Minister for Health Leo Varadkar has formally launched four new National Clinical Guidelines for clinicians and healthcare managers covering patient safety, hospital standards, dealing with an asthma attack and the treatment of a type of cancer.
One of the guidelines gives advice to healthcare professionals on Management of an Acute Asthma Attack in Adults. The aim is to reduce mortality in this potentially fatal but treatable condition, as 37 people died following an asthma attack last year. In 2011 the figure was 53. This guideline emerged from the HSE’s National Clinical Programme for Asthma.
Two of the guidelines promote patient safety and higher standards in hospitals by setting national standards for an early warning system for children, and guidelines on how patient information is shared between clinicians when the patient is handed over in adult and children’s hospitals.
The other guideline for Diagnosis, Staging and Treatment of Gestational Trophoblastic Disease emerged from the National Cancer Control Programme and also aims to reduce mortality.
“These new Guidelines will further enhance the package of patient safety measures I announced recently, including the creation of a National Patient Safety Office within the Department of Health and an independent National Advisory Council for Patient Safety,” Minister Varadkar said.
The Minister announced the Guidelines at the Third Annual Symposium at Dublin Castle organised by the National Clinical Effectiveness Committee (NCEC), which commissioned them in partnership with the HSE Clinical Programmes, expert clinicians, regulatory bodies, postgraduate training bodies, hospitals and patients.
The guidelines were quality assured by NCEC and subject to international peer review. The Minister acknowledged the work of NCEC in progressing the patient safety and quality agenda and its leadership in advancing the Irish clinical effectiveness agenda under the chairmanship of Professor Hilary Humphreys.
Details of the new Guidelines
The Management of an Acute Asthma Attack in Adults National Clinical Guideline Number 14 is important as an acute asthma attack can be fatal: in 2011 there were 53 deaths, in 2014 there were 37 deaths. In 2011, 99 patients were discharged from ICU following an acute asthma attack; in 2014, the figure was 109. This guideline helps a range of health professionals to give the most appropriate and effective immediate treatments to those over 16 years of age who are having an acute asthma attack and guides them in ‘next steps’ depending on the severity.
National Clinical Guideline Number 13 Diagnosis, Staging and Treatment of Gestational Trophoblastic Disease. This is a spectrum of malignant diseases that can occur during or after pregnancy, each having a varying propensity for local invasion and metastasis. GTD is the most curable of all gynaecologic malignancies. It represents an oncologic success story with survival rates approaching 100% but this depends on early detection and appropriate management. The management of these women is specialised and, in many countries, is undertaken by gynaecological and medical oncologists with special expertise in treating this disease. This guideline aims to improve the standard of clinical practice to ensure that young women in Ireland affected by GTD are diagnosed promptly and receive the best available care.
Adverse outcomes following clinical deterioration in children admitted to hospital are frequently preventable. The Irish Paediatric Early Warning System (National Clinical Guideline Number 12) supports a focus on prevention, early detection through early warning systems and scores, and appropriate timely responses to the clinically deteriorating child. It is a multifaceted approach based upon the implementation of several complementary safety interventions, including national paediatric observation charts, PEWS scoring tool and escalation guideline, effective communication using the national standard (ISBAR communication tool for patient deterioration), timely nursing and medical input, and clear documentation of management plans. National implementation of PEWS should improve the management of critical illness in children by facilitating earlier recognition, response to deterioration, and in turn preventing unplanned admission to PICU.
National Clinical Guideline Number 11 Communication (Clinical Handover) in Acute and Children’s Hospital Services. Clinical Handover is not a new service or initiative. It is an ongoing operational component of safe quality clinical care that occurs at several times during each day, within and between multi-disciplinary teams. The importance of standardisation of clinical handover processes in terms of patient safety cannot be overemphasised. Clinical handover has been identified, both nationally and internationally, as a high risk step in a patient’s hospital journey. This guideline requires consistent implementation of handover processes and in addition brings reference to the communication required for sepsis and each of the early warning system guidelines, already published by the NCEC.
Further information
Guidelines are statements which outline the most appropriate approaches for clinical practice. They are based on best available research and are developed using an internationally recognised process. They are then used in conjunction with clinical judgement and patient preference when making decisions about what is appropriate for each patient or population of patients.
National Clinical Guidelines endorsed by the Minister for Health are mandated for implementation in the Irish health service and their implementation will be monitored through the HSE Performance Assurance Reports, compliance with HIQAs National Standards for Safer Better Healthcare and increased alignment with the clinical indemnity scheme. Key performance indicators to measure implementation and impact of National Clinical Guidelines have been developed.
National Clinical Guidelines
National Clinical Guidelines are “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, reduce variation in practice and improve the quality of clinical decisions.
The aim of 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 so that patients, regardless of where they are in the country or the service they attend, will experience the same high quality, safe, evidence based care.
The implementation of these National Clinical Guidelines also supports services in meeting HIQA’s National Standards for Safer Better Healthcare and anticipated future licensing requirements.
The National Clinical Effectiveness Committee
1. The National Clinical Effectiveness Committee (NCEC) was established as part of the Patient Safety First Initiative in September 2010. The NCECs mission is to provide a framework for national endorsement of clinical guidelines and audit to optimise patient and service user care.
2. 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.
3. The NCEC, chaired by Professor Hilary Humphreys, is made up of key stakeholders including clinicians, patient representatives, the Department of Health, patient safety experts, health managers, regulatory bodies, training and education bodies, insurance and clinical indemnity agencies and private healthcare.
4. The NCEC through the processes of prioritisation and quality assurance of a clinical guideline reach consensus as to whether the clinical guideline has been developed using a quality methodology, is based on evidence and is important for the Irish Healthcare service. Clinical guidelines that meet these criteria are then recommended to the Minister for Health through the CMO for endorsement.
Further information: www.health.gov.ie/patient-safety/ncec