Dataset Information

What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews.

ABSTRACT:

Objectives

To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE).

Design

Interrupted time series analysis, review of case notes, survey, and interviews.

Setting

Acute and primary care trusts in England and Wales.

Participants

All primary care prescribing, hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and managers from five acute trusts.

Main outcome measures

Rates of prescribing and use of procedures and medical devices relative to evidence based guidance.

Results

6308 usable patient audit forms were returned. Implementation of NICE guidance varied by trust and by topic. Prescribing of some taxanes for cancer (P < 0.002) and orlistat for obesity (P < 0.001) significantly increased in line with guidance. Prescribing of drugs for Alzheimer's disease and prophylactic extraction of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance. Prescribing practice often did not accord with the details of the guidance. No change was apparent in the use of hearing aids, hip prostheses, implantable cardioverter defibrillators, laparoscopic hernia repair, and laparoscopic colorectal cancer surgery after NICE guidance had been issued.

Conclusions

Implementation of NICE guidance has been variable. Guidance seems more likely to be adopted when there is strong professional support, a stable and convincing evidence base, and no increased or unfunded costs, in organisations that have established good systems for tracking guidance implementation and where the professionals involved are not isolated. Guidance needs to be clear and reflect the clinical context.

SUBMITTER: Sheldon TA

PROVIDER: S-EPMC524545 | biostudies-literature | 2004 Oct

REPOSITORIES: biostudies-literature

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Publications

What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews.

Sheldon Trevor A TA Cullum Nicky N Dawson Diane D Lankshear Annette A Lowson Karin K Watt Ian I West Peter P Wright Dianne D Wright John J

BMJ (Clinical research ed.) 20041001 7473

<h4>Objectives</h4>To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE).<h4>Design</h4>Interrupted time series analysis, review of case notes, survey, and interviews.<h4>Setting</h4>Acute and primary care trusts in England and Wales.<h4>Participants</h4>All primary care prescribing, hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and manage ...[more]

PMID: 15514342

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Project description:BackgroundAlthough anesthesiologists are one of the leaders in patient safety, anesthesia in low and low-middle income countries still need improvement in safety mesures with evidence-based practice application. The study aim was to audit the safety principles implementation in the Ukrainian anesthesiologist`s practice.MethodsThe study was held in March 2021-Februrary 2022 by filling out an online questionnarie. The link to the survey was distributed through Ukrainian Anesthesiologists Association (UAA) members emails and also published on UAA webpage and facebook page. The email was sent to 1000 UAA members.ResultsSummary 210 respondents took part in the study. Among the respondents, 79.1% of respondents are aware of the Helsinki Declaration on Patient Safety in Anesthesiology, but only 40,3% declared that the principles of this Declaration had been implemented in their medical institutions. Even though most of the respondents declared that the quality of the work has improved with the application of the Helsinki Declaration, 16% stated, that there is no positive impact. Most of the medical institutions include mandatory perioperative monitoring, while 17% of hospitals have no access to pulse oximetry for all patients in the operating room and intensive care unit. Concerning using clinical protocols, the one on the treatment of massive bleeding is used in 60.3% of cases, on infection control in 60.5%. In relation to checklists, 28.2% of respondents have never heard about the WHO Safe Surgery checklist. Checklists for equipment inspection are used in only 27.8% of medical institutions. 72.8% hospitals keep records of anaesthesia complications.ConclusionThe study showed that significant positive steps are being taken to improve patient safety in Ukraine, where most hospitals comply with the minimum standarts of monitoring during anesthesia. Although there are many challenges for improvement, more hospitals need to implement WHO Safe Surgery and equipment checklists, protocols etc. These areas are a priority for further development in Ukraine.Trial registrationClinicaltrials.gov NCT05175976 on 04/01/2022.

Dataset Information

What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews.

Objectives

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews.

Similar Datasets

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