NICE in my practice Dr Matthew Snowsill Foundation Year Clinical Practice Student Champion 2011-12.
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Transcript of NICE in my practice Dr Matthew Snowsill Foundation Year Clinical Practice Student Champion 2011-12.
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