Setting standards for high-quality hospital care

These quality statements will contribute to improving the effectiveness, safety and experience of women who may need or request a caesarean section

NICE quality standards aim to drive measurable improvements within particular areas of health and care.

Each quality standard consists of a concise set of prioritised statements that aim to help healthcare workers in hospitals and other settings make decisions based on the latest evidence and best practice. They also help service providers to quickly and easily examine the performance of their organisation and assess improvement in standards of care they deliver.

In 2013/14, we produced 28 quality standards on a range of areas that include:

Caesarean section was among the topics published this year. More women are having caesarean sections than ever before, with numbers rising dramatically from 9 per cent in 1980 to around a quarter of births in 2013. NICE’s quality standard aims to ensure that women who need, request or have this procedure are given best quality care.

The quality standard states that pregnant women should have a documented discussion with the members of the maternity team about the risks and benefits of caesarean section compared with vaginal birth.

Women who ask for a caesarean section because they are worried about childbirth should be able to discuss their concerns with a suitably trained professional. Furthermore, a consultant should be involved in decisions surrounding caesarean sections, because they are best placed to advise about the potential benefits and risks.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said: “NICE has developed this standard because up to a quarter of women are now having caesarean sections, and we want to ensure that women who may need or may have had a caesarean section, or are simply asking about them as an option for delivering their baby, have the most up-to-date information about the quality of care they should receive.

“Taken as a whole, these quality statements will contribute to improving the effectiveness, safety and experience of women who may need, request or have a caesarean section.”

In March 2014, we also published a quality standard on the recognition and assessment of jaundice in newborn babies.

Jaundice is caused by raised levels of bilirubin, and is characterised by yellow colouration of the skin and the whites of the eyes. It is one of the most common conditions that need medical attention in newborn babies, affecting around 60 per cent of all term and 80 per cent of all newborn babies within the first week of life.

Clinical recognition and assessment of jaundice can be difficult, particularly in babies with dark skin tones. Once jaundice is recognised, there is uncertainty about when to treat, and there is widespread variation in the use of phototherapy and exchange transfusion.

NICE’s quality standard calls for babies with suspected jaundice who are more than 24 hours old to have their bilirubin level measured within 6 hours of a healthcare suspecting jaundice or a parent or care reporting possible jaundice.

The quality standard adds that all babies with raised bilirubin levels should be started on treatment in accordance with standardised threshold tables or charts.

Dr Janet Rennie, Consultant and Senior Lecturer in Neonatal Medicine, University College London Hospitals and member of the committee which developed the standard, said: "I am delighted that NICE is releasing a quality standard reinforcing the key messages of the guideline on neonatal jaundice published in 2010. Implementation has been patchy.

“The quality standard places further emphasis on the importance of measuring the bilirubin level rather than relying on visual inspection for the assessment of jaundice, and interpreting the result according to the baby's postnatal age in hours.

She added: “Following the guideline will target treatment to those babies who need it and should prevent the rare but tragic occurrence of brain damage due to high levels of bilirubin."

Simple steps can help reduce surgical site infections

Surgical site infections (SSI) are a type of healthcare-associated infection, where a surgical incision site becomes infected after a surgical procedure.

SSIs have been shown to account for up 16 per cent of all healthcare-associated infections, with rates of more than 10 per cent for large bowel surgery. They can often be prevented with appropriate care before, during and after surgery, and appropriate treatment can minimise any complications that might occur as a result of the infection.

In October 2013, to help healthcare workers improve the outcomes of patients following surgery, NICE produced a quality standard on SSIs. The quality standard included 7 statements to help ensure the delivery of high quality care.

These include that people having surgery should not remove hair from the site, because it may increase the risk of infection. If hair does need to be removed, this should be done by healthcare staff using electrical clippers, with a single-use head on the day of surgery.

The quality standard advices that appropriate wound and dressing care promotes healing and reduces the risk of infection, and that people having surgery and their carers should receive information and advice on wound and dressing care, including how to recognise problems with the wound and who to contact if they are concerned.

Professor Gillian Leng said: "Serious SSIs can lead to life-threatening illnesses, long-term disabilities, and longer stays in hospital as well as resulting in increased costs for the NHS. However, such infections can often be prevented by following simple steps before, during and after surgery.

“These standards will aid all healthcare professionals involved in the treatment of adults, children and young people in this area, so that they can deliver the very best levels of care across the NHS."

Dr Peter Jenks, Director of Infection Prevention and Control/Consultant Microbiologist, Plymouth Hospitals NHS Foundation Trust, said: "As well as resulting in substantial discomfort and harm to patients who have undergone operations, SSIs contribute to the burden on healthcare service providers by prolonging hospital stay and increasing costs.

“With the clinical imperative of eliminating all preventable healthcare-associated infections, this quality standard will assist providers, commissioners and patients in improving outcomes following surgical procedures."