NICE in my practiceDr Matthew Snowsill

Foundation Year Clinical Practice

Student Champion 2011-12

One of many sources of information

NICE has its place in the big world of evidence based medicine

Is not a one size fits all approach to any problem

Is not a substitute for clinical judgement in the context of the individual

But, it’s trustworthy, reviewed by experts and lay experts, and becoming easier and easier to access

My day to day role

Documenting the ward round assessment and management decisions

Speaking with families

Facilitating discharges

Only a small amount of time is making management decisions

Main areas NICE has been an influence

Quality and safety improvement

My own learning

My own information

The learning of others

Patient safety

Responsibilities of all health care professionals1. The UK Foundation Programme Curriculum 2012 (Updated

2014)

2. Standards of Conduct, Ethics and Performance; General Pharmaceutical Council 2012

3. The Code: Standards of conduct, performance and ethics for nurses and midwives; Nursing and Midwifery Council 2008

4. Standards for the Dental Team; General Dental Council 2013

5. Code of Ethics and Professional Conduct; College of Occupational Therapists, Revised edition 2010

A patient has something you’ve never heard of…

1. Many good quality online medical encyclopaedias/ data sources around

2. Some more reliable that others

3. Some more relevant to the NHS and UK medical practice than others

4. One of the first ones I use for quick answers is Clinical Knowledge Summaries

1. Includes brief overview

2. Correlation with drug history

Clinical knowledge summaries

So you’re on acute medical take…

Your job:

1.Find a patient that the med reg has accepted from the ED (not too tricky)

2.Clerk a patient (just like medical school)

3.Establish a management plan….

What to do?

They’re stable, you have some time to think about it

You aren’t 100% confident on what you should write on the plan

Your consultant will call you soon to review the patient

NICE Pathways

http://beta.pathways.nice.org.uk/?utm_source=nicesite&utm_medium=banner&utm_campaign=nicebanner#

Elderly male, confused, not eating or drinking

http://beta.pathways.nice.org.uk/pathways/acute-kidney-injury#path=view%3A/pathways/acute-kidney-injury/management-of-acute-kidney-injury.xml&content=view-node%3Anodes-indications-for-renal-replacement-therapy

Quality and safety improvement- Audit

Can be scary

Mandatory

Make your mark on your hospital

Where do I start??

http://i1.kym-cdn.com/photos/images/original/000/234/765/b7e.jpg

NICE Audit tools – AKI

Ward cover night shift….

Asked to come and review patient who has been struggling to sleep for a couple of days

After appropriate clinical assessment you decide they would benefit from zopiclone.

http://i.dailymail.co.uk/i/pix/2011/09/21/article-2040037-0E04BC2A00000578-667_634x324.jpg

Safe prescribing

The night time classic…

“Doctor, one of our patients has had a fall. We’ve started neuro-obs but would you please come and review him?”

85

Admitted for UTI

Atrial fibrillation for which he has warfarin

Seems OK… To scan or not to scan

Best practice in your pocket

Summary Just a taste, much more to come from the workshops today

Becomes easier and quicker the more you use it and look for what is available

Huge number of resources available

Evidence based medicine needs to be accessible, reliable and safe

Diverse range of features which NICE offer for various aspects of initial training

Also- Post graduate membership exams, teaching students, preparing for this talk

Invitation for questions