The Role Of The National Clinical Effectiveness Committee .

National Clinical Guidelinestheir contribution to the clinicaleffectiveness movement inIrelandProf. Karen RyanChair, National Clinical Effectiveness Committee19th November 2019

Patient SafetyAdvocacy and PolicyUnitPatient SafetySurveillance Unit2 An Roinn Sláinte Department of HealthClinical EffectivenessUnit

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Clinical EffectivenessThe extent to which specificclinical interventions do whatthey are intended to do. Acollection of activities andtools, based on research andmeasurement that are usedto improve the quality ofThe Right careIn the Right placeAt the Right timeWith the Right informationWithin available resourceshealthcare.An Roinn Sláinte Department of Health

Framework for Clinical EffectivenessNational Clinical EffectivenessCommittee (NCEC)Patient First InitiativeSuite National ClinicalGuidelinesSuite National ClinicalAuditMinisterial Committee(Supported by the Clinical Effectiveness Unit)Standards ClinicalPractice GuidanceAn Roinn Sláinte Department of Health

Terms of reference for the NCECNCEC Terms of Reference Provide strategic leadership for the national clinical effectiveness agenda. Contribute to national patient safety and quality improvement agendas. Publish standards for clinical practice guidance. Publish guidance for National Clinical Guidelines and National Clinical Audit. Prioritise and quality-assure National Clinical Guidelines and National Clinical Audit. Commission National Clinical Guidelines and National Clinical Audit. Align National Clinical Guidelines and National Clinical Audit with implementation levers. Report periodically on the implementation and impact of National Clinical Guidelines and theperformance of National Clinical Audit. Establish sub-committees for NCEC work-streams. Publish an Annual Report.An Roinn Sláinte Department of Health

Clinical Effectiveness7 An Roinn Sláinte Department of Health

National Clinical Effectiveness AgendaAuditKPIsHSE ServicePlanPublicReporting(HIPS Bill)- NCEC NCA- QAVD Audit- NOCA/QI Progs- Clinical e basedExpert reviewedStandards on HealthStructured Body Level OneGuideline:Quality AssurancePrioritisationofHealthcare Patientrequirements InvolvementBody Level TwoBody Level ThreeBody Level FourBody Level Five- Development- Adaption- AdoptionQualityImprovement8 An Roinn Sláinte Department of Health

NCEC National Clinical Guidelines“Systematically developed statements, based on athorough evaluation of the evidence, to assist practitionerand patient decisions about appropriate health care forspecific clinical circumstances, across the entire clinicalspectrum” Provide guidance and standards for improving the safety,quality and cost effectiveness of care across healthcareservices in Ireland Implementation provides for a model of care that canreduce variability and improve quality of patientdecisions Implementation supports services in providingconsistent evidence-based healthcareAn Roinn Sláinte Department of Health

Framework for Endorsement of NCGs10 An Roinn Sláinte Department of Health

NCEC PrioritisationSeven criteria and questions to guide development of theguideline proposal1Patient safety issue2Burden of clinical topic3Evidence analysis4Economic impact5Variability in practice6Potential for addressing health issues7Clinical guideline implementation11 An Roinn Sláinte Department of Health

NCEC Quality assurancePart A: Pre-requisite assurancecriteria for the Irish contextPart B: QA using AGREE II,International tool to assess thequality and reporting of guidelineshttp://www.agreetrust.org/12 An Roinn Sláinte Department of Health

Guideline Development Group (GDG)Stakeholder analysis The Chair Clinical expert representatives Methodology expertise Senior management Research, information and economic expertise Project management and administrative support Implementation lead Representatives of the people affected by the recommendations13 An Roinn Sláinte Department of Health

National Clinical Guideline TopicAreaClinical DeteriorationNo. 1 National Early Warning Score (NEWS) (Feb 2013) UPDATE2No. 4 Irish Maternity Early Warning System Version 2 (IMEWS V2) (Feb 2019)2No. 6 Sepsis Management (Nov 2014)2No. 12 Paediatric Early Warning System (PEWS) (Nov 2015)2No. 18 Emergency Medicine Early Warning System (EMEWS) (Oct 2018)2Clinical concussion guideline3Clinical HandoverNo. 5 Clinical Handover in Maternity Services (Nov 2014)*2No. 11 Clinical Handover in Acute and Children’s Hospital Services (Nov 2015)2Healthcare Associated InfectionHealthcare Associated Infections (HCAI) to include:3 No. 2 Prevention and Control of MRSA (Dec 2013) UPDATE No. 3 Surveillance, Diagnosis & Management of Clostridium difficile Infection (June2014) UPDATE Other topics to be decidedCancer and Palliative CareNo. 7 Diagnosis, Staging and Treatment of Patients with Breast Cancer (June 2015)2No. 8 Diagnosis, Staging and Treatment of Patients with Prostate Cancer (June 2015)2No. 9 Pharmacological Management of Cancer Pain in Adults (Nov 2015)3No. 10 Management of Constipation in Adult Palliative Care Patients (Nov 2015)3No. 13 Diagnosis, Staging and Treatment of Gestational Trophoblastic Disease (Nov 2015)2No. 16 Diagnosis, Staging and Treatment of Patients with Lung Cancer2Diagnosis, Staging, and Treatment of Patients with Colon Cancer2Diagnosis, Staging, and Treatment of Patients with Rectal Cancer2Care of dying adults in the last days of life3Diagnosis, Staging and Treatment of Patients with Pancreatic Cancer2No 19 Diagnosis, Staging and Treatment of Patients with Oesophageal or2Oesophagogastric Junction CancerNo. 20 Diagnosis and Staging of Patients with Ovarian Cancer2Chronic DiseaseNo. 14 Management Acute Adult Asthma Attack (Nov 2015)3Chronic Obstructive Airways Disease (COPD)3No. 17 Adult Type 1 Diabetes Guidelines (June 18)3Maternity CareIntrapartum Care Maternity Guidelines as outlined in the National Maternity Strategy, to2include: stratification of intrapartum risk, induction of labour, other topics, includingupdates of NCG Nos 4 and 5 above*PreventionUndernutrition in Acute Hospitals2No. 15 Hepatitis C Screening1Diagnosis and treatment of nicotine addiction3NCEC National Clinical Guidelines14 An Roinn Sláinte Department of Health20 published to dateService area:1 – primary care / out of hospitalservices2 – secondary care / in hospital care3 – across primary and secondary care

Clinical Handover in Acute & Children’sHospital Services (No. 11) Clinical handover refers to thetransfer of professionalresponsibility and accountabilityfor some or all aspects of care fora patient, or group of patients, toanother person or professionalgroup on a temporary orpermanent basis. It involves communicating patientinformation in a structured way. This helps prevent errors incommunication and increasepatient safety.15 An Roinn Sláinte Department of Health

Support during guideline development 2019 Guideline Developers manualHRB CICERFramework for public involvement in Clinical Effectiveness ProcessesImplementation Guide and Toolkit for National Clinical GuidelinesNCEC templatesCEU Officer as liaisonFace to face meetingsTrainingReports from NCEC16 An Roinn Sláinte Department of Health

Guideline developers manualAim to provide guidance and instruction topersons who are considering or planningto develop clinical guidelines forsubmission to the NCEC.It provides a clear pathway for thedevelopment of evidence based clinicalguidelines that are implementable in theIrish health services.17 An Roinn Sláinte Department of Health

HRB CICER“Collaboration in Ireland for Clinical Effectiveness Reviews”5 Year contract:Launched December 2016 and commenced 1st April 2017.HIQA/RCSI – experienced HTA and Primary care guidelinedevelopers.Systematic and economic reviews for National ClinicalGuidelines and for standard setting for National Clinical Audit.An Roinn Sláinte Department of Health

Patient and publicinvolvementBody Level OneBody Level TwoBody Level ThreeBody Level FourBody Level Five19 An Roinn Sláinte Department of Health

Framework for Public Involvement in Clinical Effectiveness Processes20 An Roinn Sláinte Department of Health

Implementing National Clinical GuidelinesStage 1: Exploring and PreparingStage 3: Implementing and Operationalising Stakeholder Engagement Professional development supports Outcomes/Logic Models MonitoringStage 2: Planning and ResourcingStage 4: Full Implementation Implementation Readiness Continuous improvement cycles Implementation Planning21 An Roinn Sláinte Department of Health

Other Clinical Guidance22 An Roinn Sláinte Department of Health

Clinical Practice GuidanceClinical practice guidance is defined as systematically developedstatements or processes to assist clinician and patient decisionsabout appropriate health care for specific clinical circumstances.Includes: policies, procedures, protocols and guidelinesExcludes: operational, non-clinical processes e.g. HR policiesObjectives Standardised methodology for clinical practice guidance Minimise duplication in the health system Improve the development of evidence based clinical policy Translate evidence into policy & practice23 An Roinn Sláinte Department of Health

Core components: Standards for Clinical Practice Guidance24 An Roinn Sláinte Department of Health

NCEC National Clinical AuditNational Clinical Audit is a cyclical process that aims to improvepatient care and outcomes by systematic, structured review andevaluation of clinical care against explicit clinical standardsconducted on a national basis.Clinical audit endorsed by the Minister will be titled ‘NCEC NationalClinical Audit’. Endorsement will mandate that the appropriateservices engage with the NCEC National Clinical Audit, therebysuperseding all other national clinical audits on the topic.Framework for Endorsement of National Clinical Audit (2015)25 An Roinn Sláinte Department of Health

The audit cycle (HRB, 2013)Review andresetstandardsRe-auditComparechanges1. Preparation and planningincluding for re-audit4. SustainingimprovementFeedbackfindingsAgree changesChange practice3. Implementing change26 An Roinn Sláinte Department of HealthSelect topicReviewliteratureSet standardsDesign audit2. MeasuringperformanceCollect dataValidate dataAnalyse dataWrite report

Framework for Endorsement of NationalClinical Audit1. Screening by DoH Clinical EffectivenessUnit to confirm application meetsNational Clinical Audit definition2. Prioritisation by NCEC of Clinical Audit byappraisal sub group3. Quality assurance by NCEC of ClinicalAudit as per NCEC guidance by appraisalsub group4. Endorsement of NCEC National ClinicalAudit by Minister for Health27 An Roinn Sláinte Department of Health

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NCEC National Clinical Audit National Clinical Audit is 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 endorsed by the Minister will b