nursing and Midwifery Education Bodies Dr Anne Marie Brady

Service

Forum of Hospital Group CEOs Dr Susan O’Reilly

Clinical Programmes Dr Áine Carroll

HSE Quality Improvement Division Dr Philip Crowley

HSE Office Nursing and Midwifery Services Ms Mary Wynne1

National Office for Clinical Audit Ms Fiona Cahill

Independent Hospital Association of Ireland Mr Simon Nugent

Department of Health (2)

Department of Health Dr Philippa Ryan Withero

Department of Health Ms Fionnuala Duffy

Insurers

Health Insurance Council Mr Donal Clancy

Research

Health Research Board Dr Graham Love

Patient Representation (2)

Patient representative Ms Linda Dillon

Patient representative Ms Brigid Doherty

Total: 20

1 Replacing Dr Michael Shannon

Activities Report


The NCEC met five times in 2015. Summary minutes of NCEC meetings are posted on the NCEC website. The following were the main items on the NCEC agenda for 2015:

Modus OperandiA new modus operandi was agreed at the NCEC meeting in October and was published on the website. This modus operandi established 3 sub-groups reflecting the main work-streams and 3 Chairpersons were nominated (see Table 2). Terms of reference and membership of the sub-groups will be finalised early 2016.

Table 2: NCEC Sub-groups

NCEC Sub-group Chairperson

Clinical Guidelines Prof Declan Devane2, previous NCEC member

Clinical Audit Mr Ian Callanan3, previous NCEC member

Education and Training Prof Dermot Malone4, NCEC member

National Clinical Guidelines Prioritisation and Quality Assurance criteria Guideline prioritisation criteria were reviewed in 2014. A number of issues were considered including criteria utilised, weighting of criteria, international processes of prioritisation and management of commissioned guidelines. The revised criteria are detailed in NCEC (2015) Preliminary Prioritisation Process5 National Clinical Guidelines which was published in March 2015 (Figure 2). In addition, the process of appraisal was reviewed and updated to form two parts:

Part A – Checklist of pre-requisite quality assurance criteria for the Irish contextPart B – Appraisal of Guidelines for Research & Evaluation II (AGREE II), an internationally

recognised instrument that has been validated and endorsed by the World Health Organisation and is widely considered as the standard in quality assessing clinical guidelines.

These changes to guideline processes are detailed in the NCEC Framework for Establishment of National Clinical Guidelines which was published in April 2015.

National Clinical Audit Function The NCEC audit function was developed in 2015 – see section 4 of this Annual Report.

Peer reviewThe updated HIQA/NCEC (2015) Quality Assurance Criteria for National Clinical Guidelines published in April 2015 contains a sample set of international external reviewers’ questions.

2 Prof Devane is Professor of Midwifery at NUIG Galway and Director of HRB-TMRN.3 Mr Callanan is Clinical Audit Manager of St Vincent’s Healthcare Group and Medical Director of Aviva Health

Insurance Ireland.4 Prof Malone is the current Dean of the Faculty of Radiologists at the RCSI and represents the Forum of Postgraduate

Training Bodies on the NCEC.5 The NCEC continues to consider weighting of each of the prioritisation criteria. The document title will be amended

and ‘preliminary’ removed from the title once this exercise is completed and the criteria weighting included in the document.


Figure 2: New NCEC/HIQA Publication

A joint HIQA/NCEC Quality Assurance Criteria for National Clinical Guidelines was published in April 2015.

Commissioned guidelinesFollowing the request by the Minister for Health in 2013 that the NCEC commission and quality assure a set of National Clinical Guidelines arising from the recommendations following the Patient Safety Investigation Report into Services at University Hospital Galway (HIQA, October 2013), guideline development continued on this set and was supported by NCEC in 2015. Two further National Clinical Guidelines were published in November 2015: Paediatric Early Warning System and Communication (Clinical Handover) in Acute and Children’s Hospital Services. Clinical handover occurs within and between teams and healthcare professionals at a number of points in the healthcare system. The NCEC recognised that the breadth of the scope of work in relation to a clinical handover guideline requires a phased approach. There are now NCEC Clinical Handover Guidelines for acute, maternity and paediatric services. One further guideline to reflect clinical handover between services is required in order to complete the set.

Commissioned researchA number of research and systematic literature review projects were commissioned through tendering processes in 2015 to support commissioned and other guidelines and various clinical effectiveness processes. Budgets were allocated as per Table 3.


Table 3: Research and literature review projects

Project Cost (€) including vat

PEWS focus groups 4,075.00

PEWS guideline pre-implementation research 24,000.00

Clinical Handover 86,292.73

Management of Acute Adult Asthma Attack 9,973.00

NEWS update 22,742.27

Patient engagement in clinical effectiveness processes 34,743.07

Bundle of Systematic Literature Reviews to support National Clinical Guidelines (consists of support for 5 guidelines in total; allocated as 3 large and 2 small topics)

159,644.77

Guidelines in developmentThere were 11 guideline or proposal appraisals conducted in 2015. Five guidelines were appraised by NCEC and were deemed to meet the prioritisation criteria for National Clinical Guidelines. Six guidelines were appraised and were deemed to meet the quality assurance criteria. These guidelines were recommended to the Chief Medical Officer for Ministerial endorsement.

A further five ‘Notices of Intent’ were received by the NCEC in 2015 and these are now awaiting submission to the NCEC. All of these relate to guidelines in development by the National Cancer Control Programme (NCCP). A proposal on Hepatitis C Screening was received and is undergoing prioritisation.

The NCEC undertook a review of guidelines on their list as ‘guidelines in development’: a number of which had been dormant.6 Guideline Development Leads were contacted in 2014 and early in 2015. At the end of this review, 8 were removed from the list due to non-progression.

A full listing of guidelines at their various stages is published on the website and Appendix 5 shows the status at December 2015.

Support for Guideline Development Groups (GDGs)NCEC members and the CEU held a number of meetings and teleconferences with GDGs to provide advice, guidance and general support for the on-going development of national guidelines. This included the following guideline development groups:

- Acute Adult Asthma Attack- COPD- Hepatitis C Screening- Commissioned guidelines:

• Irish Paediatrics Early Warning System • Communication (Clinical Handover) Acute Hospitals

- NEWS (update)- Emergency Department Monitoring and Care Escalation- Under-nutrition in Acute Hospital Services.

NCEC/CEU also held meetings with groups considering guideline development:- HSE Radiology Programme- HSE National Clinical Programme for Palliative Care.

6 Little or no communication with NCEC indicating that they were being progressed for submission.


Submission databaseA dedicated database to process and manage guideline submissions for review is being developed by the Department of Health IT Department.

The draft version is currently being updated to reflect the changes to the NCEC National Clinical Guideline processes made in 2015. This includes revision of appraisal criteria, addition of the pre-requisite checklist and facility for submission of guideline proposals. Once this phase is complete testing will commence.

2. Developments in NCEC National Clinical Guidelines

New National Clinical Guidelines in 2015A total of 8 National Clinical Guidelines were launched in 2015. The guidelines were subject to quality assurance by NCEC to ensure that a rigorous methodological process of development had been completed for each guideline.

Methodology for each guideline encompassed: a. A multi-disciplinary guideline development group b. Guideline development in line with NCEC methodologyc. A systematic clinical literature review to underpin guideline recommendationsd. A grade for each recommendation reflecting the strength of evidence associated with the

recommendatione. Identification of responsibility for implementation of each recommendation f. Consideration of facilitators and barriers to guideline implementation g. A budget impact assessment including a systematic economic literature review h. An implementation plan, audit criteria and key performance indicators to measure guideline

implementation and impact.

The eight new National Clinical Guidelines published in 2015 were:No. 7 - Diagnosis, Staging and Treatment of Patients with Breast CancerNo. 8 - Diagnosis, Staging and Treatment of Patients with Prostate CancerNo. 9 - Pharmacological Management of Cancer Pain in Adults No. 10 - Management of Constipation in Adult Patients Receiving Palliative CareNo. 11 - Communication (Clinical Handover) in Acute and Children’s Hospital ServicesNo. 12 - Irish Paediatric Early Warning System (PEWS)No. 13 - Diagnosis, Staging and Treatment of Patients with Gestational Trophoblastic DiseaseNo. 14 - Management of an Acute Asthma Attack in Adults

For the full list of National Clinical Guidelines published as at December 2015 see appendix 6.

Developments with published National Clinical GuidelinesNational Clinical Guideline No. 1 National Early Warning Score, published February 2013 and subsequently updated to reflect sepsis recognition requirements in August 2014, will be due for updating in 2016, and will be the first to undergo this process. To assist, a systematic literature review was commissioned. A team from UCC commenced the work in Q4 2015. The HSE Quality Assurance and Verification Division also undertook a healthcare audit on NEWS implementation in order to inform the update.

NICE accreditation of National Clinical Guideline No 6.National Clinical Guideline No 6 Sepsis Management guideline was accredited by the National Institute for Health and Care Excellence (NICE) in March 2015 and now carries the NICE accreditation logo (Figure 3). This means that it is regarded as guidance of high quality and is available on the NICE Evidence Services Portal.


NCEC, in collaboration with the National Sepsis Lead, undertook an exhaustive process over four months to achieve NICE accreditation for a five year period. The NICE Accreditation Process identifies sources of trustworthy/high quality reliable guidance through an accreditation process based on the internationally agreed AGREE II criteria. Accredited guidance is presented on a portal titled NICE Evidence Services and it supports the NICE Quality Standards Programme. It is viewed in the UK as a high quality mark for guidance.

NICE found that the scope and purpose and the recommendations of the guideline is clear. Development was systematic, multidisciplinary and included professional target users. The content and format of the guidance was deemed suitable for its target audience and implementation issues in the local context carefully considered, with support and audit tools provided. Development was considered editorially independent from any funding source as all work was performed by volunteers who had to declare any conflicts of interest.

NICE advised NCEC to involve lay people in the development of guidelines from an earlier stage and to have more than one lay person directly involved in guidance development.

Figure 3: NCG No 6

3. Monitoring and Implementation of NCEC National Clinical Guidelines

National Clinical Guidelines endorsed by the Minister for Health are mandated for implementation in the Irish health system and their implementation is monitored through the HSE Performance Assurance Reports, compliance with the National Standards for Safer Better Healthcare (HIQA 2012) and increased alignment with the clinical indemnity scheme. A number of Quality and Patient Safety Performance Indicators, that can measure implementation and impact of National Clinical Guidelines already exist and are supported by the NCGs (e.g. HCAIs7) or have been developed (e.g. Irish Maternity Early Warning System (IMEWS)) and specified in the HSE Service Plan 2015 (Table 4). These are presented in table 4 alongside the targets planned and the actual results achieved. Of note, these include full compliance with the rollout of National Early Warning Score (NEWS) and IMEWS. However, at the end of 2015 figures for the completion of the COMPASS programme, were not fully available.

7 The NCGs provide practical guidance and outline general and specific measures to prevent, control and reduce exposure to C. difficile and MRSA infections.


Table 4: Key Performance Indicators for National Clinical Guidelines

Key Performance Indicator (KPI) HSE Service Plan, 2015

Target Actual* Comment

National Clinical Guideline No 1 - National Early Warning Score (NEWS)

% of hospitals with full implementation of NEWS in all clinical areas of acute hospitals and single spe-cialty hospitals. (Quarterly)

100% 100%

% of all clinical staff who have been trained in the Compass Programme. (Quarterly)

>95% Not reported

National Clinical Guidelines No 2 and No 3 - Healthcare Associated Infections

Rate of MRSA blood stream infections in acute hospital/1000 bed days used (Quarterly)

< 0.057 0.054

Rate of new cases C. difficile in acute hospitals / 10,000 bed days used (Quarterly)

< 2.5 2.3

Medium hospital total antibiotic consumption (DDD/100 bed days) per hospital (Bi-annual)

83.0 78.4 (Sept)

Alcohol hand rub consumption (litres/1000 bed days used) (Bi-annual)

25 33.9 (Sept)

% compliance of hospital staff with the WHO 5 moments of hand hygiene using the national hand hygiene audit tool (Bi-annual)

90% 88% (Sept)

National Clinical Guideline No 4 - Irish Maternity Early Warning System (IMEWS)

% maternity units/hospitals with full implementation IMEWS (Quarterly)

100% 100% New KPI 2015

% of hospitals with implementation of IMEWS for pregnant patients (Quarterly)

100% 100% New KPI 2015

* These results are based on the HSE Performance Reports as at December 2015.

As already stated, the HSE Quality Assurance and Verification Division performed an audit of compliance with selected criteria from the NEWS NCG in a small number of acute hospital sites. This was conducted between July and November 2015. Feedback has been given to the sites involved and the findings will also inform the update of the NEWS guideline.


NCG No. 6 Sepsis Management offers a case study on implementation.

Implementation of the Sepsis guideline - a quality improvement initiative

The National Clinical Guideline No. 6: Sepsis Management was published in November 2014 with NICE accreditation in March 2015. The primary aim of the national sepsis work-stream is to decrease mortality by 20%. Secondary outcomes include decreased length of stay, decreased ICU admission and length of stay and a reduction in the burden of sequelae in survivors of severe sepsis/septic shock. In cases of clinical deterioration where infection is suspected to be the cause of the deterioration, assessment and recognition of sepsis have been included in the Early Warning Score or System National Guidelines.

2015 represented an education and implementation year. The National HSE Sepsis Team provided hospital visits, sepsis lectures and met with hospital management teams to discuss implementation strategies. This was supported by the website www.hse.ie/sepsis which contains education and awareness support information.

Sepsis summit The first National Sepsis Summit was held in July 2015 in Dublin Castle and was aimed at senior hospital management teams. The delegates heard testimony from sepsis survivors and the Canadian sepsis quality improvement initiative. Delegates were given the opportunity at round table sessions to discuss implementation and feedback to the national team.

The second Sepsis Summit was held in Farmleigh in November 2015 and was aimed at members of the sepsis committees of the acute hospitals, with representation from all the acute hospitals in the state. Delegates heard testimony from patient advocates and also presentations from Wexford General, Sligo General, Mayo University, St. James and Cork University Hospitals on their sepsis quality improvement initiatives. The six newly appointed sepsis Assistant Directors of Nursing (ADoNs) were introduced.

EducationThe sepsis work stream has been in contact with the schools of nursing, the medical schools and the postgraduate bodies with a view to embedding sepsis education in the undergraduate and postgraduate training programmes and is working on developing e-learning tools and a national sepsis app’. A patient information leaflet is under development, to be made available in Emergency Departments, ICUs and GP surgeries.

AuditThe sepsis programme aims to set up a sustainable audit programme. The National Office of Clinical Audit will produce a report on case-adjusted infection, sepsis, severe sepsis and septic shock incidence, mortality rates, lengths of stay, critical care admission rates and bed occupancy rates based on HIPE data (Australian ICD 10 coding, 8th edition). Compliance audit will occur locally under the auspices of the Group Sepsis ADoNs and local Hospital Sepsis Committees. In 2016, a gap analysis will be completed on all hospitals by the sepsis ADoNs to identify the current status of sepsis management in each hospital and then, in conjunction with each hospital’s sepsis committee, develop a phased plan in order to close the gaps (if any) between existing practice and compliance with the national guideline. At the end of the year, in conjunction with NOCA, the National Sepsis Team will produce the first National Sepsis Outcome report.


4. National Clinical Audit

The work on NCEC National Clinical Audit progressed in 2015. The original review, conducted by the HRB in 2013, was updated; a desk top analysis of potential sources of national clinical audit was undertaken; a visit to HQIP and NICE by the NCEC Chair, Director of Clinical Effectiveness and Lead for National Clinical Audit occurred; and the vision for NCEC National Clinical Audit was developed. All these activities informed the prioritisation and quality assurance criteria development. A public consultation was held on the draft criteria in Q2-Q3. Thirteen responses were submitted. A report was developed and published and included NCEC responses to the issues raised in the consultation.

The amended Prioritisation and Quality Assurance Criteria for National Clinical Audit were approved by the NCEC and published on the website in September. The Framework for Endorsement of National Clinical Audit was approved by the NCEC in October and made available on the website in November. The template for application was developed in December with input from the Audit Subgroup Chair.

During 2015, the CEU held meetings with interested parties in relation to National Clinical Audit and the Health Information and Patient Safety Bill, including:

• National Office for Clinical Audit (Executive and Governance)• RCPI Quality Improvement Programmes (Executive and Governance)

5. Standards for Clinical Practice Guidance

The NCEC was requested by the Minister for Health to develop standards for clinical practice guidance as per recommendation 19 of the Portlaoise Report 2014.8 This was to ensure consistency of approach and utilisation of appropriate methodology to develop clinical practice guidance. Clinical practice guidance is defined as systematically developed statements or processes to assist clinician and patient decisions about appropriate health care for specific clinical circumstances, with the choice of clinical practice guidance model determined by evidence-based criteria.

The NCEC developed and published the Standards for Clinical Practice Guidance in November 2015 informed by a systematic literature review, advice from an expert advisory group and feedback from a public consultation process (Figure 4). The standards are for use by healthcare staff developing evidence-based clinical practice guidance for health care and provide a standardised terminology and methodology for the development of evidence-based clinical practice guidance nationally.

The Clinical Effectiveness Unit also held meetings with groups considering guidance development:- Irish Hospice Foundation (dementia guidance)- UCC PREPARED project: delivering and evaluating training and education interventions for

primary care clinicians managing patients with dementia - HSE Sexual Health and Crisis Pregnancy Programme (Sexual health guidance)- HSE Medicines Management Programme.

8 HSE Midland Regional Hospital, Portlaoise Perinatal Deaths (2006-date). Report to the Minister for Health, Dr. James Reilly TD from Dr. Tony Holohan, Chief Medical Officer. 24th February 2014.


Figure 4: Development of Standards for Clinical Practice Guidance

Initial Preparation

Standards development

Consultation

Standards approval and publication

Scope of standards

determined

Systematic literature review

Expert advisory group

established

Initial set of standards

drafted

Meetings with NCEC and

Expert Advisory Group

Public consultation

HSE PPPG group

All feedback collated and

used to inform final draft

Approval sought from

NCEC

Launch November 12th 2015

6. Information Technology – Early Warning Systems and Clinical Handover

The consideration of innovative information technology to support implementation of National Clinical Guidelines is the next step in the sustainable integration of evidence in practice. The benefits, risks and costs of such information technology will require systematic consideration. Information technology has the potential to offer a number of advantages in terms of patient safety and quality and these will be considered in this project. Ideally a national approach would be advocated in relation to any decisions around information technology for clinical effectiveness processes. This would promote standardisation and comparability across the county.


The Department of Health considers that six National Clinical Guidelines are of interest in the information technology area:

- No. 1 - National Early Warning Score (2013) Note: due for update in 2016- No. 4 - Irish Maternity Early Warning System (2014)- No. 5 - Communication (Clinical Handover) in Maternity Services (2014)- No. 6 - Sepsis Management (2014)- No. 11 - Communication (Clinical Handover) in Acute and Children’s Hospital Services (2015)- No. 12 - Irish Paediatric Early Warning System (PEWS) (2015)

The Health Information and Quality Authority (HIQA) following a request from the Clinical Effectiveness Unit in the Department of Health conducted a health technology assessment (HTA) of the use of information technology for early warning and clinical handover systems. This was published by HIQA in March 2015.

The benefits, risks and costs of such technology are considered in this HTA to assist a coordinated evidence-based approach for integration of information technology into clinical effectiveness processes.

7. Education and Training

A consultation with Guideline Development Groups on training needs was conducted early in 2015. The consultation identified 4 key modules for inclusion in a training programme:

• Evidence based practice • Guideline development• Economic evaluation • Implementation & audit.

The consultation identified blended learning (workshops and online) as the preferred format for a training programme (Table 5). The information obtained fed into the NCEC education and training programme for 2015. The educational objectives were to increase knowledge in key areas of guideline development methodology. Education and training was provided for guideline developers, the NCEC committee and the appraisal teams.

Education and Training for Guideline Developers in 2015Table 5: Training sessions 2015

Training Month Trainers Participants

Introduction to NCEC guideline development processes

May Dr Kathleen Mac LellanClinical Effectiveness Unit, DoH

7

Systematic reviewing May Dr Dónal O’Mathúna, DCU & Cochrane Ireland

7

Searching for clinical evidence May & November

Mr Gethin White, HSE librarian Ms Breffni Smith, RCSI librarian

11

Economic evaluation for clinical guidelines

November Ms Michelle O’Neill, HIQA

9

Developing evidence-based clinical guidelines

November Dr Eve O’Toole, NCCP Ms Eileen Nolan, NCCP Dr Niamh O’Rourke, CEU

7


To increase accessibility to training, the sessions on ‘introduction to NCEC guideline development’ and ‘systematic reviews’ were video-recorded and made available on NCEC website. Most, but not all, training PowerPoint® presentations are also accessible from the website. http://health.gov.ie/patient-safety/ncec/resources-and-learning/ncec-training/

Attendees crossed the spectrum of roles that make up guideline development teams including librarians, nurses, pharmacists, researchers, clinical programme leads, managers and project officers, educators, regulators and healthcare professionals in practice. Continuing Professional Development credits were awarded for all training courses. Participants’ evaluations of training sessions were positive, with the recommendation of including content on implementation and audit.

In addition, members of the CEU gave training to particular interested groups• Health Protection Surveillance Centre (HPSC) • Clinical Effectiveness for Hospital Pharmacists. Hospital Pharmacists Association of Ireland.

Clinical Skills Course Part 1.

Training for NCEC committeeTwo half day orientation sessions were conducted by the CEU for new and returning NCEC committee members in July and August.

‘Lunch and Learn’ sessions preceded 4 NCEC meetings: January: Budget Impact requirements for National Clinical Guidelines – Ms Michelle O’Neill,

HIQAMarch: Technology Support for National Clinical Guidelines – Dr Mary O’Riordan, HIQASeptember: Developing Clinical Questions using PICOs – Mr Gethin White, HSE librarianOctober: Budget Impact requirements for National Clinical Guidelines – Ms Michelle O’Neill,

HIQA

Training for CEU StaffMarch: Systematic Reviews - Cochrane IrelandMarch: Update in Pharmacoeconomics in the Irish Healthcare Setting – NCPE May: Information Day - SIGNJuly/October: NICE Accreditation for OrganisationsSeptember: Systematic Review and Meta-Analysis - NCPE/TCDOctober: Evidence Synthesis using WinBUGs - NCPE/TCDDecember: Update on GRADE – Prof Declan Devane, NUI Galway

8. NCEC Symposium

The NCEC held its third symposium – Strategic Leadership for the National Clinical Effectiveness Agenda - in Dublin Castle on November 25th 2015 (Appendix 4). The day was attended by approximately 150 delegates representing the HSE clinical programmes, medicine, nursing, allied health professionals, health librarians, regulation, the public, HSE management and policy. On the day, the Minister for Health, Leo Varadkar launched 4 new National Clinical Guidelines (Figure 5).

Attendees were asked to complete a short online feedback survey, with 69 respondents providing feedback on the event: 93% thought the content had addressed the theme and ‘liked best’ about the event was the range of speakers (28%), speaker presentations (21%) and networking opportunities (21%). Over 74% said that enough time was given to interactive elements (speakers’ questions and panel discussion) of the programme. Suggestions were made for future events including; hearing from more international speakers, greater variety to address different aspects of clinical effectiveness and 29% want a focus on guideline implementation.


Figure 5: Dr Kathleen Mac Lellan, Mr Leo Varadkar Minister for Health and Professor Hilary Humphreys at the 3rd NCEC Annual Symposium.

9. Communications

NCEC continued to build its profile in 2015 through provision of a number of presentations, posters and publications at national and international events; and through information technology such as web content, apps’ and social media presence. In addition, and to assist in embedding the clinical effectiveness policy agenda in relevant initiatives, relationship building, consultations and committee work with pertinent stakeholders was undertaken throughout the year. A ‘Lunch and Learn’ session on the NCEC and its work was given to Department of Health staff.

A presentation on the National Clinical Guideline No 6 Sepsis Management was presented at the joint meeting of the EU Chief Medical Officers and Chief Nursing Officers in Luxembourg in October 2015 to raise awareness of sepsis internationally and to seek support from member countries for submission of a proposal on sepsis to the World Health Assembly in 2016.

In 2015, NCEC guidelines featured on international websites (Figure 6):


Figure 6: NCEC Guidelines on international websites


National and International Presentations• The National Clinical Effectiveness Agenda. Infection Prevention Society. (February 2015, Dr Kathleen Mac Lellan)• The Clinical Effectiveness Agenda. The Cochrane UK and Ireland Symposium. (April 2015, Dr Kathleen Mac Lellan)• Chicken, Egg, Fish, Anemone? NCEC Guidelines and Audit. NOCA Inaugural Conference. (May 2015, Dr Kathleen Mac Lellan and Dr Sarah Condell)• Quality Measurement in Ireland’s Healthcare System Auburn University Physician Executive

MBA Conference “2015 Comparative Healthcare Systems: Dublin and Edinburgh” (June 2015, Dr Kathleen Mac Lellan)

• Approaches to improving the implementation of clinical guidelines – an Irish perspective. G-I-N Conference, Amsterdam. (Oct 2015, Dr Kathleen Mac Lellan and Ms Rosarie Lynch)• National Clinical Guidelines for Cancer: translating Evidence into Practice. International

conference for Evidence Based Healthcare. (October 2015, Dr Niamh O’Rourke CEU and Dr Eve O’Toole, NCCP)

• Should we support measures for better sepsis management? Joint meeting of the EU Chief Medical Officers and Chief Nursing Officers. Luxembourg (October 2015. Dr Fenton Howell, on behalf of NCEC)

Peer-reviewed Publications• Mary Teresa O’Riordan, Patricia Harrington, Kathleen Mac Lellen, Máirín Ryan and Hilary

Humphreys (2015). Response to McKinnell et al’s Original Article “Cost-Benefit Analysis From the Hospital Perspective of Universal Active Screening Followed by Contact Precautions for Methicillin-Resistant Staphylococcus aureus Carriers”. Infection Control & Hospital Epidemiology, 36, pp 856-857 doi:10.1017/ice.2015.111

• Hilary Humphreys, Kathleen Mac Lellan (accepted for publication) Response to Schünemann et al’s (2015) Original Article “Guidelines International Network: Principles for disclosure of interests and management of conflicts in Guidelines” Ann Intern Med.

WebsiteThe NCEC webpages were redesigned early in 2015 although the address remains the same at www.health.gov.ie/patient-safety/ncec. As well as an event page, a highlight box on the landing page features links to latest news such as public consultations, open tenders or new patient resources (Figure 7).

Figure 7: NCEC website (1)


Information is categorised into one of six areas: National Clinical Guidelines, National Clinical Audit, Clinical Practice Guidance, the NCEC (governance), Resources and Learning, and Patient and Public (Figure 8). Summary minutes of NCEC meetings are also posted on the website.

Figure 8: NCEC website (2)

The figure (Figure 9) below shows activity in the form of ‘page-views’ for 2015. The Clinical Effectiveness Homepage received over 9,000+ hits. The National Clinical Guidelines page is 6th in the top 10 Page Titles viewed in the Department of Health’s website and its popularity may have been enhanced by guideline launches, updated content, and concurrent tweets.

Figure 9: Page Views 2015

Guidelines in Development

Resources Page

Annual Symposium Page

National Clinical Guidelines Page

Clinical Effectiveness Home Page9140; 46%

9592; 48%

355; 2% 532; 3%

155; 1%


Media and Social MediaPress releases are issued for all guideline launches. In 2015, general print press coverage for the Sepsis Guideline was reported in the Irish Daily Mail, Irish Independent and the Irish Times. General print press coverage also occurred for the Palliative Care Guidelines launch in the Irish Independent.

Features, with a specific on, or that included NCGs, also occurred in the Farmer’s Journal, and Irish Health Magazines and Newspapers (Figure 10)

Figure 10: Irish health magazine and newspaper coverage

The NCEC Twitter account has the handle @NCECIreland. By end of year 2015, there were over 500 followers, and over 300 tweets were recorded on the Annual Symposium.

Figure 11: Twitter coverage on Annual Symposium

0

50

100

150

200

250

300

350

27 Nov26 Nov25 Nov24 Nov23 Nov22 Nov21 Nov

Tweet Activity on #NCECIrl Around Peak


Publications The NCEC has developed a number of publications as a resource to guideline developers and the health service providers. They are intended to provide information on the NCEC and guideline development processes.

All NCEC publications are available at: www.health.gov.ie/patient-safety/ncec

App’ developmentA content App’ was commissioned in Q3 2015 for the National Clinical Guidelines. Accessibility to National Clinical Guidelines is of key importance for those working in busy healthcare environments and helps to ensure best practice guidelines are followed, thus improving patient care. The contract was awarded to Snap Ireland who are currently putting the first guideline onto the app’ platform. The app’ will be compatible with Android™ and iOS™ operating systems and be usable on both smart phones and tablets. Testing of the app’ will occur early in 2016 with a ‘go live’ date later in 2016.

10. Clinical Effectiveness informing policy, strategy and legislation

Helping to ensure that clinical effectiveness is used as a policy foundation for healthcare practice, members of the Clinical Effectiveness Unit participated in policy, strategy and legislation formulation in 2015. Specific activities included inputs to:

• Cancer Strategy (forthcoming in 2016)• Maternity Care Strategy (forthcoming in 2016)• Health Research Board Corporate Strategy (launching January 2016)• HIQA Corporate Plan• Health Information and Patient Safety Bill – Part 7, Clinical Audit (general scheme published

Nov 2015)• Activity Based Funding• Scope of National Patient Safety Office, Department of Health

CEU Committee MembershipMembers of the Clinical Effectiveness Unit were members of the following relevant committees in 2015:

- Cochrane Ireland Steering Group- DoH Unique Health Identifiers working group ll- DoH Activity Based Funding- DoH Maternity Strategy- DoH Cancer Strategy- HIQA HTA Prioritisation Advisory Group - HSE CSP groups for systematic reviews on integrated care- HSE Policies Procedures Protocols & Guidelines (PPPG) group.


NCEC Priorities 2016

1. National Patient Safety Office

A National Patient Safety Office will be established within the Department of Health in early 2016. This Office will lead a programme of patient safety measures and advise the HSE, HIQA and health professional regulatory bodies on patient safety issues. This patient safety programme centres on initiatives such as new legislation, the establishment of a national patient advocacy service, measurement of patient experience, introduction of a patient safety surveillance system, extending the clinical effectiveness agenda and setting up a National Advisory Council for Patient Safety.

2. Collaborate with NTMA

The NCEC will collaborate with States Claims Agency to align indemnity with National Clinical Guideline implementation.

3. Capacity Building

The NCEC will work in partnership with the HRB to scale up skill development and expertise in synthesizing evidence for practice and policy.

4. National partnerships

The NCEC will build partnerships nationally with key agencies (e.g. HIQA, State Claims Agency) to support (a) implementation of National Clinical Guidelines, (b) establishment of National Clinical Audit.

5. International partnerships

Relationships with international guideline agencies such as NICE, the Scottish Intercollegiate Guidelines Network (SIGN), and Guidelines International Network (GIN) will be explored to create an international connectedness and to explore potential synergies and partnerships.


Appendix 1

NCEC Guideline Endorsement Process

NCEC – Endorsement of National Clinical Guidelines

Minister for HealthEndorsement of National Clinical Guideline

Dissemination, communication, implementation and audit of National Clinical Guideline

STEP 1Clinical Guideline

Development Group

STEP 2NCEC

STEP 3NCEC

STEP 4NCEC

STEP 5NCEC

Submission of Clinical Guideline/Proposal

to the NCEC

Clinical Guideline/Proposal Screening

Process

Prioritisation of Clinical Guideline/

Proposal

Quality assuranceof Clinical Guideline

Decision to recommend Clinical Guideline for

endorsement

Prioritisation Criteria

1. Patient safety issue2. Burden of clinical topic3. Evidence analysis4. Economic impact5. Variability in practice6. Potential for addressing

health issues7. Clinical guideline

implementation

Quality Assurance Criteria

Part A - Checklist of pre-requisite quality assurance criteria for the irish Context

Part B - Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument


NCEC Membership and Meeting Attendance 2015

Attendance at NCEC meetings Jan – April 2015

Name 21/1 25/3 Number

Prof H Humphreys 3 3 2/2

Ms F Cahill 3 1/2

Ms E Callanan 3 3 2/2

Mr I Callanan 3 1/2

Dr Bernadette Carr 0/2

Dr A Carroll 0/2

Ms M Dawson 0/2

Prof D Devane 3 3 2/2

Dr C Doherty 0/2

Dr T Grimes 0/2

Dr P Kavanagh 3 1/2

Mr L Kearns 0/2

Ms M Kehoe-O’Sullivan 0/2

Dr M Ledwidge 0/2

Ms C McGloin 3 3 2/2

Dr D Mulholland 3 3 2/2

Ms M Nolan 3 1/2

Dr S O’Reilly 0/2

Ms N Quinlan 0/2

Dr K Ryan 0/2

Dr M Ryan 3 1/2

Dr D Slattery 3 1/2

Ms C Whelan 0/2

Appendix 2


Attendance at NCEC meetings May – October 2015

Name 27/5 8/9 13/10 Number

Prof H Humphreys 3 3 3 3/3

Dr AM Brady 3 3 2/3

Dr E Breslin 3 3 2/3

Ms F Cahill 3 3 3 3/3

Dr A Carroll 3 1/3

Mr D Clancy 3 3 3 3/3

Dr J Crowe 3 3 2/3

Dr P Crowley 3 1/3

Ms L Dillon 3 3 3 3/3

Ms B Doherty 3 1/3

Ms F Duffy 3 3 3 3/3

Dr G Love 3 3 2/3

Prof D Malone 3 3 2/3

Mr S Nugent Not appointed until Nov 2015

Dr S O’Reilly 3 3 2/3

Dr M Ryan 3 3 2/3

Dr P Ryan Withero 3 3 3 3/3

Dr D Slattery 3 3 3 3/3

Ms R Smyth 3 3 2/3

Ms M Wynne Not appointed until Nov 2015


Department of Health Clinical Effectiveness Support

Department of Health Clinical Effectiveness Support in 2015

Director of Clinical Effectiveness

Dr. Kathleen Mac Lellan

Clinical Effectiveness Officers

Dr. Sarah Condell Ms. Rosarie LynchDr. Niamh O’Rourke

Assistant Principal Susan Reilly

Higher Executive Officer Paula Monks

Clerical Officer Anne Devlin

Appendix 3


NCEC Annual Symposium Programme 2015

Appendix 4

3rd National Clinical Effectiveness SymposiumWednesday 25th November 2015

Dublin Castle


Strategic Leadership for the National Clinical Effectiveness Agenda & Launch of National Clinical Guidelines

8.30-9.00 Registration

9.15-9.30 Welcome and opening address Dr. Tony Holohan, Chief Medical Officer, Department of Health

9.30-10.00 Leading for quality – A health service perspective Mr Tony O’Brien, Director General, HSE

10.00-10.20 Minister’s Address Mr Leo Varadkar, Minister for Health

Theme: Research agenda for clinical effectivenessChairperson Professor Hilary Humphreys, Chair NCEC

10.20-10.50 Building Ireland’s clinical research infrastructure Dr Graham Love, Chief Executive Officer, Health Research Board

10.50-11.10 Linking health technology assessment to clinical research Dr Máirin Ryan, Director of Health Technology Assessment, HIQA

11.10-11.20 Panel Discussion

11.20-11.45 Coffee

Theme: The Irish clinical effectiveness landscapeChairperson Dr Kathleen Mac Lellan

11.45-13.00 Delivering Irish National Clinical Guidelines that are clinically credible & patient focused Dr John Fitzimons (PEWS) Dr Dorothy Breen & Ms Eilish Croke (Clinical Handover) Dr Karen Ryan (Palliative Care) Professor Pat Manning (Asthma) Dr Jerome Coffey (Cancer-NCCP)

13.00-13.30 Panel Discussion

13.30-14.30 Lunch

Theme: Implementation and monitoring for effective careChairperson Mr Patrick Lynch

14.30-15.10 Why don’t people just do what we say? How can ‘human factors’ help? Dr Shelly Jeffcott, Human Factors Quality and Safety Lead, NHS Lothian, Scotland

15.10-15.30 Why patients are seeking assurance of implementation of best prctice every time? Ms Shauna Keyes, Patient’s voice

15.30-16.00 Panel Debate (Dr Áine Carroll, Dr Anne-Marie Brady, Dr Shelly Jeffcott, Ms Shauna Keyes)

16.00 Close – Professor Hilary Humphreys

Programme content accurate at time of publication CPD credits will be awarded


Guidelines in Development, December 2015

Title Lead/GDG Chair

Chronic Obstructive Pulmonary DiseaseDiagnosis, assessment and management of adults with Chronic Obstructive Pulmonary Disease and guidance on the provision of rehabilitation and outreach services.

Prof Tim McDonnell

Emergency Department – Adult Clinical Escalation Monitoring Tool (ED-MACE Monitoring Tool)Appropriate and effective monitoring and escalation schedules that ensures quality and safety of care for Emergency Department patients.

Ms Fiona McDaidDr Fergal Hickey

Guideline for the Prevention and Treatment of Undernutrition: Use of Nutrition Support in Adults in the Acute Care SettingIdentification and management of undernutrition and risk of undernutrition in adults in hospitals and acute care settings, including the correct choice and delivery of nutrition support to include oral support, enteral tube feeding and parenteral nutrition.

Ms Margaret O’Neill

Hepatitis C Screening*Screening for hepatitis C infection.

Dr Lelia Thornton

Diagnosis, staging, and treatment of patients with lung cancer*Clinical management of adults with lung cancer to promote prolonged survival and a good quality of life.

Dr Marcus Kennedy

Diagnosis, staging, and treatment of patients with pancreatic cancer*Clinical management of adults with pancreatic cancer to promote prolonged survival and a good quality of life.

Mr Justin Geoghegan

Diagnosis, staging, and treatment of patients with colon cancer*Clinical management of adults with colon cancer to promote prolonged survival and a good quality of life.

Ms Deborah McNamara

Diagnosis, staging, and treatment of patients with rectal cancer*Clinical management of adults with rectal cancer to promote prolonged survival and a good quality of life.

Ms Deborah McNamara

Diagnosis, staging, and treatment of patients with oesophageal cancer*Clinical management of adults with oesophageal cancer to promote prolonged survival and a good quality of life.

Prof John Reynolds

*Note: final descriptions for these guidelines may change as they are early in the development process.

Source Key:

Non-commissioned Guidelines

Proposal

Notice of Intent

Appendix 5


National Clinical Guidelines

14 National Clinical Guidelines (NCG) have been published to December 2015:

NCG No. 1 National Early Warning Score (NEWS)(February 2013)

NCG No. 2 Prevention and Control of MRSA (December 2013)

NCG No. 3 Surveillance, Diagnosis and Management of Clostridium difficile Infection in Ireland (June 2014)

NCG No. 4 Maternity Early Warning System (IMEWS)(November 2014)

NCG No. 5 Communication (Clinical Handover) in Maternity Services Guideline (November 2014)

NCG No. 6 Sepsis Management (November 2014)

NCG No. 7 Diagnosis, Staging and Treatment of patients with Breast Cancer (June 2015)

NCG No. 8 Diagnosis, Staging and Treatment of patients with Prostate Cancer (June 2015)

NCG No. 9 Pharmacological Management of Cancer Pain in Adults (November 2015)

NCG No. 10 Management of Constipation in Adult Patients receiving Palliative Care (November 2015)

NCG No. 11 Communication (Clinical Handover) in Acute and Children’s Hospital Services (November 2015)

NCG No. 12 Paediatric Early Warning Score System (PEWS) (November 2015)

NCG No. 13 Diagnosis, Staging and Treatment of patients with Gestational Trophoblastic Disease (November 2015)

NCG No. 14 Management of an Acute Asthma Attack in Adults (November 2015)

Appendix 6


Table 6: Abbreviations

ADoN Assistant Director of Nursing

AGREE II Appraisal of Guidelines for Research & Evaluation II

CEU Clinical Effectiveness Unit

COPD Chronic Obstructive Pulmonary Disease

CPD Continuous Professional Development

CSP Clinical Strategy and Programmes

DCU Dublin City University

DoH Department of Health

GDG Guideline Development Group

GIN Guidelines International Network

GRADE Grading of Recommendations Assessment, Development and Evaluation

GTD Gestational Trophoblastic Disease

HCAI Healthcare Associated Infection

HIPE Hospital In-Patient Enquiry

HIQA Health Information and Quality Authority

HPSC Health Protection Surveillance Centre

HQIP Healthcare Quality Improvement Partnership

HRB Health Research Board

HRB-TMRN HRB’s Trials Methodology Research Network

HSE Health Service Executive

HTA Health Technology Assessment

ICU Intensive Care Unit

IMEWS Irish Maternity Early Warning System

NCA National Clinical Audit

NCCP National Cancer Control Programme

NCEC National Clinical Effectiveness Committee

NCPE National Centre for Pharmacoeconomics

NCG National Clinical Guideline

NEWS National Early Warning Score

NICE National Institute for Health and Care Excellence

NMBI Nursing and Midwifery Board of Ireland

NOCA National Office for Clinical Audit

NPSO National Patient Safety Office

NTMA National Treasury Management Agency

NUIG National University of Ireland, Galway

PEWS Paediatric Early Warning Score

PPPG Policies, Procedures, Protocols, Guidelines

RCPI Royal College of Physicians in Ireland

RCSI Royal College of Surgeons in Ireland

SIGN Scottish Intercollegiate Guidelines Network

TCD Trinity College Dublin

UCC University College Cork

Appendix 7

Department of Health, Hawkins House, Hawkins Street, Dublin, D02 VW90, IrelandTel: +353 1 6354000 • Fax: +353 1 6354001 • www.health.gov.ie

national clinical effectiveness committee

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