National Clinical Effectiveness Committee...National Clinical Audit 24 4. Clinical Practice Guidance 25 5. Education and Training 27 6. Patient and Public Involvement 29 7. Collaboration

National Clinical Effectiveness CommitteeAnnual Report 2016

NATIONALCLINICALEFFECTI ENESSCOMMITTEE

National Patient Safety OfficeOifig Náisiúnta um Shábháilteacht Othar

http://health.gov.ie/national-patient-safety-office/ncec/[email protected]

http://health.gov.ie/national-patient-safety-office/ncec/

National Clinical Effectiveness Committee

Annual Report 2016

Table of Contents

Introduction to Clinical Effectiveness 4

National Clinical Effectiveness Committee 6

Chairperson’s Statement 7

Introduction from the Director of the National Patient Safety Office 8

NCEC outputs: 2016 at a glance 10

Activities Report 12 1. National Clinical Effectiveness Committee 12 2. National Clinical Guidelines 14 3. National Clinical Audit 24 4. Clinical Practice Guidance 25 5. Education and Training 27 6. Patient and Public Involvement 29 7. Collaboration in Ireland for Clinical Effectiveness Reviews 30 8. The National Patient Safety Conference 31 9. Communications, Collaboration and Dissemination 34 10. Clinical Effectiveness Informing Policy, Strategy and Legislation 37

Appendix 1: NCEC Meeting Attendance 38

Appendix 2: Department of Health Clinical Effectiveness Unit 39

Appendix 3: National Patient Safety Conference Programme 40

Appendix 4: Guidelines in development 42

Appendix 5: National Clinical Guidelines and National Clinical Audit 44

Appendix 6: NCEC Subgroups – membership and terms of reference 45

Appendix 7: Contributors to Appraisal Teams 49

Appendix 8: Abbreviations 50

List of tablesTable 1 NCEC Membership 12Table 2 NCEC Subgroups 13Table 3 Research, literature reviews and clinical effectiveness education projects 14Table 4 Key performance indicators for National Clinical Guidelines 17Table 5 Education and Training for Guideline Development Groups in 2016 27

List of figuresFigure 1 National Patient Safety Office 5Figure 2 NCEC key areas of work 6Figure 3 NCEC Outputs: 2016 at a glance 10-11Figure 4 NCEC Twitter activity for December 2016 35Figure 5 Sample NCEC tweets from 2016 36

4 Annual Report 2016 National Clinical Effectiveness Committee

What is Clinical Effectiveness?Clinical effectiveness is a collection of activities and tools, based on research and measurement that are used to improve the quality of healthcare. The activities include, but are not limited to, guidelines, audit, research and evaluation.

What is the aim of Clinical Effectiveness?Clinical effectiveness aims to ensure that healthcare practice is based on the best available data and evidence of effectiveness. It is a key component for improving patient safety and quality health service delivery.

How does Clinical Effectiveness work?Clinical effectiveness uses information gathered from national and international research and audit to identify what practices are safe, effective and efficient. It brings this information together to draw conclusions that help healthcare practitioners and their patients to make decisions about what is best for the Irish healthcare system and its individual users.

Is Ireland the only country developing Clinical Effectiveness?No, other countries such as the UK and Australia are developing clinical effectiveness for their national health systems through agencies such as the UK’s National Institute for Health and Care Excellence (NICE) and the Australian Commission on Safety and Quality in Healthcare.

How is Ireland developing Clinical Effectiveness?Ireland is developing clinical effectiveness through the National Clinical Effectiveness Committee (NCEC) that the Minister of Health set up in 2010. The NCEC role is to recommend guidelines and audit to the Minister for Health to become National Clinical Guidelines and National Clinical Audit for implementation in Irish healthcare. Currently, it does this by:

• Prioritising clinical guidelines that are important to national policy and the Irish health system.• Assessing clinical guidelines against internationally accepted criteria to judge that they have

been developed in the best possible way. This assures that National Clinical Guidelines are based on best available evidence, have involved key people, including patients, in their development and have examined the cost involved in implementation.

Clinical guidelines that successfully go through these steps are recommended to the Minister for Health through the Chief Medical Officer for endorsement and publication as National Clinical Guidelines. A similar process occurs for clinical audit.

What do National Clinical Guidelines do?NCEC National Clinical Guidelines are defined as ‘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 for patients, reduce variation in practice and improve the quality of clinical decisions that patients and healthcare staff have to make. National Clinical Guidelines will inform patients about the care they should be receiving and assist them to make healthcare choices based on best available information. National Clinical Guidelines can be used to set the standards for measurement in clinical audit.

Introduction to Clinical Effectiveness

5National Clinical Effectiveness Committee Annual Report 2016

What does National Clinical Audit do?NCEC National Clinical Audit is defined as ‘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 is an internationally recognised process that requires action to be taken where the audit identifies that quality improvement is necessary. When in place, the results of NCEC National Clinical Audits can inform patients of the structures, process and outcomes of healthcare and show them where improvements are being made.

What are National Standards for Clinical Practice Guidance?Clinical practice guidance is defined as systematically developed statements or processes to assist clinician and patient decisions about appropriate healthcare for specific clinical circumstances. National Standards for Clinical Practice Guidance were published by the NCEC in 2015. These Standards help healthcare staff develop quality policies, procedures, protocols and guidelines by using an agreed approach nationally.

The objectives of the standards are to:• Provide a standardised terminology and methodology for the development of evidence-

based clinical practice guidance nationally.• Ensure consistency of approach and minimise duplication of clinical practice guidance in

the health system.

What is the National Patient Safety Office (NPSO)?The National Patient Safety Office was launched in December 2016. This office will provide national patient safety policy leadership. It will lead a programme of patient safety measures focused on patient safety legislation, extending the national clinical effectiveness framework, establishing a patient safety surveillance system, building further the National Healthcare Quality Reporting System and setting up a National Advisory Council for Patient Safety. Within the programme of legislation it is intended to progress the licensing of public and private hospitals, the patient safety elements of the Health Information and Patient Safety Bill and provisions for open disclosure. The NPSO will identify patient safety priorities and initiatives.

The NPSO comprises three streams of work: patient safety advocacy and policy, clinical effectiveness and patient safety surveillance as seen in figure 1 below.

Figure 1: National Patient Safety Office.

Further information is available on the website:http://health.gov.ie/national-patient-safety-office/ncec/

National Patient Safety Office

Patient Safety Advocacy and Policy Unit

Patient SafetySurveillance Unit

Clinical EffectivenessUnit



National Clinical Effectiveness Committee

The National Clinical Effectiveness Committee (NCEC) was established in 2010 as a partnership between key stakeholders in patient safety and clinical effectiveness. The NCEC’s mission is to provide a framework for national endorsement of clinical guidelines and audit to optimise patient and service user care. 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.

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 supports the provision of evidence-based and consistent care across Irish healthcare services. The aim of National Clinical Audit is to systematically measure performance against an evidence-based standard. Implementation gathers robust data to be used for quality improvement at local level, in addition to providing data for planning at a national level. The NCEC process for endorsement of National Clinical Guidelines and National Clinical Audit uses a defined process. The oversight of the national clinical effectiveness agenda is provided by the NCEC (Appendix 1) which is supported by the Clinical Effectiveness Unit (CEU, Department of Health) (Appendix 2) and subgroups (Appendix 6), with each sub-group reflecting the agreed work-stream of the committee.

NCEC Terms of Reference

1. Provide strategic leadership for the national clinical effectiveness agenda.

2. Contribute to national patient safety and quality improvement agendas.

3. Publish standards for clinical practice guidance.

4. Publish guidance for National Clinical Guidelines and National Clinical Audit.

5. Prioritise and quality assure National Clinical Guidelines and National Clinical Audit.

6. Commission National Clinical Guidelines and National Clinical Audit.

7. Align National Clinical Guidelines and National Clinical Audit with implementation levers.

8. Report periodically on the implementation and impact of National Clinical Guidelines and the performance of National Clinical Audit.

9. Establish sub-committees for NCEC work-streams.

10. Publish an Annual Report.

The NCEC key areas of work are outlined in the figure below.

Figure 2: NCEC key areas of work.

National Clinical Effectiveness Committee (NCEC)

Patient Safety First InitiativeMinisterial Committee

(Supported by the Clinical Effectiveness Unit)

Vision

Suite of National Clinical Guidelines

Standards for Clinical Practice Guidance

Suite of National Clinical Audit


Chairperson’s Statement

This is the 4th annual NCEC report and my last as Chairman. As in recent years, 2016 was a busy one, with significant progress and achievements. There were five meetings of the NCEC during the year, with considerable work and activity in-between these meetings, including many educational activities. All three sub-groups have evolved impressively and further identified their programme of work, and are now contributing significantly to the work of the NCEC. For that, I am very grateful to the Chairs, namely Professor Declan Devane, Mr. Ian Callanan and Professor Dermot Malone, and to their membership for their time and efforts.

During 2016, the NCEC prioritised and quality assured its first audit in the area of trauma, and this was launched and endorsed by the Minister for Health at the National Patient Safety Conference in December. Other notable achievements were agreement on aspects of publication governance to ensure that guideline developers are recognised for their work and that their names are cited during any literature searches. The Health Research Board (HRB) launched a tender for the establishment of the Collaboration in Ireland for Clinical Effectiveness Reviews (CICER) which was awarded to a consortium involving HIQA and the Royal College of Surgeons in Ireland. It is anticipated that CICER will be up and running during the first quarter of 2017 and will greatly support guideline development groups through conducting comprehensive and rigorous literature searches and their analysis.

There was no NCEC Symposium in 2016 but rather the work of the NCEC was highlighted and presented at the National Patient Safety Office Conference, held at Dublin Castle in December 2016, which was attended by 481 delegates. This forum served to place the work and influence of the NCEC in a wider context.

At the last meeting of the NCEC of 2016, Dr Karen Ryan was introduced as the new Chairperson of the NCEC. She is a consultant in palliative care medicine, and has led guideline development groups which have produced guidelines that were prioritised and quality assured by the NCEC. She has an impressive background in patient safety and audit and will, no doubt, develop further the impact and reach of the NCEC.

In standing down as Chair of the NCEC, I wish to thank all Committee members over the last six years for their guidance, wisdom and support. I am also grateful to all guideline developers for their commitment and patience, especially early on when we were finalising our procedures and methods. Finally, I would like to put on record my gratitude to the Department of Health for their professionalism, encouragement and advice, specifically those in the Clinical Effectiveness Unit. Both Dr. Kathleen Mac Lellan, Director of Clinical Effectiveness and Dr Tony Holohan, Chief Medical Officer have been unstinting in their time, efforts and engagement. While much more needs to be done, I am very encouraged by the commitment, belief and leadership that exist in our health service to further improve patient care. I therefore strongly believe that this will help ensure greater patient safety in to the future.

_____________________________

Professor Hilary Humphreys, Chairman NCEC

December 2016


Introduction from the Director of the National Patient Safety Office

This has been a busy and productive year for the national clinical effectiveness agenda. 2016 has provided an opportunity to embed the core work of the NCEC into the national policy and Health Service Executive priorities. Early in the year the NCEC worked with the National Office for Clinical Audit to develop the Major Trauma Audit to the level of an NCEC National Clinical Audit. This, the first NCEC National Clinical Audit was endorsed by the Minister in December 2016. It will provide important data for the development of the Department’s Trauma Strategy and the delivery of national trauma services. The work of the NCEC was identified as a having a significant contribution to the development of the first National Maternity Strategy which was published by the Department of Health in January 2016. The NCEC was subsequently commissioned by the Minister to develop National Clinical Guidelines for Maternity Services to underpin the new pathways of maternity care. This work has now commenced.

For some time the NCEC has worked with the Health Research Board to secure an on-going high quality evidence synthesis service for National Clinical Guidelines and Audit. The Health Research Board – CICER was awarded to a team led by Dr Máirín Ryan late in 2016. We look forward to this work providing support to guideline and audit development groups to ensure a rigorous evidence-based approach to the development of NCEC guidelines and audit. This is part of our planned programme of work to build clinical effectiveness capacity in the system and 2017 will see the provision of more education and web-based learning materials.

The NCEC now has an experienced multi-disciplinary team of guideline and audit prioritisation and quality assurance appraisers. Their work is invaluable to the high quality NCEC approval processes for guidelines and audit. I would like to thank them for their professionalism and support of the NCEC. This work is in addition to their day jobs. See appendix 7 for our list of 2016 contributors.

This is an important year for the NCEC and the clinical effectiveness framework in that this work is now one of the main work-streams of the newly established National Patient Safety Office (NPSO). This office which was launched by the Minister in December 2016 will provide the patient safety policy leadership for the health system. It is anticipated that the Clinical Effectiveness Unit along with the other two units which will be focused on patient safety surveillance and patient safety advocacy and policy will lead and deliver policy and legislation to improve patient safety and quality across the health system. NCEC National Clinical Guidelines and National Clinical Audit are key elements of this policy direction. It has been very heartening to see specific acknowledgement of the implementation of NCEC National Clinical Guidelines for early warning systems and clinical handover as drivers for patient safety in a number of HIQA and other national reports this year.

We are on a pathway to develop new ways to include patients and the public in our work and I look forward to progressing this in 2017 where we intend to publish a framework for patient and public involvement in clinical effectiveness processes.

The Clinical Effectiveness Unit team in the Department of Health is fully operational and is providing sustainable and highly effective support to the NCEC. I would like to acknowledge their commitment and expertise in moving forward the national clinical effectiveness framework.


I would like to sincerely acknowledge the commitment, dedication and leadership of Professor Hilary Humphreys as he steps down as Chair of the NCEC. He was the first Chair for the NCEC and has established its foundations and pathway for progression. I am confident that he will continue to be an advocate and support for the work of the NCEC. I welcome Dr Karen Ryan as our new Chair from January 2017. She brings a breath of experience and vision for NCEC.

Our challenges for 2017 will involve building on and embedding the NCEC work within the NPSO and continuing to identify priority guidelines and audit which have the potential for significant impact on patient safety and quality. Meeting these challenges will support an on-going evidence-base for clinically effective service delivery with both clinician and patient input for policy and service development.

_____________________________

Dr Kathleen Mac LellanDirector, National Patient Safety Office


NCEC outputs: 2016 at a glanceFigure 3: NCEC Outputs: 2016 at a glance.

NCEC subgroup meeting (Education & training)



NCEC subgroup meeting (Guideline methodology)


NCEC subgroup meeting (Clinical audit)

Appraisal:Guideline prioritisation: Screening for

Hepatitis C Infection

Guideline rapid update: Diagnosis, staging and treatment of

patients with prostate cancer

Training:Searching for evidence


Training:Guideline implementation – theory,

practice, monitoring & audit

Training:Economic evaluation for clinical guidelines

Training:Economic evaluation for clinical guidelines

Training:Developing evidence-based clinical

guidelines

Training:Developing evidence-based clinical

guidelines

Lunch & learn:Approaches to the implementation of

clinical guidelines, CEU

Training:Developing evidence-based

clinical guidelines

Lunch & learn:Mental Health Commission

- Role and Function

Presentation of NCEC processes (Clinical Practice Guidance, developing

evidence-based guidelines) at ‘Evidence Live’, Centre for Evidence-

Based Medicine, Oxford University


Lunch & learn:Patient and Public Involvement

Appraisal:Guideline prioritisation: Diagnosis,

staging and treatment of patients with lung cancer

Appraisal:Audit prioritisation: Major Trauma Audit




NCEC subgroup meeting (Clinical audit)

Training Seminar:Moving from evidence to decisions using

the Evidence to Decision framework

5 NCEC Meetings


Lunch & learn:Health Products Regulatory Authority

Lunch & learn:Health Research Board

Presentation of NCEC prioritisation process at Guidelines International

Network (GIN) Conference

National Patient Safety Office Conference

Appraisal:Guideline rapid update: Paediatric Early

Warning System (PEWS)


staging and treatment of patients with colon cancer


staging and treatment of patients with rectal cancer

Appraisal:Guideline QA: Diagnosis, staging and

treatment of patients with lung cancer

Guideline rapid update: PEWS

Launch of 1st NCEC National Clinical Audit: Major Trauma Audit

Launch of HRB-CICER

Launch of National Patient Safety Office

Training:Economic evaluation for clinical

guidelines

Postgraduate training workshop (NCEC subgroup on education

& training)

Training:Introduction to NCEC guideline

development process

Appraisal:Audit quality assurance: Major Trauma Audit



1. National Clinical Effectiveness Committee

Table 1: NCEC membership.

NCEC Membership 2016

Chairman Professor Hilary Humphreys

Regulation

Health Information and Quality Authority Dr Máirin Ryan

Mental Health Commission Ms Rosemary Smyth

Health and Social Care Regulatory Forum Dr Jayne Crowe

Health Products Regulatory Authority Dr Elaine Breslin

State Claims Agency Dr Dubhfeasa Slattery

Education

Forum of Postgraduate Training Bodies Prof Dermot Malone (until 4/12/16)

Nursing and Midwifery Education Bodies Dr Anne Marie Brady

Service

Forum of Hospital Group CEOs Dr Susan O’Reilly

HSE National Clinical Programmes Dr Áine Carroll

HSE Quality Improvement Division Dr Philip Crowley

HSE Office Nursing and Midwifery Services Ms Mary Wynne

National Office for Clinical Audit Ms Fiona Cahill, (until 1/3/16)Ms Colette Tully (from 12/9/16)

Private Hospitals Association Mr Simon Nugent

Department of Health (2)

Department of Health Dr Philippa Ryan Withero

Department of Health Ms Fionnuala Duffy

Insurers

Health Insurance Council Mr Donal Clancy

Research

Health Research Board Dr Graham Love

Patient Representation (2)

Patient representative Ms Linda Dillon

Patient representative Ms Brigid Doherty

Total: 20

Activities Report


The NCEC met five times in 2016. Summary minutes of NCEC meetings are posted on the NCEC website. The following were the main items on the NCEC agenda for 2016:

• Publication governance • NICE guideline contextualisation• Prioritisation and quality assurance of NCGs and NCA and rapid updates of NCGs• NCEC subgroups• Conflict of interest policy and new declaration of interest form.

Welcoming the new Chair of the NCEC, Dr. Karen Ryan. Left to right: Dr. Tony Holohan, Dr. Karen Ryan, Mr. Simon Harris T.D., Dr. Kathleen Mac Lellan, Prof. Hilary Humphreys.

Table 2: NCEC Subgroups.

NCEC Subgroup Chair

Clinical Audit Mr Ian Callanan, previous NCEC member

Education and Training in Clinical Effectiveness Prof Dermot Malone, NCEC member

Clinical Guideline Methodology Prof Declan Devane, previous NCEC member

Terms of reference and membership of the NCEC subgroups are contained in Appendix 6.

A panel of appraisers is maintained for prioritisation and quality assurance processes on National Clinical Guidelines and National Clinical Audit. Contributors to appraisal teams in 2016 are outlined in appendix 7.


2. National Clinical Guidelines

Commissioned guidelinesFollowing the publication of the first National Maternity Strategy in February 2016, the Minister for Health mandated as a matter of priority, the commissioning and quality assurance of prioritised national maternity clinical guidelines through the NCEC. This is in line with recommendations 28 and 31 of the National Maternity Strategy. Work on the clinical guideline has progressed, Professor Michael Turner has been confirmed as the Chairperson, and at the time of writing the Guideline Development Group is being established.

Commissioned researchA number of research and systematic literature review projects were commissioned through tendering processes in 2016 to support commissioned and other guidelines and various clinical effectiveness processes. Budgets were allocated as per Table 3.

Table 3: Research, literature review and clinical effectiveness education projects.

Project Cost (€) including VAT

Baseline research for healthcare –associated infections 23,555.27

PPI Framework (Patient and Public Involvement) 39,917.00

Palliative Care Point Prevalence Study (PPS) 9,813.40 + 4,996.87

(co-funding)

Research on Teaching of Evidence-based Practice in Ireland 24,698.82

Training and resources in Implementation Science for Guideline Development Groups 24,900.00

Learning Management System and E-learning courseware 38,425.00

The contract awarded to National University of Ireland Galway (NUIG) in December 2015 for a series of systematic literature reviews to support National Clinical Guidelines has provided the evidence-base to support Guideline Development Groups working on Hepatitis C screening, Chronic Obstructive Pulmonary Disease (COPD) and the Emergency Medicine Early Warning System (EM-EWS).

The contracts awarded to University College Cork (UCC) to conduct a systematic literature review to inform the update of NCG No. 1 NEWS and to Dublin City University (DCU) to conduct baseline research on the Paediatric Early Warning System (PEWS) were completed in 2016.

Contracts were awarded in Q4 2016 • to UCC to conduct baseline research to inform the update of NCGs on Healthcare Associated

Infections (HCAIs) • to UCC to conduct baseline research on the teaching of evidence-based practice in Ireland• to DCU for the development of a PPI Framework• to the Centre for Effective Services (CES) to develop training and resources in implementation

science for guideline development groups• to Aurion Learning to develop a learning management system and e-learning modules on

clinical effectiveness processes.


Guidelines in development There were five guideline or proposal appraisals conducted in 2016. Four guidelines were appraised by the NCEC and were deemed to meet the prioritisation criteria for National Clinical Guidelines. One guideline was appraised and was deemed to meet the quality assurance criteria. Two guidelines were considered for rapid update.

As of December 2016, there are three guidelines at ‘Notice of Intent’ stage and there are two guideline proposals going through the NCEC process for prioritisation.

A full listing of guidelines at their various stages is published on the NCEC website and Appendix 4 shows the status of all NCEC guidelines as of December 2016.

NCEC members and the CEU held a number of meetings and teleconferences with potential and active GDGs to provide advice, guidance and general support for the ongoing development of national guidelines.

Developments in NCEC National Clinical Guidelines The full list of the 14 National Clinical Guidelines published at December 2016 can be seen in appendix 5.

The methodology for each of these guidelines encompassed: • A multi-disciplinary guideline development group• Guideline development in line with NCEC methodology• A systematic literature review to underpin guideline recommendations• A grade for each recommendation reflecting the strength of evidence associated with the

recommendation• Identification of responsibility for implementation of each recommendation• Consideration of facilitators and barriers to guideline implementation• A budget impact assessment including a systematic economic literature review• An implementation plan, audit criteria and key performance indicators to measure guideline

implementation and impact.

A scoping exercise was conducted on a healthcare-associated infection (HCAI) guideline, which will now progress as a single guideline with infection specific chapters. It will encompass the updates of NCG No. 2 and 3 on MRSA and Clostridium difficile.

Work commenced in 2016 to support the update of National Clinical Guideline No. 1 (National Early Warning Score), published in February 2013 and subsequently updated to reflect sepsis recognition requirements in August 2014. A systematic literature review was commissioned from a team in UCC and the final report was completed in July 2016.

Rapid updates were conducted for two national clinical guidelines:• NCG No. 8 Diagnosis, staging and treatment of prostate cancer – rapid update reflecting

changes to drug reimbursement. • NCG No 12 Paediatric Early Warning System (PEWS) – rapid update reflecting updated tools

and other changes based on the experience to date of implementation.

Developments in methodology for National Clinical GuidelinesThe possibility of collaboration with the National Institute for Health and Care Excellence (NICE) in the UK to contextualise guidelines was explored and two meetings were held. This NICE contextualisation exercise will proceed as a pilot with one national clinical guideline in 2017.


The Clinical Guideline Methodology Subgroup (CGMS) prepared a paper on NICE guideline contextualisation for the NCEC. This Subgroup has commenced work on a revised Guideline Developer’s Manual to update the current edition which was published in 2013.

Work was done to update templates for NCEC guidelines and supporting documents, including a survey to previous guideline developers on the guideline proposal template and a template for consultation.

A short video on the role of NCEC appraisers in the prioritisation and quality assurance processes for NCGs was produced and is available on the website.

Monitoring and Implementation of NCEC National Clinical Guidelines

National Clinical Guidelines endorsed by the Minister for Health are mandated for implementation in the Irish health system and their implementation is monitored through; the HSE Performance Assurance Reports, compliance with the National Standards for Safer Better Healthcare (HIQA 2012) and increased alignment with the clinical indemnity scheme. A number of Quality and Patient Safety Performance Indicators that can measure implementation and the impact of National Clinical Guidelines already exist and are specified in the HSE Service Plan 2016. These are presented in table 4 alongside the targets planned and the actual results achieved.

Implementation of National Clinical Guidelines is also evident in many national reports such as the HIQA review of progress made at the Midland Regional Hospital Portlaoise, which found evidence of learning and sharing of findings from previous investigations at the hospital such as training and education for new staff at staff induction on the Irish Maternity Early Warning System (IMEWS) and National Early Warning Score (NEWS). The hospital audited compliance with IMEWS and demonstrated a high level of compliance with recording of observations.

Since the publication of the NCEC Guidelines on HCAIs (MRSA, published in December 2013 and Clostridium difficile, published in June 2014) cases of MRSA have continued to decrease each year and provisional data for 2016 sees this downward trend holding. C. diff infection rates notified from 2014 have seen a more modest decrease in 2016 however, reducing infection rates is a challenge Europe-wide for this notifiable disease.

In 2016, the HSE quality assurance and verification division (QAVD) team conducted an audit on NCG No. 5 Communication (Clinical Handover) in Maternity Services, the executive summary of which will be published on the HSE website.

Planning for the audit of National Clinical Guideline No.12 (Paediatric Early Warning System - PEWS) commenced in 2016. This audit will be undertaken by the HSE QAVD team in 2017. This audit will review inpatient charts to audit compliance with PEWS national guideline, determine if the PEWS escalation guide is adhered to and determine if PEWS audits are undertaken at hospital level.


Monitoring of National Clinical Guidelines

Table 4: Key Performance Indicators for National Clinical Guidelines.

Key Performance Indicator (KPI) HSE Service Plan, 2016

Target Actual Comment

National Clinical Guideline No 1 - National Early Warning Score (NEWS)

% of hospitals with full implementation of NEWS in all clinical areas of acute hospitals and single specialty hospitals. (Quarterly)

100% 90%*

% of all clinical staff who have been trained in the Compass Programme. (Quarterly)

>95% 62%*

National Clinical Guidelines No 2 and No 3 - Healthcare Associated Infections (HCAIs)

Rate of MRSA blood stream infections in acute hospital/1000 bed days used (Quarterly in arrears)

< 0.057 0.043*

Rate of new cases C. difficile in acute hospitals / 10,000 bed days used (Quarterly in arrears)

< 2.5 2.0*

Medium hospital total antibiotic consumption (DDD/100 bed days) per hospital (Bi-annual in arrears)

83.0 84.0**

Alcohol hand rub consumption (litres/1000 bed days used) (Bi-annual in arrears)

25 30.6**

% compliance of hospital staff with the WHO 5 moments of hand hygiene using the national hand hygiene audit tool (Bi-annual in arrears)

90% 90.3%**

Consumption of antibiotics in community settings (DDD/ 1,000 population) (Quarterly in arrears)

<21.7 21.7* New KPI 2016

National Clinical Guideline No 4 - Irish Maternity Early Warning System (IMEWS)

% maternity units/hospitals with full implementation IMEWS (Quarterly)

100% 100%*

% of hospitals with implementation of IMEWS for pregnant patients (Quarterly)

100% 82%*

National Clinical Guideline No 5 - Clinical Handover in Maternity Services

% of maternity units / hospitals with implementation of the guideline for clinical handover in maternity services (Quarterly)

Not reported New KPI 2016

National Clinical Guideline No 11 - Clinical Handover in Acute and Children’s Hospital Services

% of acute hospitals with implementation of the guideline for clinical handover (Quarterly)

Not reported New KPI 2016

* These results are based on the HSE Performance Report and Management Data Report at December 2016 reporting cycle.

** These results are based on the HSE Performance Report and Management Data Report at September 2016 reporting cycle.


Implementation of National Clinical Guidelines

An update on implementation for the following national clinical guidelines is provided in this year’s annual report:

Diagnosis, staging and treatment of patients with breast cancer

National Clinical Guideline No. 7Published June 2015HSE National Cancer Control Programme

Diagnosis, staging and treatment of patients with breast cancer

National Clinical Guideline No. 7

June 2015

Diagnosis, staging and treatment of patients with prostate cancer

National Clinical Guideline No. 8Published June 2015, revised March 2016.HSE National Cancer Control Programme

Diagnosis, staging and treatment of patients with prostate cancer


June 2015

The Irish Paediatric Early Warning System (PEWS)

National Clinical Guideline No. 12Published November 2015, revised November 2016Chair & Project manager: Dr John Fitzsimons/Ms Rachel MacDonellHSE national clinical programme for paediatrics and neonatology The Irish Paediatric Early Warning System

(PEWS)


National Patient Safety OfficeOifig Náisiúnta um Shábháilteacht Othar

November 2015Updated November 2016, version 2

Diagnosis, staging and treatment of patients with gestational trophoblastic disease (GTD)

National Clinical Guideline No. 13Published November 2015HSE National Cancer Control Programme Diagnosis, staging and treatment of patients

with gestational trophoblastic diseaseNational Clinical Guideline No. 13

November 2015

Management of an Acute Asthma Attack in Adults (aged 16 years and older)

National Clinical Guideline No. 14Published November 2015 Chair & Project manager: Prof Pat Manning/Ms Linda KearnsHSE national clinical programme for asthma Management of an Acute Asthma Attack

in Adults (aged 16 years and older)


November 2015


Guideline Implementation: Diagnosis, staging and treatment of patients with breast cancer

National Clinical Guideline No. 7. Published June 2015

The objectives of this guideline are; to improve the quality of clinical care, to prevent variation in practice and to address areas of clinical care with new and emerging evidence. The implementation of this National Clinical Guideline will support the provision of evidence-based and consistent care across Irish healthcare services. Specific health outcomes are addressed in each clinical question.

Progress on implementation of guideline recommendations:

Total number of recommendations in guideline 53

Number of recommendations implemented in full (as of December 2016) 27

Monitoring and audit The following Key Performance Indicators (KPIs) are monitored by the National Cancer Control Programme:

• Radiology (axillary ultrasound): Patients with a diagnosis of primary operable breast invasive cancer shall have an ultrasound of the axillary nodes.

• Surgery: For patients having breast conserving surgery, the number of therapeutic interventions shall be recorded.

• Radiation Oncology (access): For primary invasive or in-situ tumours, following surgery, patients who require radiation therapy alone shall commence treatment within 12 weeks (less than or equal to 84 days) of the final surgical procedure.

The following recommendation has been identified for audit in 2017:

Radiation oncology: Hypo-fractionation schedules are recommended for patients with early breast cancer. This audit will be carried out in 2017 in collaboration with the Discipline of Radiation Therapy, Trinity Centre for Health Sciences. Implementation supportsThe following tools have been developed by the National Cancer Control Programme (NCCP) to support the implementation of this guideline, available on http://www.hse.ie/eng/services/list/5/cancer/

• NCCP GP resources (referral criteria, electronic referral, e-learning).

• NCCP chemotherapy protocols.• Prevention of clinical lymphoedema after cancer treatment:

early detection and risk reduction – a guide for health professionals.

• Symptomatic Breast Clinic – A guide for patients.• Your follow-up care plan after treatment for breast cancer – A

guide for women.• Breast Pain – A guide for women.• National Clinical Guidelines for Cancer – Methodology Manual,

NCCP.

Prevention of clinical lymphoedema after cancer treatment:Early detection and risk reduction

A guide for health professionals

Your follow-up care plan after treatment for breast cancer

A guide for women

http://www.hse.ie/eng/services/list/5/cancer/


Guideline implementation: Diagnosis, staging and treatment of patients with prostate cancer

National Clinical Guideline No. 8. Published June 2015, revised March 2016

The objectives of this guideline are: to improve the quality of clinical care, to prevent variation in practice and to address areas of clinical care with new and emerging evidence. The implementation of this Clinical Guideline will support the provision of evidence-based and consistent care across Irish healthcare services. Specific health outcomes are addressed in each clinical question.




MonitoringThe following KPIs are monitored by the National Cancer Control Programme (NCCP):

• Access: Referrals to the rapid access prostate clinic shall be offered an appointment within 20 working days of the date of receipt of a letter of referral in the cancer centre.

• Time to Treatment: For all patients diagnosed with a primary prostate cancer, the interval between the date of decision to treat and date of first surgical intervention, where surgery is the first treatment, shall be less than or equal to 30 working days.

• Multidisciplinary Working: All patients who are diagnosed with prostate cancer shall be discussed at Multidisciplinary Team (MDT) meeting.

• Diagnosis: The histology report following a prostate biopsy should be available within 10 working days of the procedure being carried out in 80% of cases.

• Radiotherapy: New patients with a primary prostate cancer undergoing radical therapy will be treated within 15 working days of being deemed ready to treat.

• Surgery: For patients who have a radical prostatectomy for prostate cancer and the specimen is classified as a pathological stage pT2, the positive margin status should not exceed 15%.

Audit An audit took place in 2016 on the following guideline recommendation: Clinical question: Which men with prostate cancer should have an isotope bone scan?Guideline recommendation: An isotope bone scan is recommended for patients with prostate cancer with a Gleason score ≥8, PSA>20μg/L or stage ≥T3, regardless of serum PSA.

Implementation supportsThe following tools have been developed by the NCCP to support implementation of this guideline, available at http://www.hse.ie/eng/services/list/5/cancer/:

• NCCP GP resources (referral criteria, electronic referral, e-learning).• NCCP chemotherapy protocols.• Patient Booklet: Having your Prostate checked: what you should know.• Patient Booklet: Having your Prostate TRUS biopsy: what you should know.• National Policy on the Prevention and Management of Infection Post Trans Rectal Ultrasound

(TRUS) Guided Prostate Biopsy 2014.• National Clinical Guidelines for Cancer – NCCP Methodology Manual.

Having your prostate checked:what you should know

A Guide For Men

http://www.hse.ie/eng/services/list/5/cancer/


Guideline Implementation: The Irish Paediatric Early Warning System (PEWS)

National Clinical Guideline No. 12. Published November 2015, revised November 2016

The purpose of this National Clinical Guideline is to improve prevention, recognition of and response to children at risk of clinical deterioration in paediatric inpatient settings, through the implementation of a standardised paediatric early warning system. National implementation of PEWS should improve the management of critical illness in children by facilitating earlier recognition and response to deterioration and in turn preventing unplanned admission to PICU. The outcome for clinicians, children and families is a greater awareness and understanding of the child’s clinical condition and needs.


Monitoring and auditThe PEWS audit toolkit is available at: http://www.hse.ie/pews. Audit parameters include compliance with documentation standards, recording observations, escalation and safe variance use.

An evaluation of Hospital safety culture and situation awareness in acute paediatric hospitals in Ireland: service evaluation pre-implementation of the Irish Paediatric Early Warning System (PEWS) was carried out by DCU in 2016.

Implementation supportsThe PEWS implementation toolkit is available online at www.hse.ie/pews and includes:

• PEWS training and support (Implementation guidance, sample national age-specific paediatric observation charts, PEWS user manual, quick reference guide, PEWS physiological parameter tables, paediatric sepsis 6 poster).

• PEWS trainer toolkit (PEWS training guidance, PEWS training slides, PEWS training quiz, PEWS case studies).

• PEWS audit toolkit (Clinical outcome minimum dataset, PEWS audit for quality improvement).

• PEWS parent/carer engagement toolkit (Information for staff and parents/carers about PEWS, ‘Listening to you’ poster, ‘Listening to you’ leaflet).

• PEWS supplementary resources (PEWS systematic literature review, PEWS focus groups research).

Plans for 2017• Development of a retraining/refresher programme

and national audit structure.• The Quality Assurance and Verification Division, Health

Services Executive will undertake a national PEWS Audit in 2017.

• The HSE Acute Hospitals Division 2017 Key Performance Indicator (KPI) for PEWS, entitled ‘Percentage of hospitals with implementation of PEWS (Paediatric Early Warning System)’ will examine compliance with national PEWS documentation standards, governance, training and audit.

Paediatric Early Warning System (PEWS)

Listening to you

If you are worried about your child’s condition, please tell us

For more information go to: www.hse.ie/pews or ask your nurse for a PEWS: Listening to You leaflet

• Children’s wards in Ireland have an early warning system called PEWS. • PEWS helps doctors and nurses to make decisions about the care your

child may need if they become more unwell during a hospital stay. • If you have a concern about your child’s condition including a ‘gut

feeling’, you should tell your nurse. • If there is anything you don’t understand, just ask us to explain.

I don’t know what it is, but Claire just isn’t

herself...

Alex has been sleepy since

the medication changed...

I am worried that

David is sleeping too much...

Is your child’s breathing...

• Faster• Slower• Working harder• Noisy?

Is your child...• Confused or

muddled• Irritable • Crying differently• More sleepy• Quieter than usual• Saying that they

don’t feel right• Behaving

differently?

Have you noticed a difference in your child’s...

• Wee or poo• Eating or drinking• Vomiting?

Is your child...• Restless or moving around a lot • Lying still• In pain or saying somewhere

hurts?

How does your child look?

• More pale or flushed than usual

• Blotchy• Puffy• Sweaty• Rash or marks

on body

Clinical Strategy and Programmes Division

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Des

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http://www.hse.ie/pews

http://www.hse.ie/pews


Guideline Implementation: Diagnosis, staging and treatment of patients with gestational trophoblastic disease (GTD)

National Clinical Guideline No. 13. Published November 2015

The overall objectives of this guideline are: to improve the quality of clinical care, to prevent variation in practice and to address areas of clinical care with new and emerging evidence. The implementation of this Clinical Guideline will support the provision of evidence-based and consistent care across Irish healthcare services. Specific health outcomes are addressed in each clinical question.




Key developments in 2016: • Human chorionic gonadotrophin (hCG) and Ca1251 harmonization board and expert review

panel established.• Survey carried out with laboratories in relation to hCG and platforms used.• Survey disseminated to laboratories in relation to the histopathology GTD workload and

availability of tests (such as P57, immunohistochemistry, flow cytometry and molecular genotyping).

• National GTD patient registration and referral form established and piloting of the database commenced.

• International Conference on GTD held in Cork in May 2016 with the objective of sharing best practice and collaboration.

The following tools have been developed in co-operation with the GTD Steering Committee to support implementation of this guideline:

• Flow document and discharge pathways.• A set of guidelines developed for initial suspicion of molar pregnancy i.e. partial hydatidiform

mole (PHM) and complete hydatidiform mole (CHM) as aids to teaching/support. • Patient registration form and clinician information regarding registration.• Guidelines for theatres (aids to teaching/support).• Guidelines for 2 week consultation (aids to teaching/support). • Database. • Website, including frequently asked questions (FAQs). • Leaflets for PHM and CHM. The leaflets have received the plain English quality mark from the

National Adult Literacy Agency (NALA).

Plans for 2017• The GTD Registry will commence and the Monitoring and Advisory

Centre in Cork will be launched. • MDT will be set up and standard operating procedures for the

MDT will be agreed. • Patient Information leaflets on the rarer forms of GTD will be

developed.• KPIs will be developed.

1 hCG and CA125 are types of tumour markers occurring in blood or tissue that are associated with cancer and whose measurement and identification is useful in patient diagnosis or clinical management.

1

An information guide for patients diagnosed with

‘Partial Hydatidiform Mole’ (PHM)

National Gestational Trophoblastic Disease

Registry, Monitoring and Advisory Centre

Cork University Maternity Hospital, Wilton, Cork.

Phone: (021) 492 0526 Fax: (021) 492 0566


Guideline Implementation: Management of an Acute Asthma Attack in Adults (aged 16 years and older)

National Clinical Guideline No. 14. Published November 2015

The aim of the Guideline is to assist healthcare professionals (HCPs) in assessing and making decisions on the management of acute asthma in adults by outlining evidence-based treatment protocols. It also aims to assist policy makers and those planning acute services for adult asthma patients.

The expected outcomes resulting from the implementation of the Guideline include:• A reduction in asthma related deaths in adults.• Improved patient experience, safety and quality of care.• Raised levels of awareness among healthcare professionals on how to manage acute

asthma attacks in adults, including pregnant women.• Improved efficiency in the admission, care, discharge and follow-up of adults experiencing

an acute asthma attack.


Monitoring and audit The following KPIs were chosen to evaluate the implementation of the Guidelines:

• Percentage of nurses in primary and secondary care who are trained by the National Asthma Programme

• Number of deaths caused by asthma annually

Implementation supportsImplementation supports for the guideline are as follows:

• Implementation tools:– Emergency treatment protocols for management of acute adult asthma– Emergency treatment care bundles for management of acute adult asthma– Discharge letter, fax, e-mail template for management of acute adult asthma– Audit form for emergency asthma care– Asthma management plans– Peak flow measurements– Medications in acute asthma

• Asthma education e-learning programme (due for completion in 2017).

• A training video featuring Prof Manning, clinical lead, has been produced by the Royal College of Physicians in Ireland (RCPI) entitled ‘Guideline on the Management of an Acute Asthma Attack in Adults’. The video will be available in early 2017 for Basic Specialist Training of General Medicine Trainees (471 registered trainees nationally, at senior house officer (SHO) level, across nine schemes).

• Article featured in the Irish Medical Times in May 2016 about the launch and the highlights of the Guideline.

Initial AssessmentLook for LIFE THREATENING FEATURES - take history, physical examination (auscultation, use of accessory

muscles, heart rate, respiratory rate, PEF, or FEV1, oxygen saturation, arterial blood gas if patient in extremis)

Management of acute adult asthma in ED, AMU & In Hospital

PEF >75% best or predictedSpO2 >92%Mild- Can lie down- Talks in sentences- Mild-Mod wheeze- PR<100 Beats/ min- RR<25 Breaths/ min- BP Normal

PEF 33–50% best or predicted SpO2 >92%

Severe PEF <50% (severe) Respiration >25 breaths/min Pulse > 110 beats/min Cannot complete sentence in one

breath BP Normal

PEF < 33% best or predictedSpO2 <92% OR any one of the

Life Threatening Asthma Features: Silent chest, cyanosis, poor

respiratory effort Bradycardia, arrhythmia, Check BP for hypotension Exhaustion, confusion, coma

Give salbutamol up to 12 puffs via spacer or oxygen driven nebuliser

Obtain Senior/ICU/ Specialist help now if any life threatening asthma

features are present

IMMEDIATE MANAGEMENT High concentration oxygen (>60% if

possible – goal to maintain sats at 94%)

Give salbutamol 5 mg plus ipratropium 0.5 mg via oxygen-driven nebuliser

AND prednisolone 40-50mg orally or IV hydrocortisone 100 mg or125mg of methyprednisolone

Measure arterial blood gasesMarkers of severity: Normal or raised PaCO2

(Pa CO2>4.6kPa) Severe hypoxia

(Pa O2<8 kPa) Low pH (or high H+)

Chest X-ray 12-Lead ECG Give/repeat salbutamol 5 mg with

ipratropium 0.5 mg by oxygen-driven nebuliser after 15 minutes

Consider continuous salbutamol nebuliser 5-10 mg/hr.

Consider IV magnesium sulphate2g over 20 minutes

Correct fluid/electrolytes, especially K+ disturbances

Clinically stable AND

PEF >75%

No life threatening asthma features AND

PEF 50-75%

Life threatening

asthma features OR PEF <50%

Repeat salbutamol via inhaler/nebulizer 5mg at 15-30 min intervals

Give prednisolone 40-50mg orally

Patient recoveringAND PEF >75%

No signs of severeAsthma

AND PEF 50-75%

Signs of severeAsthma

OR PEF <50%

OBSERVEMonitor SpO2,Heart rate and

Respiratory rate

Patient StableAND PEF >50%

Signs of severe asthma

OR PEF <50%

ADMIT for minimum of 24 hoursPatient should be accompanied by a

nurse or doctor at all times

Peak expiratory flow in normal adults DISCHARGE PLAN In all patients who received nebulised ß2 agonists prior to

presentation, consider an extended observation period prior todischarge

If PEF<50% on presentation, prescribe prednisolone 40-50mg/day for 5 days. Ensure all patients have a treatment supply

In all patients ensure treatment supply of inhaled steroid and ß2 agonist as a minimum and check inhaler technique

PEF meter instruction and written asthma management plan Consider psycho-social factors before discharge GP follow up within 2 working days post presentation advised

for moderate / severe / life-threatening exacerbation (2 weeks – mild)

Fax Or email discharge letter to GP and copy to patient Refer to Asthma/ Respiratory Service for follow up within 4

weeks Complete Asthma Discharge Plan Consider delay in discharge to 8 am if after midnight

10 -15 mins

Give usual bronchodilator

Start on inhaled Steroids

Give salbutamol 5 mg and ipratropium 0.5mg by oxygen-driven nebuliser

PEF 50-75% best or predicted SpO2 >92%Moderate- Loud wheeze- Prefer to sit- Talks in phrases- PR<110 Beats/ min- RR<25 Breaths/ min- BP Normal

2 hours

Based on GINA and BTS Guideline on the Management of Asthma 2008Based on GINA and BTS Guideline on the Management of Asthma 2008


3. National Clinical Audit

The work on NCEC National Clinical Audit progressed in 2016. By invitation, the National Office for Clinical Audit submitted a mature audit and participated in testing the developed NCEC National Clinical Audit Template. Their Major Trauma Audit was successfully prioritised and quality assured simultaneously with template testing.

A rigorous process of development has been completed for the audit: • A multi-disciplinary National Clinical Audit Governance Committee exists• The audit utilises an international methodology, in this case from TARN, the Trauma Audit and

Research Network of the UK• The clinical standards on which the audit is based are current evidence–based standards• Responsibility for implementation across existing levels of the audit is outlined• A monitoring and escalation policy has been agreed with the Health Services Executive• A systematic economic literature review has been completed to assess the economic

impact of the audit• Reporting of audit findings is made public.

The Major Trauma Audit was endorsed by the Minister for Health as the NCEC’s first National Clinical Audit in December 2016 and launched at the National Patient Safety Office Conference.

Launch of 1st NCEC National Clinical Audit. Left to right: Prof. Conor O’Keane, Dr. Tony Holohan, Ms. Colette Tully, Mr. Simon Harris T.D., Dr. Kathleen Mac Lellan, Ms. Marina Cronin, Dr. Conor Deasy, Prof Hilary Humphreys.

A second clinical audit has been invited to submit an application, alongside finalising the template testing. Meetings have also been held with other audit organisations with regard to future applications to the NCEC for NCEC National Clinical Audit.


4. Clinical Practice Guidance

In clinical practice, there are different types of clinical guidance that vary in complexity and scope. It is important that the development of all clinical guidance uses an evidence-based approach, to ensure evidence-based healthcare.

Clinical practice guidance is defined as systematically developed statements or processes to assist clinician and patient decisions about appropriate healthcare for specific clinical circumstances. Clinical guidance includes clinical policies, procedures, protocols and guidelines.

The National Standards for Clinical Practice Guidance were published by the NCEC in November 2015 for healthcare staff developing clinical practice guidance.The objectives of the NCEC standards are to:

• Provide a standardised terminology and methodology for the development of evidence-based clinical practice guidance nationally.

• Ensure consistency of approach and minimise duplication of clinical practice guidance in the health system.

NCEC Standards for Clinical Practice Guidance 2015, available at: http://health.gov.ie/national-patient-safety-office/ncec/clinical-practice-guidance/

It is not in the interests of patient safety for individual organisations/units to develop or implement different guidance for similar clinical circumstances. Through consistency in approach and a reduction in duplication, variations in practice can be reduced. Sharing of best practice will optimise the use of health service resources and expertise.

Clinical effectiveness is a key component of patient safety and quality. The integration of best evidence in service provision, through clinical effectiveness processes such as clinical practice guidance, promotes healthcare that is evidence-based, up-to-date and effective.

These standards aim to translate evidence into policy and practice, closing the gap between research and clinical care. The standards promote the implementation of evidence-based solutions in healthcare, ultimately providing better quality health services for patients. It is well recognised and documented that high performing health systems should have robust policies, procedures, protocols and guidelines (PPPG) in place in order to deliver quality and safe care.

http://health.gov.ie/national-patient-safety-office/ncec/clinical-practice-guidance/

http://health.gov.ie/national-patient-safety-office/ncec/clinical-practice-guidance/


HSE National Framework for developing Policies, Procedures,

Protocols and Guidelines (PPPGs)

In 2016 the HSE developed a national framework for developing PPPGs in line with the NCEC standards. The HSE is also planning to establish a HSE National Central Repository for all approved national HSE PPPGs.

Launch of the HSE National Framework for developing policies procedures, protocols and guidelines. Left to right: Dr Niamh O’Rourke, Ms Caralyn Horne, Ms Bríd Boyce, Dr Philip Crowley, Dr Áine Carroll, Ms Maria Lordan Dunphy.

The NCEC Standards for Clinical Practice Guidance were presented at an international conference of Evidence-Based Practice (Evidence Live) at the Centre for Evidence-Based Medicine, Oxford in June 2016.


5. Education and Training

A consultation with guideline development groups in 2015 identified training requirements in the following key areas, and these were the focus for the training programme in 2016.

• Evidence-based practice • Guideline development• Economic evaluation • Implementation & audit.

Table 5: Education and Training for Guideline Development Groups in 2016.

Training Month (2016) Trainers Participants

Searching for evidence January 7th March 10thMay 19th

Mr Gethin White, HSE librarian Ms Breffni Smith, RCSI librarian

8116

Economic evaluation for clinical guidelines

March 10thMay 19th November 16th

Ms Michelle O’Neill, HIQA 101314

Developing evidence-based clinical guidelines

January 14th March 2nd May 5th

Dr Eve O’Toole, NCCPMs Eileen Nolan, NCCPDr Niamh O’Rourke, CEU

151210

Guideline implementation – theory, practice, monitoring & audit

April 7th Prof Catherine Hayes, TCDDr Eva Doherty, RCSIDr Lisa Mellon, RCSIDr Sarah Condell, CEUDr Niamh O’Rourke, CEU

18

Introduction to NCEC guideline development process

November 16th Ms Rosarie Lynch, CEU 17

The DECIDE project and moving from evidence to decisions using the Evidence to Decision framework

October 7th Prof Shaun Treweek, University of Aberdeen

33

Total 167

Attendees on the training programme crossed the spectrum of roles that make up guideline development and audit teams including librarians, nurses, pharmacists, researchers, clinical programme leads, managers and project officers, educators, regulators and healthcare professionals in practice. Continuing Professional Development credits were awarded for all training courses.

An evaluation was carried out of all training courses. Participants provided very positive feedback, commenting that the training was useful, met their needs, was fit for purpose, clear and relevant.

Participants planned to use the training as follows: • “Will be used to develop clinical questions and search literature for my guideline”• “I plan to do a budget impact assessment in my work” • “It gave me a good understanding and resources to develop guidelines” • “I will use this to inform my approach to guideline development”.

Specific comments from participants included: • “Excellent/very useful”• “Very clear delivery. Easy to understand. A possibly complex subject made easy”• “Very enjoyable, gave good overview of economics with respect to guideline development”


• “Excellent overview for guideline development, highlighting pitfalls and recommendations from team’s own experience”

• “Very in-depth and comprehensive training”• “It was a great training day – particularly found group exercises very helpful”• “Excellent course. Very high quality and interesting also”• “Very comprehensive and informative. Trainers were excellent”• “The training overall was excellent; presenters brilliant in explaining and presenting the

training”• “Really excellent. Very comprehensive overview of implementation theory, audit, planning

and practice”• “Excellent training. Broad range of topics in the right level of detail”• “Well done – brilliant day”.

Future training Participants recommended additional information/training in the areas of:

• NCEC guideline development process, including aspects of submission, proposals, updating, templates and appraisal of the literature

• Clinical practice guidance; policies, procedures, protocols & guidelines (PPPGs)• Monitoring & audit• Project management• Implementation, behaviour change & human factors.

Structure & format Participants recommended a combination of training structures including:

• Workshops• e-learning• Material on NCEC website.

To increase accessibility to training, additional training sessions were video-recorded and made available on the NCEC website. Most of the training PowerPoint® presentations are also accessible on the website http://health.gov.ie/national-patient-safety-office/ncec/

The additional training videos developed in 2016 were: • Economic evaluation for clinical guidelines – Ms

Shelley O’Neill, HIQA • Guideline implementation – theory, practice,

monitoring & audit– Introduction to implementation science and

Implementation theory. Prof Catherine Hayes, TCD

– Monitoring & audit of National Clinical Guidelines. Dr Sarah Condell, Clinical Effectiveness Unit

– Understanding human factors for successful implementation of guidelines. Dr Eva Doherty, RCSI

– Developing an implementation plan for your national clinical guideline. Dr Niamh O’Rourke, Clinical Effectiveness Unit

• Appraisal of clinical guidelines. Dr Mary O’Riordan, HPSC, HSE • Project management for guideline development, Ms Eileen Nolan, NCCP, HSE • Developing evidence-based guidelines, Dr Eve O’Toole, NCCP, HSE

– Module 1: An overview of guideline development methodology – Module 2: Developing clinical questions – Module 3: Critically appraising the evidence– Module 4: Developing guideline recommendations.



Training for the NCEC‘Lunch and Learn’ sessions preceded the five NCEC meetings:January Approaches to the implementation of clinical guidelines – reflections on the

Guideline International Network (GIN) Conference 2015 by Dr Kathleen Mac Lellan and Rosarie Lynch, CEU.

March Patient and Public Involvement by Dr Veronica Lambert, DCU. May Mental Health Commission (MCH) - Role and Function by Ms Rosemary Smyth, MHC.September Health Products Regulatory Authority (HPRA) by Dr Elaine Breslin, HPRA.October Health Research Board by Dr Graham Love, HRB.

In October, Prof Shaun Treweek delivered a presentation on “The DECIDE project and moving from evidence to decisions using the Evidence to Decision framework”. The audience consisted of NCEC members and guideline developers. In total 33 delegates attended. The DECIDE project involved “Developing and Evaluating Communication strategies to support Informed Decisions and practice based on Evidence.” The objective was to “to improve the dissemination of evidence-based recommendations by building on the work of the GRADE Working Group to develop and evaluate methods that address the targeted dissemination of guidelines”. Prof Treweek is Professor of Health Services Research at the University of Aberdeen and a member of the NCEC Clinical Guidelines Methodology Subgroup (CGMS).

The NCEC is extremely grateful to all the trainers, who generously gave of their time and expertise and who greatly contributed to the work of the NCEC in capacity building for clinical effectiveness.

6. Patient and Public Involvement (PPI)

At the March NCEC meeting, a team from Dublin City University, led by Dr Veronica Lambert, presented their findings on the commissioned tender ‘Patient engagement in the governance and development of national clinical effectiveness processes’ (i.e. clinical audit & guidelines): A systematic literature review and desk-top analysis. (Available at http://health.gov.ie/wp-content/uploads/2016/12/PPI_FINAL-REPORT_08032016.pdf)

The five main objectives of the review focused on examining the benefits, barriers, enablers, approaches, supports and evaluation mechanisms in relation to PPI in clinical effectiveness processes. Overall, the review revealed evidence that PPI in national clinical effectiveness processes does take place internationally; however empirical evidence on which PPI strategy or approach is most effective was limited. The majority of documents reviewed reported on PPI in clinical guideline development with a dearth of data on PPI in clinical audit processes. The team presented some principles for NCEC consideration.

Following this review, the Department of Health’s Clinical Effectiveness Unit invited tenders for the development of a Framework for Patient and Public Involvement in the NCEC’s Clinical Effectiveness Processes of National Clinical Guidelines and National Clinical Audit. The objectives of the Framework are to:

• Support the NCEC in its Terms of Reference to provide strategic leadership for the national clinical effectiveness agenda

• Assist guideline development and clinical audit governance groups to fulfil relevant NCEC prioritisation and quality assurance criteria

• Act as a resource for ‘best practice’ in patient and public involvement in national clinical effectiveness processes

• Outline the content and optimum delivery mode for training programme(s) for the competency and skills required by all relevant stakeholders including patients and public.

• Provide an evaluation framework to monitor and measure patient and public involvement in clinical effectiveness processes.

http://health.gov.ie/wp-content/uploads/2016/12/PPI_FINAL-REPORT_08032016.pdf

http://health.gov.ie/wp-content/uploads/2016/12/PPI_FINAL-REPORT_08032016.pdf


It is expected that the Framework will detail a values statement and model for PPI for adoption by the NCEC. It will also include a set of guidance document(s), such as a resource pack and/or toolkit, containing templates, case studies, checklists, performance indicators etc., for use by all key stakeholders and specifically by guideline development groups and clinical audit governance committees. The contract for the Framework tender was signed in December 2016.

7. Collaboration in Ireland for Clinical Effectiveness Reviews (CICER)

In 2016, the NCEC continued to work in partnership with the Health Research Board (HRB) to scale up skill development and expertise in synthesizing evidence for practice and policy. This culminated with the award for Collaboration in Ireland for Clinical Effectiveness Reviews (CICER) to a team led by Dr Máirín Ryan of HIQA’s Health Technology Assessment (HTA) division, with clinical lead support from Prof. Susan Smith of the HRB Centre for Primary Care Research at the Royal College of Surgeons in Ireland (RCSI).

Launch of CICER. Left to right: Dr. Máirín Ryan, Dr. Graham Love, Prof. Susan Smith, Dr. Karen Ryan.


For the next 5 years from 2017, the CICER team will undertake evidence reviews and provide scientific support and specialist training for the development of the NCEC’s national clinical guidelines. It will provide prioritised clinical guideline groups with the services, support and training they need to:

• Rapidly assess the international evidence in the area under consideration in order to design new clinical guidelines

• Identify the economic evaluation and budget impact of the proposed new guidelines• Update existing NCEC guidelines on an on-going basis.

This is critical in the practical implementation of clinical effectiveness in a fast, reliable and robust manner. HRB-CICER will also provide training in advanced methods for the NCEC and, as required, may examine the evidence-base for clinical standard setting for NCEC National Clinical Audit.

8. The National Patient Safety Conference

The NCEC held its annual symposium as part of the new National Patient Safety Office Conference in Dublin Castle on December 7th – 8th 2016 (Appendix 3). It was attended by approximately 480 delegates representing the HSE clinical programmes, medicine, nursing, allied health professionals, health librarians, regulation, the public, HSE management and policy. On day 2, the Minister for Health launched the National Clinical Audit on major trauma and the Clinical Effectiveness Evidence hub (HRB-CICER).

Prof Hilary Humphreys outgoing Chair of the NCEC, welcoming Dr Karen Ryan who will take up her appointment in 2017.


How can we really partner with our patients?Mr Phelim Quinn, Ms Patricia Gilheaney, Mr Tony O’Brien, Dr Graham Love, Ms Brigid Doherty.

Launch of the National Patient Safety Office.Dr Tony Holohan, Mr Simon Harris T.D., Dr Kathleen Mac Lellan.


Evaluation of the National Patient Safety ConferenceAttendees were asked to complete a short online survey with 124 respondents providing feedback on the event in the 31 days the survey was available.

The main findings were:Overall, the responses were very positive. Clinical effectiveness was ranked 2nd as an appropriate theme and in the main was scheduled in Day 2. Unfortunately, due to availability, the 2 keynote speakers on clinical effectiveness spoke on separate days. However, both were noted to have memorable content:

On Professor Bruce Guthrie -“message that we as healthcare professionals have to take ‘ownership’ of safety issues relating to our patients”

On Dr Johan Thor – “We spend all our time collecting data and often we don’t know what the purpose is or how to interpret. Also the same data can be collected in multiple formats which means that those doing the data collection and analysis are doubling up on their work. If we shared info across different systems/departments then we would lessen the workload for all concerned”.

Clinical Effectiveness concurrent sessions and workshops were also well received.

Thirty of the 112 posters focused on Clinical Effectiveness. Poster presenters were offered the opportunity to join a facilitated ‘walk-round’ of the themed session that included a 3 minute short presentation of the poster. The feedback on this idea varied: with some negative comments (n=7) on poster presenters missing concurrent sessions to positive comments - “Excellent idea, made it much more informative and interesting as a poster presenter and conference participant”. Fifty three survey respondents would like this format retained for next year as opposed to 23 who wish to revert to a poster display only.

Suggestions were made for future events including:• 24% wanting more international speakers• 15.5% wanting more national speakers• 25% wanting more patient/public perspectives

We would like to thank our NCEC members (Prof Hilary Humphreys, Dr Áine Carroll, Dr Philip Crowley, Ms Brigid Doherty, Dr Dubhfeasa Slattery, Ms Rosemary Smyth and Ms Mary Wynne) for chairing sessions or facilitating poster walk-rounds at the event.


9. Communications, Collaboration and Dissemination

NCEC continued to build its profile in 2016 through the provision of a number of presentations, posters and publications at national and international events, and through information technology such as web content and social media presence. In addition, and to assist in embedding the clinical effectiveness policy agenda in relevant initiatives, relationship building, consultations and committee work with pertinent stakeholders was undertaken throughout the year.

Presentations on NCEC processes

International presentations Establishing Prioritisation and Quality Assurance of National Clinical Audit.Dr Sarah Condell, Dr Kathleen Mac Lellan, and Professor Hilary Humphreys. International Forum on Quality and Safety in Healthcare. Gothenburg, April 2016. Poster presentation.

Development of Standards for Clinical Practice Guidance in Ireland. Dr Niamh O’Rourke. Evidence Live conference, University of Oxford, UK. June 2016. Oral presentation.

Developing evidence-based clinical guidelines – from clinical questions to implementation. Dr Niamh O’Rourke & Dr Eve O’Toole. Evidence Live, University of Oxford, UK. June 2016. Workshop.

Rationale and Process for Prioritisation of National Clinical Guidelines in Ireland.Ms Rosarie Lynch, Dr Kathleen Mac Lellan, Dr Máirín Ryan, Dr Sarah Condell and Ms Michelle O’Neill. Guidelines International Network (GIN), September 2016. Oral Presentation.

Overview of Health and Social Care in Ireland.Dr Sarah Condell & Ms Rosarie Lynch. National Institute for Health and Care Excellence (NICE) UK, October 2016. Presentation.

National presentations Development of National Standards for Clinical Practice Guidance. Dr Niamh O’Rourke and Ms Brid Boyce. Nursing & Midwifery Research & Innovation Conference, Limerick, March 2016.

Clinical Effectiveness – the Irish picture. Dr Sarah Condell to RCPI Diploma in Safety, April 2016.

Introduction to Clinical Effectiveness.Ms Rosarie Lynch to the Irish Medication Safety Network (IMSN), May 2016.

Introduction to NCEC National Clinical Guidelines processes.Ms Rosarie Lynch to Clinical Advisory Group, National Clinical Programme for COPD, May 2016.

Introduction to NCEC National Clinical Guidelines processes.Ms Rosarie Lynch to Consensus Conference for Adult Type 1 Diabetes Guidelines, National Clinical Programme for Diabetes, May 2016.

HTA for Clinical Effectiveness - An overview. Ms Rosarie Lynch to Irish Government Economic and Evaluation Service (IGEES) group as part of the IGEES Strategic Policy Discussion Series, July 2016.


NCEC website and social mediaThe NCEC website is part of the National Patient Safety Office website from December 2016.

Information is categorised into one of six areas on the NCEC webpages: National Clinical Guidelines, National Clinical Audit, Clinical Practice Guidance, the NCEC (governance), Resources and Learning, and Patient and Public Involvement. Summary minutes of NCEC meetings are also posted on the website. The NCEC webpages had 14,700 sessions in 2016. Almost 53% of sessions were from new visitors and the average session duration was just over 4.5 minutes.

To find us on the Department of Health home page http://health.gov.ie/ select NPSO logo below and follow the trail to Clinical Effectiveness and the NCEC webpages.

STEP1

STEP2

STEP3

Select NPSO logo and follow the trail to Clinical Effectiveness and the NCEC webpages

The NCEC Twitter account has the handle @NCECIreland. By end of year 2016, there was an increase from 500 to a total of 949 followers. The NPSO conference trended on Twitter during the 2 days and figures 4 and 5 shows the NCEC Twitter activity for December, the month of the conference.

Figure 4: NCEC Twitter activity for December 2016.


Figure 5: Sample NCEC tweets from 2016.

PublicationsThe NCEC has developed a number of publications as a resource to guideline developers and the health service providers. They are intended to provide information on the NCEC and guideline and audit development processes.

All NCEC publications are available at: http://health.gov.ie/national-patient-safety-office/ncec/

International partnerships and collaboration Relationships with international guideline agencies such as NICE, the Scottish Intercollegiate Guidelines Network (SIGN), and Guidelines International Network (GIN) were explored to create an international connectedness and to explore potential synergies and partnerships.

Links were made with the following working groups of GIN:• GINAHTA, a joint working group between GIN and INAHTA (International Network of Agencies

for Health Technology Assessment) whose aim is to explore common methods and to facilitate collaboration between the guideline and health technology assessment communities

• Updating Guidelines Working Group, which provides a network for those interested in the methodology of updating guidelines

• Implementation working group. The G-I-N implementation working group carried out research on the use of theory in guideline development in 2016, with input from the Clinical Effectiveness Unit in Ireland.

Working with NICE on guideline contextualisation was explored. In addition, links were made with the Best Practice Advocacy Centre in New Zealand (BPACNZ) around their experiences of conducting guideline contextualisation.

To further the work on guidelines for Healthcare Associated Infection, the Department have signed up as a collaborating partner for Joint Action JA-04-2016 - Antimicrobial resistance and Health Care Associated Infections (HCAI), which began in 2016. The Joint Action is an EU initiative under the third EU Health Programme (2014-2020). The collaborating partner role allows input into the technical and scientific aspects of the joint action and the area of interest is “state of the art reviews and development of tools, guidelines and training for supporting and maintaining good practice in clinical care in relation to AMR and HCAI in the hospital, long term care and community settings”.



The Clinical Effectiveness Unit worked with an international collaboration on a sepsis resolution, for discussion at the World Health Assembly (WHA) to promote recognition, use of evidence-based guidelines and early treatment of sepsis.

10. Clinical Effectiveness Informing Policy, Strategy and Legislation

Members of the Clinical Effectiveness Unit participated in policy, strategy and legislation formulation in 2016 in order to help ensure that clinical effectiveness is used as a policy foundation for healthcare practice. Specific activities included inputs to:

• National Cancer Strategy• NOCA Strategic Planning • HIQA Corporate Plan• Patient Safety Licensing Bill development • Health Information and Patient Safety Bill development • NMBI Statement of Strategy • HSE Framework for Policies, Procedures, Protocols and Guidelines• Department of Health, Statement of Strategy.

CEU Committee MembershipMembers of the Clinical Effectiveness Unit were members of the following relevant committees in 2016:

• Cochrane Ireland Steering Group • DoH Maternity Strategy• DoH Cancer Strategy• DoH Medication Safety Forum• HIQA Healthcare Associate Infection (HCAI) Standards update• HIQA Medication Management Standards Advisory Committee• HSE Policies Procedures Protocols & Guidelines (PPPG) group.


NCEC Meeting Attendance

Attendance at NCEC meetings

26/01/16 15/03/16 24/05/16 06/09/16 11/10/16

Prof Hilary Humphreys (Chair)* 3 3 3 3 3

Dr Anne Marie Brady 3 3 3 3 3

Dr Elaine Breslin 3 0 3 3 0

Ms Fiona Cahill* 3 0 – – –

Dr Áine Carroll 3 3 0 3 0

Mr Donal Clancy 3 3 3 3 0

Dr Jayne Crowe 3 3 0 3 3

Dr. Philip Crowley 0 0 0 0 3

Ms Fionnuala Duffy 0 0 3 0 3

Ms Linda Dillon 3 0 0 3 3

Ms Brigid Doherty 3 3 3 3 3

Dr Graham Love 3 3 3 3 3

Prof Dermot Malone* 3 3 3 3 0

Mr Simon Nugent 3 3 3 0 3

Dr Susan O’Reilly 3 0 0 3 0

Dr Karen Ryan* – – – – 3

Dr Máirín Ryan 3 0 3 3 3

Dr Philippa Ryan Withero 3 0 3 3 0

Dr Dubhfeasa Slattery 3 3 3 3 0

Ms Rosemary Smyth 0 3 3 3 3

Ms Collette Tully* – – – – 3

Ms Mary Wynne 3 3 0 3 3

* Prof Humphreys resigned as Chair on 11/10/16 with effect from 31/12/16 Ms Fiona Cahill resigned with effect from 14/03/16 Prof Dermot Malone resigned with effect from 04/12/16 Dr Karen Ryan appointed Chair NCEC on 27/09/16 with effect from 01/01/17 Ms Collette Tully replaced Ms Fiona Cahill with effect from 12/09/16

Appendix 1


Department of Health Clinical Effectiveness Unit

Department of Health Clinical Effectiveness Support

Director of National Patient Safety Office

Dr Kathleen Mac Lellan

Clinical Effectiveness Officers

Dr Sarah CondellMs Pauline DempseyMs Rosarie LynchDr Niamh O’Rourke

Assistant Principal Ms Susan Reilly

Higher Executive Officer Ms Paula Monks

Executive Officer Ms Sarah Delaney

Clerical Officers Ms Anne DevlinMr Keith BrowneMs Maeve Guilfoyle

Appendix 2


National Patient Safety Conference Programme 2016

Appendix 3

Day 17th December 2016

Time Topic Speakers

Chair: Dr Tony Holohan, Chief Medical Officer

9.45 Welcome Dr Tony Holohan

10.00 Keynote 1 Improving Safety for People with Multi-morbidity in Primary Care

Prof Bruce Guthrie

11.30 Chair: Ms Mary WynneMonitoring and Measuring Patient Safety

Chair: Ms Marie Kehoe-O’Sullivan Knowledge Translation for Patient Safety

Facilitator:Dr Mary Browne

11.30 National Sepsis Outcome Report 2016Dr Vida Hamilton, Clinical Lead, HSE Sepsis Programme

Developing a QI Learning Collaborative: The 'Better Beaumont' JourneyMs Debbie McNamara and the Better Beaumont team

Poster Walk Around 1

Knowledge Translation for Patient Safety 112.00 Taming the Wicked Problem of Hand

HygieneDr Paul O’Connor, NUI Galway

12.30 The Role of the Pharmacist in Optimising Patient Care, Lessons to be Learned both Clinically and Economically Prof Stephen Byrne, UCC

Medical Professionalism in Relation to Safety – Junior Doctors’ Experiences in PracticeMs Karen Egan, Patient Representative, Patient and Public Involvement in Healthcare at HSE and Dr Éidín Ní Shé, UCD Health Systems

Chair: Dr Fidelma Fitzpatrick Facilitator:Ms Margaret Brennan

14.00 Introduction to Longitude Prize Ms Nina Cromeyer Dieke Poster Walk Around 2

Knowledge Translation for Patient Safety 2

14.10 Longitude Prize – Infectious Futures 1 Ms Cathy Belton

14.25 Plenary – Prudent use of Antimicrobial Agents in the European Union: Lessons from the Commission Survey, 2015

Dr Catherine Dumartin

14.55 Plenary – Case Studies in Quality Improvement using Front-Line Ownership

Dr Michael Gardam

15.25 Longitude Prize – Infectious Futures 2 Ms Cathy Belton

15.40 Is it too Late to Turn the Antibiotic Resistance Tide - what can you do to help? On the Couch* with Dr Fidelma Fitzpatrick

16.20 Day 1 Round Up and close Dr Philip Crowley

* Confirmed Couch participants – Dr Rob Cunney (Clinical Lead, HSE HCAI/AMR Clinical Programme), Dr Vida Hamilton (Clinical Lead, HSE Sepsis Programme), Dr Nuala O’Connor (ICGP Lead for Preventing Health Care Associated Infections and Antimicrobial Resistance), Dr Michael Gardam (Assoc Prof of Medicine, University of Toronto), Ms Mary McKenna (HSE Lead Infection Prevention and Control), Prof Martin Cormican (Professor of Bacteriology, NUI Galway.)

Tea/Coffee on arrival Day 1 and Day 2

For break times and rooms, see your name badge.

Correct at time of printing.


Day 28th December 2016

Time Topic Speakers

Chair: Dr Tony Holohan, Chief Medical Officer

8.30 Minister for Health: Launch of the National Patient Safety Office (NPSO) Mr Simon Harris, T.D.

9.30 Chair: Prof Hilary Humphreys

Keynote 2 Using National Quality Registries to Guide and Evaluate Clinical Improvement Efforts – Encouragement from Sweden

Dr Johan Thor

10.15 Launches:Prof Hilary Humphreys introducing the new Chair National Clinical Effectiveness Committee (NCEC)Dr Graham Love introducing new HRB-Collaboration in Ireland for Clinical Effectiveness Reviews (CICER) Director

Chair: Dr John FitzsimonsClinical Effectiveness

Chair: Ms Brigid DohertyPatients as Partners in Safety

Facilitator: Ms Cornelia Stuart

11.15 Clinical Handover Workshop Dr John Fitzsimons, Dr David Vaughan, Dr Catherine Diskin(numbers restricted)

Two Sides of the CoinMs Ger Kilkelly, Patient Advice Liaison Officer, Galway University Hospitals


Clinical Effectiveness

National Patient Experience Survey Programme - the Partnership Approach Ms Tracy O’Carroll, HIQA

Co-designing Patient-Centred Care; people working together to create value Dr Colin Doherty, Ms Mary Fitzsimons and Dr Jarlath Varley

12.45 How can we really Partner with our Patients? On the Couch* with Dr Kathleen Mac Lellan, Director, NPSO

Chair: Prof Hilary Humphreys Chair: Dr Dubhfeasa SlatteryLaunch of 1st NCEC National Clinical Audit

Facilitator:Ms Rosemary Smyth

14.15 Clinical EffectivenessHSE National PPPG Framework (Policies, Procedures, Protocols & Guidelines) Workshop Ms Brid Boyce, Ms Maria Lordan-Dunphy

Clinical EffectivenessMajor Trauma Audit – Lessons and ReflectionsDr Conor Deasy, Clinical Lead, NOCA (MTA), Ms Marina Cronin, Hospital Relations Manager, NOCA


Patients as Partners in Safety

and

Monitoring and Measuring Patient Safety

14.45 Monitoring and Measuring Patient SafetyPatient Safety Research – What Might Measuring Adverse Events AchieveDr Natasha Rafter and Prof David Williams on behalf of the INAES team. Prof Rhona Flin, University of Aberdeen

15.15 Monitoring and Measuring Patient SafetyPaediatric Early Warning System (PEWS) – lessons learned Dr John Fitzsimons, Ms Rachel MacDonell

Chair: Dr Áine Carroll

15.45 Keynote 3 The Coroner’s Inquest: Patient Safety Issues Dr Brian Farrell

16.30 Day 2 Round Up Mr Patrick Lynch

16.40 Poster Prizes and Conference Close Dr Tony Holohan

*Confirmed couch participants Mr Tony O’Brien (DG, HSE), Dr Graham Love (CEO, HRB), Mr Phelim Quinn (CEO, HIQA), Ms Patricia Gilheaney (CEO, Mental Health Commission) and Ms Brigid Doherty (Patient Focus).

Correct at time of printing.


Guidelines in development

Title Lead/GDG Chair

NCG No. 1 National early warning score (NEWS) UPDATESee more details at http://health.gov.ie/patient-safety/ncec/commissioned-g-in-d/

To be announced

Maternity guidelines (to include Induction of Labour) This in line with the National Maternity Strategy 2016-2026. See more details at http://health.gov.ie/patient-safety/ncec/commissioned-g-in-d/

Prof Michael Turner

Healthcare associated infection (HCAI) guideline(to include NCG No. 2 prevention and control of methicillin-resistant staphylococcus aureus (MRSA) & NCG No. 3 Surveillance, diagnosis and management of Clostridium difficile infection in Ireland (UPDATE)*Update on NCGs Nos. 2 and 3 and additional sections on other infection and pathogen specific topics.

To be announced

Chronic obstructive pulmonary diseaseManagement of adults with chronic obstructive pulmonary disease (COPD) and guidance on the provision of rehabilitation and outreach services.

Prof Tim McDonnell

Emergency medicine early warning system (EM-EWS) Appropriate and effective monitoring and escalation schedules that ensures quality and safety of care for Emergency Department patients. Note this was previously known as the “Emergency Department – Adult Clinical Escalation Monitoring Tool (ED-MACE)”.

Ms Fiona McDaidDr Fergal Hickey

Guideline for the prevention and treatment of under-nutrition: use of nutrition support in adults in the acute care settingIdentification and management of under-nutrition and risk of under-nutrition in adults in hospitals and acute care settings, including the correct choice and delivery of nutrition support to include oral support, enteral tube feeding and parenteral nutrition.

Prof John ReynoldsDr Declan Byrne

Hepatitis C screeningScreening for hepatitis C infection.

Dr Lelia Thornton

Diagnosis, staging, and treatment of patients with lung cancerClinical management of adults with lung cancer to promote prolonged survival and a good quality of life.

Dr Marcus Kennedy

Diagnosis, staging, and treatment of patients with colon cancerClinical management of adults with colon cancer to promote prolonged survival and a good quality of life.

Ms Deborah McNamara

Diagnosis, staging, and treatment of patients with rectal cancerClinical management of adults with rectal cancer to promote prolonged survival and a good quality of life.

Ms Deborah McNamara

Adult Type 1 Diabetes guidelinesAdult Type 1 diabetes guidelines for use by patients, members of the diabetes multidisciplinary team, other healthcare professionals and others.

Dr Kevin Moore

Care of the dying adult in the last days of lifeCare of adults (aged 18 years and over) in whom death is expected within a few days.

Dr Karen Ryan

Appendix 4

http://health.gov.ie/patient-safety/ncec/commissioned-g-in-d

http://health.gov.ie/patient-safety/ncec/commissioned-g-in-d

http://health.gov.ie/patient-safety/ncec/commissioned-g-in-d/


Title Lead/GDG Chair

Diagnosis, staging, and treatment of patients with pancreatic cancer*Clinical management of adults with pancreatic cancer to promote prolonged survival and a good quality of life.

Mr Justin Geoghegan

Diagnosis, staging, and treatment of patients with oesophageal cancer*Clinical management of adults with oesophageal cancer to promote prolonged survival and a good quality of life.

Prof John Reynolds

Diagnosis and treatment of nicotine addiction* Increase diagnosis and strengthen treatment of nicotine dependence in order to maximise the likelihood of successful quit smoking attempts by patients contacting healthcare services, thereby reducing the prevalence of smoking and minimising the burden of tobacco-related disease in Ireland.

Dr Paul Kavanagh

*Note: final descriptions for these guidelines may change as they are early in the development process.

Source Key:

Commissioned Guidelines

Non-commissioned Guidelines

Proposal

Notice of Intent


National Clinical Guidelines and National Clinical Audit

14 National Clinical Guidelines (NCG) published to December 2016:

NCG No. 1 National Early Warning Score (NEWS)(February 2013)

NCG No. 2 Prevention and Control of MRSA (December 2013)

NCG No. 3 Surveillance, Diagnosis and Management of Clostridium difficile Infection in Ireland (June 2014)

NCG No. 4 Maternity Early Warning System (IMEWS)(November 2014)

NCG No. 5 Communication (Clinical Handover) in Maternity Services Guideline (November 2014)

NCG No. 6 Sepsis Management (November 2014)

NCG No. 7 Diagnosis, Staging and Treatment of Patients with Breast Cancer (June 2015)

NCG No. 8 Diagnosis, Staging and Treatment of Patients with Prostate Cancer (June 2015)

NCG No. 9 Pharmacological Management of Cancer Pain in Adults (November 2015)

NCG No. 10 Management of Constipation in Adult Patients receiving Palliative Care (November 2015)

NCG No. 11 Communication (Clinical Handover) in Acute and Children’s Hospital Services (November 2015)

NCG No. 12 Paediatric Early Warning Score System (PEWS) (November 2015)

NCG No. 13 Diagnosis, Staging and Treatment of Patients with Gestational Trophoblastic Disease (November 2015)

NCG No. 14 Management of an Acute Asthma Attack in Adults (November 2015)

National Clinical Audit

NCA No. 1 Major Trauma Audit (MTA)(December 2016)

Appendix 5


NCEC Subgroups – Membership and Terms of Reference

NCEC subgroup - Clinical Audit

The Terms of Reference for this subgroup are:• Guiding the further development of NCEC processes for prioritisation and quality assurance

of National Clinical Audit, including the development and updating of documents, manuals and tools

• Considering changes and making recommendations to NCEC National Clinical Audit processes so as to maintain relevance, quality assurance and efficiency

• Developing and maintaining a communication plan for NCEC National Clinical Audit• Horizon scanning developments in National Clinical Audit internationally• Developing documents and processes to support and govern the work of NCEC in relation

to National Clinical Audit.

The membership is

Member Affiliation

Mr Ian Callanan (Chair) Clinical Audit Manager of St Vincent’s Healthcare Group and Medical Director of Aviva Health Insurance Ireland

Ms Margaret Brennan Quality and Patient Safety Lead, Acute Hospitals Division, HSE

Dr Claire Collins Director of Research, Irish College of General Practitioners

Dr Edwina Dunne (until Nov 2016)

Assistant National Director, Quality Assurance Verification Division, HSE

Dr Una Geary Director for Quality and Safety Improvement, St. James’s Hospital

Dr Jennifer Martin Information & Analysis Lead, Quality Improvement Division, HSE

Dr Teresa Maguire Research and Development and Health Analytics, Department of Health

Ms Margaret McHugh Quality and Safety Manager, Bon Secours Hospital, Galway

Mr Des O’Toole Business Manager and Quality Improver, Beaumont Hospital

The Clinical Audit Subgroup met twice in 2016: 26th April and 20th September.

Appendix 6


NCEC subgroup – Education and training in Clinical Effectiveness The NCEC subgroup on education and training will support the NCEC to meet its terms of reference in the area of Clinical Effectiveness by:

• Guiding the development of multidisciplinary education in clinical effectiveness• Liaison with postgraduate and undergraduate educational organisations to identify mutual

goals and areas of interest relevant to clinical effectiveness and evidence-based practice• Liaison and horizon scanning national and international developments in relevant education

and training • Making recommendations to the NCEC regarding training and education in clinical

effectiveness.

The membership is

Member Affiliation

Prof Dermot Malone (Chair)

Dean, Faculty of Radiologists, RCSI and NCEC representative, Forum of Postgraduate Training Bodies

Dr Eve O’Toole Research Manager and Guideline Methodologist, National Cancer Control Programme, HSE

Dr Fidelma Fitzpatrick Consultant Microbiologist Beaumont Hospital and Senior Lecturer, RCSI

Dr Tamasine Grimes Associate Professor in Practice of Pharmacy, TCD and Research Pharmacist, Tallaght Hospital, Dublin

Mr Patrick Glackin Area Director of Nursing and Midwifery Planning and Development, HSE West

Ms Marie Kehoe O'Sullivan

Director, Safety and Quality Improvement, Health Information and Quality Authority

The education and training subgroup met 7 times in 2016: February 3rd, March 3rd, May 6th, August 25th, September 28th, November 2nd and December 1st.

The subgroup developed a proposal for education and training in clinical effectiveness, with the following work-flows, which was signed off by the NCEC committee in September 2016:

• Guiding the development of multidisciplinary education in clinical effectiveness• Liaison with postgraduate and undergraduate educational organisations to identify mutual

goals and areas of interest relevant to clinical effectiveness and evidence-based practice• Liaison and horizon scanning developments in education and training.

The main projects of this NCEC subgroup in 2016 were:• Expansion of training videos in Clinical Effectiveness for NCEC website• Evaluation of NCEC Clinical Effectiveness training programme• Collaboration established with Centre for Evidence-Based Medicine (CEBM) in Oxford• Training in Implementation Science (development of proposal, advertisement on e-tenders

and award of contract). The aim of the training and resources is to support health service staff in the implementation of national clinical guidelines

• Research on teaching of Evidence-Based Medicine in Ireland (development of research proposal, advertisement on e-tenders and award of contract). The aim of the research is to determine current practice in the teaching of evidence-based practice for health professionals at third level in Ireland

• Workshop held on November 3rd 2016 to discuss postgraduate education relevant to clinical effectiveness and evidence-based practice in Ireland.


The discussion forum held on November 3rd 2016 to discuss postgraduate education relevant to clinical effectiveness and evidence-based practice in Ireland was an exploratory workshop to explore the vision for clinical effectiveness training and capacity building in Ireland.

Delegates included 34 participants from: • Multidisciplinary group of healthcare professionals responsible for the provision of

postgraduate education in Ireland (medicine, nursing, pharmacy, physiotherapy, speech & language therapy, occupational therapy)

• Professional bodies representing medicine, nursing/midwifery & allied health professionals. These included the Medical Council, Nursing and Midwifery Board of Ireland (NMBI) and CORU; the health and social care professional’s council

• Key stakeholders in clinical effectiveness (HRB, HSE, Department of Health, HIQA).

The purpose of this workshop was to: • Commence process of engagement with key stakeholders to examine opportunities for

clinical effectiveness education and training (for translation of evidence into practice)• Discuss current and future provision of education relevant to clinical effectiveness/evidence-

based practice in Ireland (commencing with postgraduate education)• Identify mutual goals/areas of interest • Identify core competencies/educational goals to enable health service staff to support the

clinical effectiveness agenda • Discuss potential for joint (multidisciplinary) team learning • Discuss principles for inclusion in curriculum/syllabus• Explore vision for clinical effectiveness training and capacity building in Ireland.

The workshop groups recommended the development and introduction of a core curriculum on evidence-based practice and clinical effectiveness for health professionals at both undergraduate and post graduate level.

Workshop on education in evidence-based practice and clinical effectiveness, November 2016.


NCEC subgroup – Guideline Methodology The Clinical Guidelines Methodology Subgroup (CGMS) is a subgroup of the National Clinical Effectiveness Committee (NCEC). There were three meetings in 2016 (28th April, 3rd June and 7th October). An additional teleconference was held on 23rd August. Work for the subgroup focused on revising the NCEC Guideline Developer’s Manual and consideration of NICE contextualisation of guidelines.

The CGMS supports the NCEC to meet its terms of reference on National Clinical Guidelines by:• Guiding the development of NCEC processes for prioritisation and quality assurance of

National Clinical Guidelines, including providing guidance on processes for the development and updating of documents, manuals and tools.

• Considering changes and making recommendations to NCEC National Clinical Guidelines processes to maintain relevance, quality assurance and efficiency.

• Horizon scanning developments in the methodology of guideline development.

The membership is:

Member Affiliation

Prof Declan Devane (Chair)

Professor of Midwifery, NUI Galway; Director, Health Research Board – Trials Methodology Research Network (HRB-TMRN)

Ms Shelley O’Neill Senior Health Economist, Health Information and Quality Authority

Dr Mary O’Riordan Specialist in Public Health Medicine, Health Protection Surveillance Centre

Dr Donna Tedstone Lead Programme Manager, Research & Development for National Health Programmes and Strategic Partnerships, Health Research Board

Ms Anne Madden (from June 2016)

Assistant Librarian, St. Vincent's University Hospital, Dublin

Prof Martin O’Donnell Professor of Translational Medicine at NUI Galway and Interim Director of the HRB Clinical Research Facility, Galway (CRFG)

Prof Shaun Treweek Chair in Health Services Research, University of Aberdeen, Scotland

Prof Mike Clarke Professor/Director of MRC Methodology Hub, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast

Dr Nancy Sentesso Assistant Professor, Department of Clinical Epidemiology & Biostatistics, McMaster University, Canada

Ms Marina Cronin (until Oct 2016)

Hospital Relations Manager, National Office of Clinical Audit


Contributors to Appraisal Teams, 2016

Dr Catriona BradleyMs Edel CallananMs Amanda CaseyMr Ian CallananDr Claire Collins Ms Marina CroninDr Edwina DunneDr Mary FarrellyMr Patrick GlackinDr Trish HarringtonDr Fenton Howell Mr Terence HynesMs Ciara KirkeDr Jennifer MartinDr Lisa MellonDr Laura MurphyMs Eileen Nolan Dr Lois O’ConnorMs Carmel O’Hanlon Ms Michelle O’NeillDr Mary O’Riordan Dr Natasha Rafter Dr Eve RobinsonDr Máirín Ryan Ms Ruth RyanMs Méabh Smith Dr Donna TedstoneDr David Vaughan

Appendix 7


Abbreviations

ADoN Assistant Director of Nursing

AGREE II Appraisal of Guidelines for Research & Evaluation II

AMR Antimicrobial Resistance

BPACNZ Best Practice Advocacy Centre in New Zealand

Cdiff Clostridium difficile

CEBM Centre for Evidence-Based Medicine

CES Centre for Effective Services

CEU Clinical Effectiveness Unit

CGMS Clinical Guideline Methodology Subgroup

CHM Complete Hydatidiform Mole

CICER Collaboration in Ireland for Clinical Effectiveness Reviews

COPD Chronic Obstructive Pulmonary Disease

CPD Continuous Professional Development

CRFG Clinical Research Facility, Galway

CSP Clinical Strategy and Programmes

DCU Dublin City University

DoH Department of Health

E-MEWS Emergency Medicine Early Warning System

FAQ Frequently Asked Questions

GDG Guideline Development Group

GIN Guidelines International Network

GRADE Grading of Recommendations Assessment, Development and Evaluation

GTD Gestational Trophoblastic Disease

HCAI Healthcare Associated Infection

hCG Human Chorionic Gonadotrophin

HCP Health Care Professional

HIPE Hospital In-Patient Enquiry

HIQA Health Information and Quality Authority

HPRA Health Products Regulatory Authority

HPSC Health Protection Surveillance Centre

HQIP Healthcare Quality Improvement Partnership

HRB Health Research Board

HSE Health Service Executive

HTA Health Technology Assessment

ICU Intensive Care Unit

IGEES Irish Government Economic and Evaluation Service

IMEWS Irish Maternity Early Warning System

IMSN Irish Medication Safety Network

INAHTA International Network of Agencies for Health Technology Assessment

KPI Key Performance Indicator

MCH Mental Health Commission

MDT Multi-Disciplinary Team

Appendix 8


MRSA Methicillin-resistant Staphylococcus Aureus

NALA National Adult Literacy Agency

NCA National Clinical Audit

NCCP National Cancer Control Programme

NCEC National Clinical Effectiveness Committee

NCG National Clinical Guideline

NCPE National Centre for Pharmaco-economics

NEWS National Early Warning Score

NICE National Institute for Health and Care Excellence

NMBI Nursing and Midwifery Board of Ireland

NOCA National Office for Clinical Audit

NPSO National Patient Safety Office

NTMA National Treasury Management Agency

NUIG National University of Ireland, Galway

PEWS Paediatric Early Warning System

PHM Partial Hydatidiform Mole

PICU Paediatric Intensive Care Unit

PPI Patient and Public Involvement

PPPG Policies, Procedures, Protocols, Guidelines

PPS Point Prevalence Study

QAVD Quality Assurance and Verification Division

RCPI Royal College of Physicians in Ireland

RCSI Royal College of Surgeons in Ireland

SHO Senior House Officer

SIGN Scottish Intercollegiate Guidelines Network

TARN Trauma Audit and Research Network

TCD Trinity College Dublin

TD Teachta Dála

TMRN Trials Methodology Research Network

TRUS Trans-Rectal Ultrasound

UCC University College Cork

VAT Value Added Tax

WHA World Health Assembly

WHO World Health Organisation


Department of Health, Hawkins House, Hawkins Street, Dublin 2, D02 VW90, IrelandTel: +353 1 6354000 • Fax: +353 1 6354001 • www.health.gov.ie

http://www.health.gov.ie

Documents

National Clinical Effectiveness Committee...National Clinical Audit 24 4. Clinical Practice Guidance 25 5. Education and Training 27 6. Patient and Public Involvement 29 7. Collaboration