Bringing clinically and cost-effective care to the NHS

This year, the effect that NICE clinical guidelines have in improving healthcare was reflected in recent rises in the number of organ donations.

NICE clinical guidelines provide recommendations to healthcare workers in the NHS on the appropriate treatment and care of people with specific diseases and conditions.

Our guidelines are based on the best available evidence, aim to change the process of healthcare and improve people’s chances of getting as well as possible. Bv implementing our guidelines healthcare professionals can trust they are carrying out evidence-based treatments that are both clinically and cost effective.

We have published 179 clinical guidelines so far on a wide range of topics. In 2013/14, our clinical guidelines covered:

This year, the effect that NICE clinical guidelines have in improving healthcare was reflected in recent rises in the number of organ donations.

We originally published our clinical guideline on organ donation in 2011, which recommends that patients who are potentially suitable donors should be identified as early as possible based on two possible criteria.

During 2012-13, more than 1,200 people in the UK donated their organs, leading to about 3,100 transplants, according to NHS Blood and Transplant.

The improvements are, in part, the result of guidance from NICE which has helped to identify a greater number of patients who may become suitable donors.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE said: “Organ donation can be a sensitive subject, particularly if decisions are made at a time of bereavement. It's important that healthcare professionals have clear guideline in place to support and assist them.”

“Whilst there is clearly more to do in improving consent rates for organ donation, exceptional progress has been achieved in the other main focus of the NICE clinical guideline in identifying patients who might become suitable donors and this is where much of the increase in donation has come from.”

This year, work has also been undertaken on developing a new manual for the development of clinical, public health and social care guidelines. The manual will set out a consistent process for developing guidelines across different areas and aims to increase transparency, by documenting the rationale for the use of different methods.

Major change in treatment of breast cancer

In June 2013, NICE published updated guidance on familial breast cancer. The guidance meant that hundreds of thousands of women across England and Wales could be spared the distress of a breast cancer diagnosis, simply by taking a daily pill to help prevent the disease.

Our guideline recommended that the NHS should give tamoxifen or raloxifene to particular groups of women with a family history of cancer. This is because the drugs can help stop them getting breast cancer if they are taken for five years.

Before the guideline was published, if a person was considered to have a high risk of breast cancer through factors such as a family history, they were eligible for annual screening to detect any tumour early on.

Alternatively they could choose surgery to remove their breasts to prevent developing disease. This is a major and traumatic intervention for all involved, and was highlighted by the case of Angelina Jolie who chose to go public with her decision to opt for a double mastectomy.

The updated guidance from NICE, meant that women with a family history of breast cancer are now eligible for drug treatments as a measure to help prevent the disease.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “People are considered to have a family history of cancer if a number of their relatives have lived through, or died from, certain cancers like breast, ovarian or prostate.

“Our updated guideline  gives women more options in how they manage their risk of breast cancer; those with a ‘moderate' or ‘high' risk of developing breast cancer because of their family history but who have not had the disease themselves can now be offered tamoxifen or raloxifene for five years to prevent it.

“Although neither drug is licensed as a preventative treatment in the UK, clinical evidence shows they are an effective option for many women and could be preferable to surgery.”

Guideline on IV fluids to play “vital role” in improving care

In December 2013, NICE produced new guidelines to help address the serious risk to patient safety through errors in intravenous (IV) fluid care.

Despite being an extremely common treatment, a lack of training for healthcare professionals has resulted in patients receiving too much or too little fluid, or even the wrong type of fluid.

It is thought that as many as 1 in 5 patients on IV fluids and electrolytes suffer complications due to inappropriate administration, according to figures from the National Enquiry into Perioperative Deaths.

Too much fluid can lead to problems such as pneumonia and heart failure, while too little fluid can damage the kidneys.

To address the situation, NICE produced a clear step-by-step algorithm outlining the fluids a patient may require and is urging healthcare professionals to start considering fluids as drugs.

The guideline recommends that any healthcare professional prescribing IV fluids should remember the ‘five Rs' of IV fluid management: resuscitation, routine maintenance, replacement, redistribution and reassessment.

Dr Mike Stroud, Consultant in Gastroenterology and General Medicine at Southampton University Hospitals NHS Trust and Chair of the group responsible for the guidance, said: “I estimate that tens of thousands of patients will have a complication related to IV fluids every year.

“It is astonishing really that doctors are not well educated in fluid therapy, but because it is not a speciality it has fallen through the cracks.

“This new NICE guideline has training and education at its heart and will play a vital role in making sure that staff at all levels in the NHS deliver consistent, high-quality care for all patients.”