Nice guidelines manual 2007

NICE guideline recommendations are based on the best available evidence. We use a wide range of different types of evidence and other information — from scientific research using a variety of methods, to testimony from practitioners and people using services. Review questions guide the search for evidence, and the type of evidence used depends on the type of question see the chapter on developing review questions and planning the evidence review. For example, a randomised controlled trial is often the most appropriate type of study to assess the efficacy or effectiveness including cost effectiveness of an intervention.

However, a range of other non-randomised evidence, such as observational evidence including that derived from the analysis of primary data sources such as patient registries , experimental and qualitative evidence, may also be used to inform assessments of effectiveness, or aspects of effectiveness. This evidence may include ways of delivering services, or the experience of people using services and how this contributes to outcomes.

For some topics, there is little evidence from scientific studies, or the evidence is weak or contradictory. In these cases, we look for evidence from other sources to see if it agrees or differs 'triangulation'. When there is little or no evidence, the committee may also use expert testimony, make consensus recommendations using their knowledge and experience, or make recommendations for further research.

Whatever evidence is used, it is selected and quality assessed using clear and appropriate methods see the chapters on identifying the evidence: literature searching and evidence submission , reviewing research evidence and incorporating economic evaluation. When developing guidelines, NICE involves people who might be affected by the guideline recommendations in a collaborative and transparent way.

This includes commissioners, practitioners and others involved in providing services. People using health and care services, carers and the public also contribute to ensure that guidelines address issues relevant to them, reflect their views, and meet their health and social care needs. There are 2 main ways to get involved: organisations can register as a stakeholder and individuals can join or advise a committee that works on guidelines. There is more information about stakeholders and committee members in the section on who is involved and in our guide for stakeholders and the public Developing NICE guidelines: how to get involved.

A public involvement adviser is allocated to each topic. Practitioners and people who use health and care services, family members, carers and the public may also be involved as:. NICE's equality objectives and equality programme — summarises NICE's legal and other equality obligations and describes NICE's approach to meeting them, particularly the process of equality impact assessment.

Identifying such groups is an aspect of NICE's compliance with both general public law requirements to act fairly and reasonably, and human rights obligations.

The committee is the independent advisory group that considers the evidence and develops the recommendations, taking into account the views of stakeholders. It may be a standing committee working on many guideline topics, or a topic-specific committee put together to work on a specific guideline or multiple guidelines within a topic area see the chapter on decision-making committees.

Committee members include practitioners both specialists in the topic and generalists , service or care providers or commissioners, and others working in the area covered by the guideline see the chapter on decision-making committees. In addition, at least 2 members of every committee are people using services, their family members or carers, or members of the public and community or voluntary sector with relevant experience lay members.

If needed for a topic, the committee can co-opt members with specific expertise to contribute to developing some of the recommendations see the sections on standing committees and topic-specific committees in the chapter on decision-making committees. Registered stakeholders are organisations that have registered with NICE because they have an interest in the guideline topic, or they represent people whose practice or care may be directly affected by the guideline.

They play an important role in developing and advocating for, or implementing, NICE guidelines. During guideline development NICE keeps registered stakeholders informed of progress by email. The schedule for the guideline, the scope and details of the committee are also available on the NICE website. Stakeholder organisations are encouraged to get involved in guideline development in a range of ways.

The NICE website explains how to register as a stakeholder and how to contribute to the development of a guideline. Registered stakeholders comment on the draft scope and draft guideline, and they may be invited to provide evidence during guideline development. Stakeholders support implementation of the guideline once it is published. Individuals cannot register as stakeholders but NICE encourages anyone with an interest in the topic to express their views to a registered stakeholder listed on the guideline page on the NICE website.

Although NICE will consider comments on the draft scope and guideline from individuals, we do not have the resources to write responses to these comments. Local or regional professional or practitioner groups, and local or regional groups for people who use health and social care services cannot register as stakeholders unless there is no national organisation that represents the group's specific interests. We want our guidelines to be useful in these countries, so encourage stakeholders from anywhere in the UK to take part in developing them.

Tobacco companies and those who speak for them or are funded by them collectively referred to as 'tobacco organisations' cannot register as stakeholders. Tobacco organisations are simply referred to as ' respondents '. Any comments received during consultation from respondents are reviewed for factual inaccuracy claims and are made public along with any responses.

The committees are assisted by teams whose work covers guideline development, evidence review and support, and quality assurance. These teams are represented at committee meetings and contribute to discussions. They are not committee members, do not contribute to the quorum of the committee or the development of recommendations during meetings, and do not hold voting rights. NICE staff carry out quality assurance of the guideline to ensure that processes have been followed appropriately, and that the methods are clear and transparent.

They also check that there is a valid link between the evidence and the recommendations. After completion of the repair, document an accurate detailed account covering the extent of the trauma, the method of repair and the materials used. Lancet to Recommendations Putting this guideline into practice Context Recommendations for research Appendix A: Adverse outcomes Finding more information and committee details Update information. Download guidance PDF. Next Recommendations 1.

Recommendations People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.

Medical conditions and other factors that may affect planned place of birth 1. Women's experience in all birth settings 1. Service organisation and clinical governance 1. Ask how the woman is feeling and whether there is anything in particular she is worried about. If the woman has a written birth plan, read and discuss it with her.

Encourage the woman to adapt the environment to meet her individual needs. Mobilisation 1. Support 1. Hygiene measures 1. Education and early assessment 1. Pain relief 1. The assessment should comprise the following: Observations of the woman: Review the antenatal notes including all antenatal screening results and discuss these with the woman. Ask her about the length, strength and frequency of her contractions.

Ask her about any pain she is experiencing and discuss her options for pain relief. Record her pulse, blood pressure and temperature, and carry out urinalysis.

Record if she has had any vaginal loss. Measuring fetal heart rate as part of initial assessment 1. Record accelerations and decelerations if heard. Presence of meconium 1. The woman is made to feel as comfortable as possible before and during transfer.

Controlling gastric acidity 1. Inhalational analgesia 1. Intravenous and intramuscular opioids 1. It provides more effective pain relief than opioids. Timing of regional analgesia 1. Care and observations for women with regional analgesia 1. Assess the level of the sensory block hourly. Establishing and maintaining regional analgesia 1. If a rising baseline or decelerations are confirmed, further actions should include: summoning help advising continuous cardiotocography, and explaining to the woman and her birth companion s why it is needed transferring the woman to obstetric-led care, provided that it is safe and appropriate to do so follow the general principles for transfer of care described in section 1.

Explain that it may restrict her mobility. Telemetry 1. Interpretation of cardiotocograph traces 1. Table 10 Description of cardiotocograph trace features Overall care Make a documented systematic assessment of the condition of the woman and unborn baby including cardiotocography [CTG] findings every hour, or more frequently if there are concerns.

Do not make any decision about a woman's care in labour on the basis of CTG findings alone. Ensure that the focus of care remains on the woman rather than the CTG trace. Remain with the woman in order to continue providing one-to-one support. Table 11 Management based on interpretation of cardiotocograph traces Category Definition Management Normal All features are reassuring Continue CTG unless it was started because of concerns arising from intermittent auscultation and there are no ongoing risk factors; see recommendation 1.

Overall care 1. Baseline fetal heart rate 1. Baseline variability 1. Decelerations 1. Accelerations 1. Categorisation of traces 1. Management 1. If the cardiotocograph trace is still pathological after fetal scalp stimulation, consider: fetal blood sampling see recommendations 1. Conservative measures 1. Intrauterine resuscitation 1. Fetal scalp stimulation 1. Fetal blood sampling 1. When a fetal blood sample cannot be obtained 1. Record keeping 1. Duration of the first stage 1. Observations during the established first stage 1.

Download guidance PDF. NICE interactive flowchart - Acutely ill patients in hospital 3 Quality standards Acute kidney injury Rehabilitation after critical illness in adults Emergency and acute medical care in over 16s. Recommendations This guideline includes recommendations on: physiological observations to be recorded in acute hospital settings using physiological track and trigger systems to identify at risk patients response strategies for patients who are deteriorating transfer of patients from critical care areas to general wards Who is it for?

Healthcare professionals All adult inpatients, including patients in the emergency department being admitted to hospital and those being moved between departments Family and carers of adults in hospital Is this guideline up to date? Guideline development process How we develop NICE guidelines This guideline was previously called acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital. Browse by topic Topic pages bring together products on the same subject, for example diabetes , mental health and wellbeing or children and young people.

Guidance by programme NICE guidelines Review the evidence across broad health and social care topics. Technology appraisal guidance Review clinical and cost effectiveness of new treatments.

Diagnostics guidance Review new diagnostic technologies for adoption in the NHS.