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					                                                                SHEFFIELD PCT
                                                           Framework of NICE Guidance
                                                                                                                                                    October 2008

Guideline   Title                            Summary                                                                        Implications                Review    Local
No                                                                                                                                                       Date     Action
TA159       Spinal cord stimulation for       Spinal cord stimulation is recommended as a treatment option for             NICE state that this       November
            chronic pain of neuropathic or     adults with chronic pain of neuropathic origin who:                          guidance is for acute        2011
            ischaemic origin                     – continue to experience chronic pain (measuring at least 50 mm            care only.
                                                       on a 0–100 mm visual analogue scale) for at least 6 months
                                                       despite appropriate conventional medical management,                 NICE state that this
                                                 – and who have had a successful trial of stimulation as part of the        guidance is outside
                                                       assessment specified below.                                          PbR. Chemotherapy
                                              Spinal cord stimulation is not recommended as a treatment option for         drugs and the activity
                                               adults with chronic pain of ischaemic origin except in the context of        that relates to delivery
                                               research as part of a clinical trial. Such research should be designed to    (HRG codes ending with
                                               generate robust evidence about the benefits of spinal cord stimulation       98) are excluded from
                                               (including pain relief, functional outcomes and quality of life) compared    PbR and remain subject
                                               with standard care.                                                          to local negotiation and
                                              Spinal cord stimulation should be provided only after an assessment by       agreement.
                                               a multidisciplinary team experienced in chronic pain assessment and
                                               management of people with spinal cord stimulation devices, including         NICE state that the
                                               experience in the provision of ongoing monitoring and support of the         increased cost in using
                                               person assessed.                                                             this guidance is £15,000
                                              When assessing the severity of pain and the trial of stimulation, the        per 100,000 population.
                                               multidisciplinary team should be aware of the need to ensure equality
                                               of access to treatment with spinal cord stimulation. Tests to assess
                                               pain and response to spinal cord stimulation should take into account a
                                               person‟s disabilities (such as physical or sensory disabilities), or
                                               linguistic or other communication difficulties, and may need to be
                                               adapted.
                                              If different spinal cord stimulation systems are considered to be equally
                                               suitable for a person, the least costly should be used. Assessment of
                                               cost should take into account acquisition costs, the anticipated
                                               longevity of the system, the stimulation requirements of the person with
                                               chronic pain and the support package offered.
                                              People who are currently using spinal cord stimulation for the treatment
                                               of chronic pain of ischaemic origin should have the option to continue
                                               treatment until they and their clinicians consider it appropriate to stop.




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                                                               SHEFFIELD PCT
                                                          Framework of NICE Guidance
                                                                                                                                                  October 2008

Guideline   Title                          Summary                                                                         Implications               Review   Local
No                                                                                                                                                     Date    Action
CG74        Surgical site infection        This guideline updates and replaces NICE technology appraisal                   NICE state that this       T.B.C.
                                           guidance 24 (published April 2001)                                              guidance is for primary,
                                                                                                                           community and acute
                                           Information for patients and carers                                             care.
                                             Offer patients and carers clear, consistent information and advice
                                              throughout all stages of their care. This should include the risks of        This guideline concerns
                                              surgical site infections, what is being done to reduce them and how          post operative
                                              they are managed.                                                            complications following
                                           Preoperative phase                                                              a surgical procedure.
                                             Do not use hair removal routinely to reduce the risk of surgical site        The guideline covers
                                              infection.                                                                   both adults and children
                                             If hair has to be removed, use electric clippers with a single-use head      undergoing surgical
                                              on the day of surgery.                                                       incision through the
                                             Do not use razors for hair removal, because they increase the risk of        skin. Therefore, this
                                              surgical site infection.                                                     guidance will have an
                                             Give antibiotic prophylaxis to patients before:                              impact on PbR for
                                                – clean surgery involving the placement of a prosthesis or implant         procedures carried out
                                                – clean-contaminated surgery                                               in secondary care.
                                                – contaminated surgery.
                                             Do not use antibiotic prophylaxis routinely for clean non-prosthetic         NICE state that this
                                              uncomplicated surgery.                                                       guidance is “unlikely to
                                             Use the local antibiotic formulary and always consider potential             result in a significant
                                              adverse effects when choosing specific antibiotics for prophylaxis.          change in resource use
                                                                                                                           in the NHS nationally”.
                                             Consider giving a single dose of antibiotic prophylaxis intravenously on
                                                                                                                           NICE do state, however,
                                              starting anaesthesia. However, give prophylaxis earlier for operations
                                                                                                                           that the following
                                              in which a tourniquet is used.
                                                                                                                           recommendations may
                                           Intraoperative phase
                                                                                                                           have significant costs
                                             Prepare the skin at the surgical site immediately before incision using
                                                                                                                           locally:
                                              an antiseptic (aqueous or alcohol-based) preparation: povidone-iodine
                                                                                                                            Information for
                                              or chlorhexidine are most suitable.
                                                                                                                               patients and carers
                                             Cover surgical incisions with an appropriate interactive dressing at the
                                                                                                                            Perioperative phase:
                                              end of the operation.
                                                                                                                               hair removal
                                           Postoperative phase
                                                                                                                            Intraoperative phase;
                                             Refer to a tissue viability nurse (or another healthcare professional with
                                                                                                                               maintaining patient




1a1f161d-171b-4c89-99fe-c89bf8fc3b83.doc                                                                                                              Page 2
                                                               SHEFFIELD PCT
                                                          Framework of NICE Guidance
                                                                                                                                                 October 2008

Guideline   Title                          Summary                                                                        Implications                Review   Local
No                                                                                                                                                     Date    Action
                                              tissue viability expertise) for advice on appropriate dressings for the        temperature
                                              management of surgical wounds that are healing by secondary                  Intraoperative phase:
                                              intention.                                                                     optimising blood
                                                                                                                             glucose levels
                                                                                                                           Intraoperative phase:
                                                                                                                             wound dressing
PH16        Mental wellbeing and older     Occupational therapy interventions                                             This guidance is for        T.B.C.
            people                         Recommendation 1                                                               primary and community
                                           Who is the target population?                                                  care.
                                             Older people and their carers.
                                           Who should take action?                                                        NICE give no indication
                                             Occupational therapists or other professionals who provide support and      as to whether this
                                              care services for older people in community or residential settings and     guidance impacts on
                                              who have been trained to apply the principles and methods of                PbR.
                                              occupational therapy.
                                           What action should they take?                                                  NICE state that
                                             Offer regular group and/or individual sessions to encourage older           quantifying the national
                                              people to identify, construct, rehearse and carry out daily routines and    cost of implementing the
                                              activities that help to maintain or improve their health and wellbeing.     identified
                                             Sessions should:                                                            recommendations has
                                              – involve older people as experts and partners in maintaining or            not been possible for
                                                 improving their quality of life                                          reasons outlined in the
                                              – pay particular attention to communication, physical access, length of     main body of this report.
                                                 session and informality to encourage the exchange of ideas and
                                                 foster peer support
                                              – take place in a setting and style that best meet the needs of the older
                                                 person or group
                                              – provide practical solutions to problem areas.
                                             Increase older people‟s knowledge and awareness of where to get
                                              reliable information and advice on a broad range of topics, by providing
                                              information directly, inviting local advisers to give informal talks, or
                                              arranging trips and social activities. Topics covered should include:
                                              – meeting or maintaining healthcare needs (for example, eye, hearing
                                                 and foot care)




1a1f161d-171b-4c89-99fe-c89bf8fc3b83.doc                                                                                                              Page 3
                                                               SHEFFIELD PCT
                                                          Framework of NICE Guidance
                                                                                                                                          October 2008

Guideline   Title                          Summary                                                                         Implications       Review   Local
No                                                                                                                                             Date    Action
                                             – nutrition (for example, healthy eating on a budget)
                                             – personal care (for example, shopping, laundry, keeping warm)
                                             – staying active and increasing daily mobility
                                             – getting information on accessing services and benefits
                                             – home and community safety
                                             – using local transport schemes.
                                            Invite regular feedback from participants and use it to inform the
                                             content of the sessions and to gauge levels of motivation.

                                           Physical activity
                                           Recommendation 2
                                           Who is the target population?
                                             Older people and their carers.
                                           Who should take action?
                                             Physiotherapists, registered exercise professionals and fitness
                                              instructors and other health, social care, leisure services and voluntary
                                              sector staff who have the qualifications, skills and experience to deliver
                                              exercise programmes appropriate for older people.
                                           What action should they take?
                                             In collaboration with older people and their carers, offer tailored
                                              exercise and physical activity programmes in the community, focusing
                                              on:
                                              – a range of mixed exercise programmes of moderate intensity (for
                                                 example, dancing, walking, swimming)
                                              – strength and resistance exercise, especially for frail older people
                                              – toning and stretching exercise.
                                             Ensure that exercise programmes reflect the preferences of older
                                              people.
                                             Encourage older people to attend sessions at least once or twice a
                                              week by explaining the benefits of regular physical activity.
                                             Advise older people and their carers how to exercise safely for 30
                                              minutes a day (which can be broken down into 10-minute bursts) on 5
                                              days each week or more. Provide useful examples of activities in daily
                                              life that would help achieve this (for example, shopping, housework,




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                                                              SHEFFIELD PCT
                                                         Framework of NICE Guidance
                                                                                                                                        October 2008

Guideline   Title                          Summary                                                                       Implications       Review   Local
No                                                                                                                                           Date    Action
                                             gardening, cycling).
                                            Invite regular feedback from participants and use it to inform the
                                             content of the service and to gauge levels of motivation.

                                           Walking schemes
                                           Recommendation 3
                                           Who is the target population?
                                             Older people and their carers.
                                           Who should take action?
                                             GPs, community nurses, public health and health promotion
                                              specialists, „Walking the way to health‟ initiative walk leaders, local
                                              authorities, leisure services, voluntary sector organisations, community
                                              development groups working with older people, carers, and older
                                              people themselves.
                                           What action should they take?
                                             In collaboration with older people and their carers, offer a range of
                                              walking schemes of low to moderate intensity with a choice of local
                                              routes to suit different abilities.
                                             Promote regular participation in local walking schemes as a way to
                                              improve mental wellbeing for older people, and provide health advice
                                              and information on the benefits of walking.
                                             Encourage and support older people to participate fully according to
                                              health and mobility needs, and personal preference.
                                             Ensure that walking schemes:
                                              – are organised and led by trained workers or „Walking the way to
                                                health‟ initiative walk leaders from the local community who have
                                                been trained in first aid and in creating suitable walking routes
                                              – incorporate a group meeting at the outset of a walking scheme that
                                                introduces the walk leader and participants
                                              – offer opportunities for local walks at least three times a week, with
                                                timing and location to be agreed with participants
                                              – last about 1 hour and include at least 30–40 minutes of walking plus
                                                stretching and warm-up/cool-down exercises (depending on older
                                                people‟s mobility and capacity)




1a1f161d-171b-4c89-99fe-c89bf8fc3b83.doc                                                                                                    Page 5
                                                              SHEFFIELD PCT
                                                         Framework of NICE Guidance
                                                                                                                                         October 2008

Guideline   Title                          Summary                                                                        Implications       Review   Local
No                                                                                                                                            Date    Action
                                              – Invite regular feedback from participants and use it to inform the
                                                content of the service and to gauge levels of motivation.

                                           Training
                                           Recommendation 4
                                           Who is the target population?
                                             Health and social care professionals, domiciliary care staff, residential
                                              care home managers and staff, and support workers, including the
                                              voluntary sector.
                                           Who should take action?
                                             Professional bodies, skills councils and other organisations responsible
                                              for developing training programmes and setting competencies,
                                              standards and continuing professional development schemes.
                                             NHS and local authority senior managers, human resources and
                                              training providers and employers of residential and domiciliary care
                                              staff in the private and voluntary sector.
                                           What action should they take?
                                             Involve occupational therapists in the design and development of
                                              locally relevant training schemes for those working with older people.
                                             Training schemes should include:
                                              – essential knowledge of (and application of) the principles and
                                                 methods of occupational therapy and health and wellbeing promotion
                                              – effective communication skills to engage with older people and their
                                                 carers (including group facilitation skills or a person-centred
                                                 approach)
                                              – information on how to monitor and make the best use of service
                                                 feedback to evaluate or redesign services to meet the needs of older
                                                 people.
                                             Ensure practitioners have the skills to:
                                              – communicate effectively with older people to encourage an exchange
                                                 of ideas and foster peer support
                                              – encourage older people to identify, construct, rehearse and carry out
                                                 daily routines and promote activities that help to maintain or improve
                                                 health and wellbeing




1a1f161d-171b-4c89-99fe-c89bf8fc3b83.doc                                                                                                     Page 6
                                                             SHEFFIELD PCT
                                                        Framework of NICE Guidance
                                                                                                                                        October 2008

Guideline   Title                          Summary                                                                       Implications       Review   Local
No                                                                                                                                           Date    Action
                                             – improve, maintain and support older people‟s ability to carry out daily
                                               routines and promote independence
                                             – collect and use regular feedback from participants.




1a1f161d-171b-4c89-99fe-c89bf8fc3b83.doc                                                                                                    Page 7

				
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