NICE to HELP: Operationalizing National Institute for Health and Clinical Excellence Guidelines to Improve Clinical Practice

Abstract

The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom developed guidelines for the diagnosis, prevention, and management of delirium in July, 2010, which included 10 recommendations for delirium prevention. The Hospital Elder Life Program (HELP) is a targeted multicomponent strategy which has proven effective and cost-effective to prevent functional and cognitive decline in hospitalized older persons. HELP provided much of the basis for 7/10 (70%) of the NICE recommendations. Given interest by new HELP sites to meet NICE guidelines, we developed 3 new protocols which were not previously included in the HELP program, addressing hypoxia, infection, and pain. Additionally, the NICE dehydration guideline included constipation, which was not specifically addressed in the HELP protocols. This project describes the systematic development of 3 new protocols (hypoxia, infection, and pain) and the expansion of an existing HELP protocol (constipation/dehydration) to achieve alignment between the HELP protocols and NICE guidelines. Following the Institute of Medicine recommendations for developing trustworthy guidelines, we undertook a systematic review of current literature by an interdisciplinary group of experts, rated the quality of the evidence, developed intervention protocols based on the highest quality evidence, and submitted the protocols first to internal review, then external review by an interdisciplinary panel of experts. The protocols were revised based on the review process, and were incorporated into the HELP materials. Inclusion of these protocols enhances the scope of the HELP program, and allows fulfillment of NICE guideline recommendations for delirium prevention. The rigorous process we applied may provide a useful example for updating existing guidelines or protocols, which may be applicable to a broad range of clinical applications.

Nursing assessment as an effective tool for the identification of delirium risk in older in‐patients: A case–control study

“…The areas of care and the risk factors identified using the comprehensive nursing assessment instrument broadly coincide with those of the protocols and basic interventions in the multicomponent HELP program (Chen et al., ; Hshieh et al., ; Yue et al., ).…”

“…To this end, a working group of six expert nurses (with clinical experience or expertise in nursing care and standardisation of care) was set up. The tasks of this group were to review the potential predictive variables for delirium selected from a literature review: the predisposing risk and precipitating factors according to the literature on predictive models (Ahmed, Leurent, & Sampson, ; Inouye et al., ; Martins & Fernandes, ; Newman et al., ; Perello Campaner, ), the risk factors listed in the NICE guide (NICE, 2010; O'Mahony et al., ) and the protocols including the Hospital Elder Life Program (HELP) multicomponent programme (Strijbos et al., ; Yue et al., ). All the available information was distributed separately among three pairs of expert nurses, and finally compared and agreed among the six experts.…”

“…the predisposing risk and precipitating factors according to the literature on predictive models (Ahmed, Leurent, & Sampson, 2014;Inouye et al, 2014;Martins & Fernandes, 2012;Newman et al, 2015;Perello Campaner, 2010), the risk factors listed in the NICE guide (NICE, 2010;O'Mahony et al, 2011) and the protocols including the Hospital Elder Life Program (HELP) multicomponent programme (Strijbos et al, 2013;Yue et al, 2014). All the available information was distributed separately among three pairs of expert nurses, and finally compared and agreed among the six experts.…”

“…Multifactorial and multicomponent interventions have been described as being the cornerstone of prevention and treatment of delirium (Hshieh et al., ; Inouye et al., ). Interventions that try to improve modifiable variables have proved to be effective in preventing the onset of delirium (Strijbos, Steunenberg, van der Mast, Inouye, & Schuurmans, ; Yue et al., ). These multicomponent programs highlight the importance of nursing care in preventing delirium (Avendano‐Cespedes et al., ).…”

Delirium: actualización en manejo no farmacológico

“…Este programa en la actualidad se implementa en más de 200 hospitales en todo el mundo, siendo necesario en algunas oportunidades realizar adaptaciones por falta de recursos o poca disponibilidad de profesionales interdisciplinarios calificados 43,44 . Otras intervenciones multicomponentes son las sugeridas por el Instituto Nacional de Salud y Excelencia Clínica del Reino Unido (National Institute for Health and Clinical Excellence, NICE), quienes desarrollaron una guía que incluye 10 recomendaciones para prevenir el delirium, sumando a los ya recientemente comentados 6 factores prevenibles de HELP, la prevención o corrección de hipoxemia, infección, dolor y constipación 21,45 . En Chile, un ensayo clínico, controlado, randomizado, realizado en la Unidad de Paciente Crítico (UPC) del Hospital Clínico de la Universidad de Chile (HCUCH), comparó la eficacia de la prevención no farmacológica estándar (PnFE) versus la prevención no farmacológica reforzada (PnFR).…”