Author Clare Lomas, BSc, BA, RGN, is news reporter, Nursing Times.
NICE guidance has to be updated in line with new research, technology and improved understanding of people’s healthcare needs. Clare Lomas explains.
When NICE publishes final guidance on a topic, it does so with the expectation that it will be reviewed and updated.
According to NICE, a study of guidelines in the US suggested that the majority go out of date in some respect within three years of publication.
‘When a guideline is published, a review date is set accordingly, based on any knowledge we have about when new evidence, such as clinical trial data, will emerge,’ says Lucy Betterton, associate director for external communications at NICE.
Frequent changes to guidelines would make it difficult for health professionals to implement them, so review dates have to flexible. For up to two years after publication, NICE will collate post-publication comments but will not actively seek new evidence.
‘Unless it was identified in the original guideline that important new evidence was likely to emerge in this time, the review date will usually be set at 2–4 years,’ says Ms Betterton.
There are two main reasons for which guidelines are updated:
- When any new evidence emerges;
- 'If errors are found in the original guideline.
Following the publication of new evidence on CT imaging, and research evidence on the management of paediatric head injuries, NICE updated its clinical guidance on head injury in September 2007, four years after its original publication date.
If a post-publication comment is made that highlights an error in a guideline, the director of NICE’s Centre for Clinical Practice and the guideline development group (GDG) will look at it. If the comment is found to undermine the conclusions on which the guidance is based, will result in harm to patients or compromises the institute’s quality-assurance procedures, it will be referred to NICE’s guidance executive. If it is then decided by the guidance executive that an error has been made, the guidelines will be amended and registered stakeholders may be notified in writing.
The responsibility for updating a guideline usually lies with the National Collaborating Centre (NCC) that developed it. As Ms Betterton explains: ‘One person takes responsibility for keeping up to date with the evidence, and they advise the collaborating centre of any significant changes’. However, she is quick to point out that ‘nurses can still be involved’.
If a nurse has new information and feels that a guideline needs to be updated, they can send their comments or feedback to email@example.com, explaining why they consider the new information to be sufficient to require a guideline change.
But Ms Betterton emphasises that it is often best for a nurse to approach their stakeholder organisation first, as it may already be aware of the information. In such cases, a more coordinated response is much more helpful to NICE. A response from a stakeholder organisation, rather than an individual, can also add more weight to the comment.
Once new information is received, it will be discussed by the Centre for Clinical Practice and the relevant NCC and, if they decide that an update is likely to be needed, an expert advisory group will be convened. The group will address whether an update is necessary, check if there is any other new evidence available that might affect the update and decide which recommendations in the original guidance need to be updated.
Using the advice from this group, the director of the Clinical Practice Centre and the NICE guidance executive will make a final decision on whether an update is needed and, if so, they will commission the relevant NCC to carry out the work. It is then the responsibility of NHS trusts to look at the updated guidance and review and change practice accordingly. NICE will update the tools to reflect the changes that have taken place, but the implementation process is the same as for the original guidance.
- Guidelines are reviewed every 2–4 years;
- Guidelines are updated in response to new evidence;
- Nurses can pass information to NICE if they feel a guideline needs to be updated;
- Nurses should ideally do this through a stakeholder such as a professional organisation or special interest group. This will add weight to the comment.