Guidelines to enhance clinical practice and raise standards of care

NICE clinical guidelines aim to help promote good health and prevent ill health. Our guidance is for those working in the NHS, local authorities and the wider public, private and voluntary sectors. NICE guidelines are essential to enhancing clinical practice, raising standards of patient care and reducing variation in practice.

Our guidelines are based on the best available evidence, aim to change the process of healthcare and improve people’s chances of getting as well as possible. By implementing our guidelines healthcare professionals can trust they are carrying out evidence-based treatments that are both clinically and cost effective.

Guidelines published in 2014/15

We have published 195 clinical guidelines so far on a wide range of topics. In 2014/15 we published 23 guidelines which included new guidelines on:

Guidelines that were updated through the new standing committee process included:

Guidance on acute heart failure calls for treatment from dedicated specialist teams

Acute heart failure is the leading cause of hospital admission in people over 65, and accounts for more than 67,000 people being admitted to hospital in England each year. In guidance published in October 2014, NICE underlined the importance and benefits of specialist treatment for patients with the condition.

When a person has acute heart failure, they are usually admitted to an accident and emergency department, and those who are not very sick are then admitted to general medical wards or cardiology wards.

However, recent research has shown that while mortality rates for acute heart failure are improving, management and care of the condition still varies widely.

The NICE guideline recommends that all hospitals admitting people with suspected heart failure should provide a specialist heart failure team that is based on a cardiology ward and provides outreach services.

In addition, they should ensure that all people being admitted to hospital with suspected heart failure have early and continuing input from a dedicated specialist heart failure team.

Dr Suzanna Hardman, Consultant Cardiologist and member of the guideline development group, said: “Untreated acute heart failure kills and can have a serious long-term impact on quality of life, but this can be transformed with specialist care.

“This guideline should ensure all patients admitted to hospital with acute heart failure are cared for by a specialist consultant-led multidisciplinary heart failure team.

She added: “The use of tests (natriuretic peptides and early echocardiography) for possible new heart failure will prevent delayed diagnoses.

“The requirement for specialist team review within two weeks of going home will minimise readmissions and integrate acute and community care as outlined in NICE’s chronic heart failure guideline.

“This should result in a reduction in the number of people who die as a result of acute heart failure, improved well-being and less pressure on hospital beds.”

Pneumonia guidance recommends test that could limit unnecessary use of antibiotics

In its first guideline on pneumonia (published December 2014), NICE recommended that using the test in cases which are unclear could help limit the unnecessary use of antibiotics.

Pneumonia is a common condition which causes sickness and can end in death if not treated properly. Every year up to 480,000 adults will develop the condition in the UK

Many people will go to their GP with the symptoms of a chest infection. The exact cause and severity needs to be known to determine the best way to treat them. Antibiotics will benefit people whose condition is brought on by a bacterial infection. However if it is caused by a viral infection, antibiotics have no effect and can cause harm because of side effects.

The guideline prioritises recommendations to help GPs and hospital doctors follow the principles of antimicrobial stewardship, such as only prescribing antibiotics when necessary and reviewing the continued need for them.

The guideline includes a recommendation for GPs to use a simple blood test, known as the C-reactive protein (CRP) test2, if it is unclear whether a person has pneumonia and to determine if they should be treated with antibiotics. Antibiotics may not always be needed or the GP and patient may agree to wait to see if their condition worsens before prescribing.

Professor Mark Baker, NICE’s director of clinical practice, said: “Pneumonia is very common. If it is not treated properly, people spend more time in hospital or in the worst cases, it can kill.

“Assessing severity of illness is really important to find out the most appropriate way to treat each individual patient. Antibiotics should be offered as soon as possible to people who need them. The recommendations in this new guideline set out how to identify those people with severe pneumonia. There will also be people with less severe illness who may not need antibiotics at all or who could have a shorter course.

“Accurate assessment of respiratory infections like pneumonia allows healthcare professionals to prescribe treatments responsibly. This both reduces costs and any potential harm from over-exposure to antibiotics. We need to make sure that clinicians are absolutely clear on the best way to treat people with pneumonia, whether that’s in hospital or in the community and this guideline provides that.”

Standing committee formed to help update published guidelines

This year, the Centre for Clinical Practice, which develops our guidelines, is piloting using a standing committee, rather than an ad hoc guideline development committee, to update particular parts of published clinical guidelines when a full update is not needed.

The main role of the committee is to update clinical guideline recommendations across a range of clinical guidelines as requested by NICE’s Guidance Executive. The committee develops recommendations for the NHS in accordance with NICE’s published methods, but the process takes less time than a full update. This process was formerly known as ‘rapid updates’.