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					                                                             NHS Sheffield
                                                       Framework of NICE Guidance
                                                            September 2009

Guideline   Title                  Summary                                                                          Implications                        Review    Local
No                                                                                                                                                       Date     Action
TA 179      Sunitinib for the         Sunitinib is recommended, within its licensed indication, as treatment       NICE state that this guidance       August
            treatment of               option for people with unresectable and/or metastatic malignant              is for acute care only.             2011
            gastrointestinal           gastrointestinal stromal tumours if:
            stromal tumours            – imatinib treatment has failed because of resistance or intolerance,        NICE state that this guidance
                                             and                                                                    is outside of PBR.
                                       – the drug cost of sunitinib (excluding any related costs) for the first
                                             treatment cycle will be met by the manufacturer.                       NICE state that the net cost of
                                      The use of sunitinib should be supervised by cancer specialists with         implementing this guidance is
                                       experience in treating people with unresectable and/or metastatic            £12,000 per 100,000
                                       malignant gastrointestinal stromal tumours after failure of imatinib         population. This includes a
                                       treatment because of resistance or intolerance.                              £3,000 manufacturer refund
TA 180      Ustekinumab for the       Ustekinumab is recommended as a treatment option for adults with             NICE state that this guidance       January
            treatment of adults        plaque psoriasis when the following criteria are met.                        is for acute care only.             2010 !
            with moderate to           – The disease is severe, as defined by a total Psoriasis Area
            severe psoriasis                 Severity Index (PASI) score of 10 or more and a Dermatology Life       NICE state that this guidance
                                             Quality Index (DLQI) score of more than 10.                            is outside of PBR.
                                       – The psoriasis has not responded to standard systemic therapies,
                                             including ciclosporin, methotrexate and PUVA psoralen and long-        NICE state that implementing
                                             wave ultraviolet radiation), or the person is intolerant of or has a   this guidance is unlikely to
                                             contraindication to these treatments.                                  result in a significant change in
                                       – The manufacturer provides the 90 mg dose (two 45 mg vials) for             resource use in the NHS.
                                             people who weigh more than 100 kg at the same total cost as for a
                                             single 45 mg vial.
                                      Ustekinumab treatment should be stopped in people whose psoriasis
                                       has not responded adequately by 16 weeks after starting treatment.
                                      An adequate response is defined as either:
                                       – A 75% reduction in the PASI score (PASI 75) from when treatment
                                             started or
                                       – a 50% reduction in the PASI score (PASI 50) and a 5-point
                                             reduction in the DLQI score from when treatment started.
                                      When using the DLQI, healthcare professionals should take into account
                                       any physical, sensory or learning disabilities, or communication
                                       difficulties that could affect the responses to the DLQI and make any
                                       adjustments they consider appropriate.




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                                                                 NHS Sheffield
                                                           Framework of NICE Guidance
                                                                September 2009

Guideline   Title                     Summary                                                                             Implications                       Review      Local
No                                                                                                                                                            Date       Action
TA 181      Pemetrexed for the        In August 2007, NICE issued technology appraisal guidance 124                       NICE state that this guidance      July
            first-line treatment of   ‘Pemetrexed for the treatment of non-small-cell lung cancer’, which                 is for acute care only.            2010
            non-small-cell-lung       states that pemetrexed is not recommended for patients with NSCLC
            cancer                    who have had prior chemotherapy. This guidance (technology                          NICE state that this guidance
                                      appraisal 181) applies to the first-line use of pemetrexed in patients              is outside of PBR.
                                      with NSCLC.
                                        Pemetrexed in combination with cisplatin is recommended as an option             NICE state that implementing
                                           for the first-line treatment of patients with locally advanced or metastatic   this guidance will cost £5,363
                                           non-small-cell lung cancer (NSCLC) only if the histology of the tumour         per 100,000 population.
                                           has been confirmed as adenocarcinoma or large-cell carcinoma.
                                        People who are currently being treated with pemetrexed for NSCLC but
                                           who do not meet the criteria in 1 should have the option to continue
                                           their therapy until they and their clinicians consider it appropriate to
                                           stop.
PH 20       Social and                Recommendation 1 Strategic framework                                                NICE state that this guidance
            emotional well-being      Who is the target population?                                                       is for primary care, acute care,
            in secondary               Practitioners working with young people in secondary education.                   community services and
            education                 Who should take action?                                                             education.
                                       Commissioners and providers of services to young people in secondary
                                       education including those working in:                                             NICE state that this guidance
                                            – children’s trusts                                                           does not impact on PBR.
                                            – local authorities (in particular, children’s services)
                                            – schools and other secondary education establishments                        NICE have not released any
                                            – primary care trusts (PCTs)                                                  costing information at the time
                                            – child and adolescent mental health services                                 of producing this summary.
                                            – voluntary agencies.
                                       Governors.
                                      What action should they take?
                                       Enable all secondary education establishments to adopt an organisation-
                                          wide approach to promoting the social and emotional wellbeing of young
                                          people. This should encompass organisation and management issues
                                          as well as the curriculum and extra-curriculum provision. The approach
                                          should form part of the local children and young people’s plan and joint
                                          commissioning. It should also be linked to the local area agreement. It




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                                                             NHS Sheffield
                                                       Framework of NICE Guidance
                                                            September 2009

Guideline   Title                  Summary                                                                        Implications   Review   Local
No                                                                                                                                Date    Action
                                      should help achieve the Every Child Matters (ECM) Outcome
                                      Framework wellbeing objectives and targets (HM Government 2004). It
                                      should also contribute towards efforts to gain National Healthy Schools
                                      Status (NHSS).
                                    Encourage the appropriate local authority scrutiny committee to assess
                                      the progress made by secondary education establishments in adopting
                                      an organisation-wide approach to social and emotional wellbeing.
                                    Help secondary education establishments to develop the necessary
                                      organisational capacity to promote social and emotional wellbeing. This
                                      includes leadership and management arrangements, specialist skills and
                                      resources.
                                    Help secondary education establishments to share practical advice on
                                      how to promote the social and emotional wellbeing of young people.
                                    Ensure secondary education establishments have access to the
                                      specialist skills, advice and support they require. This may be provided
                                      by public, private, voluntary and community organisations. It may involve
                                      working with local authority advisory services, personal, social, health
                                      and economic (PSHE) education services, educational psychology and
                                      child and adolescent mental health services.
                                    Ensure policies and arrangements are in place to promote the social and
                                      emotional wellbeing of those who work with young people in secondary
                                      education.
                                   Recommendation 2 Key principles and conditions
                                   Who is the target population?
                                    Young people in secondary education, their parents and carers.
                                   Who should take action?
                                    Head teachers, governors, teachers, support staff and other practitioners
                                      working with young people in secondary education.
                                    Those working in (and with) education, children’s and youth services
                                      (including healthy schools teams) within local authorities, primary care
                                      (including school nurses), child and adolescent mental health services
                                      and voluntary agencies.
                                   What action should they take?
                                    Head teachers, governors and teachers should demonstrate a




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                                                             NHS Sheffield
                                                       Framework of NICE Guidance
                                                            September 2009

Guideline   Title                  Summary                                                                       Implications   Review   Local
No                                                                                                                               Date    Action
                                      commitment to the social and emotional wellbeing of young people.
                                      They should provide leadership in this area by ensuring social and
                                      emotional wellbeing features within improvement plans, policies,
                                      systems and activities. These should all be monitored and evaluated.
                                    Foster an ethos that promotes mutual respect, learning and successful
                                      relationships among young people and staff. Create a culture of
                                      inclusiveness and communication that ensures all young people’s
                                      concerns can be addressed (including the concerns of those who may
                                      be at particular risk of poor mental health).
                                    Provide a safe environment which nurtures and encourages young
                                      people’s sense of self-worth and self-efficacy, reduces the threat of
                                      bullying and violence and promotes positive behaviours.
                                    Systematically measure and assess young people’s social and
                                      emotional wellbeing. Use the outcomes as the basis for planning
                                      activities and evaluating their impact (informed by Ofsted guidance on
                                      social and emotional wellbeing).
                                    Ensure young people have access to pastoral care and support, as well
                                      as specialist services, so that emotional, social and behavioural
                                      problems can be dealt with as soon as they occur. (Specialist services
                                      include child and adolescent mental health services.)
                                   Recommendation 3 Curriculum approaches
                                   Who is the target population?
                                    Young people in secondary education, their parents and carers.
                                   Who should take action?
                                    Head teachers, governors, teachers, support staff and other practitioners
                                      working with young people in secondary education.
                                    Those working in (and with) education and children’s and youth services
                                      (including healthy schools teams) within local authorities, primary care
                                      (including school nurses), child and adolescent mental health services
                                      and voluntary agencies.
                                   What action should they take?
                                    Provide a curriculum that promotes positive behaviours and successful
                                      relationships and helps reduce disruptive behaviour and bullying. This
                                      can be achieved by integrating social and emotional skills development




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                                                             NHS Sheffield
                                                       Framework of NICE Guidance
                                                            September 2009

Guideline   Title                  Summary                                                                         Implications   Review   Local
No                                                                                                                                 Date    Action
                                      within all areas of the curriculum. Skills that should be developed
                                      include: motivation, self-awareness, problem-solving, conflict
                                      management and resolution, collaborative working, how to understand
                                      and manage feelings, and how to manage relationships with parents,
                                      carers and peers.
                                    Tailor social and emotional skills education to the developmental needs
                                      of young people. The curriculum should build on learning in primary
                                      education and be sustained throughout their education.
                                    Reinforce curriculum learning on social and emotional skills and
                                      wellbeing by integrating relevant activities into all aspects of secondary
                                      education. For example, such skills might be developed through
                                      extracurricular activities, using projects set for homework or via
                                      community-based and individual voluntary work.
                                   Recommendation 4 Working with parents and families
                                   Who is the target population?
                                    Parents, carers and other members of the family of young people in
                                      secondary education.
                                   Who should take action?
                                    Head teachers, governors, teachers, support staff and other practitioners
                                      working with young people in secondary education.
                                    Those working in (and with) education and children’s and youth services
                                      (including healthy schools teams) within local authorities, primary care
                                      (including school nurses), child and adolescent mental health services
                                      and voluntary agencies.
                                   What action should they take?
                                    Work in partnership with parents, carers and other family members to
                                      promote young people’s social and emotional wellbeing.
                                    To help reinforce young people’s learning from the curriculum, help
                                      parents and carers develop their parenting skills. This may involve
                                      providing information or offering small, group-based programmes run by
                                      appropriately trained health or education practitioners.
                                    Ensure parents, carers and other family members living in
                                      disadvantaged circumstances are given the support they need to
                                      participate fully in activities to promote social and emotional wellbeing.




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                                                             NHS Sheffield
                                                       Framework of NICE Guidance
                                                            September 2009

Guideline   Title                  Summary                                                                          Implications   Review   Local
No                                                                                                                                  Date    Action
                                      This should include support to participate fully in any parenting sessions
                                      (for example, by offering a range of times for the sessions or providing
                                      help with transport and childcare). This might involve liaison with family
                                      support agencies.
                                   Recommendation 5 Working in partnership with young people
                                   Who is the target population?
                                    Young people in secondary education, their parents and carers.
                                   Who should take action?
                                    Head teachers, governors, teachers, support staff and other practitioners
                                      working with young people in secondary education.
                                    Those working in (and with) education and children’s and youth services
                                      (including healthy schools teams) within local authorities, primary care
                                      (including school nurses), child and adolescent mental health services
                                      and voluntary agencies.
                                   What action should they take?
                                    Develop partnerships between young people and staff to formulate,
                                      implement and evaluate organisation-wide approaches to promoting
                                      social and emotional wellbeing.
                                    Introduce a variety of mechanisms to ensure all young people have the
                                      opportunity to contribute to decisions that may impact on their social and
                                      emotional wellbeing.
                                    Provide young people with opportunities to build relationships,
                                      particularly those who may find it difficult to seek support when they
                                      need it. This could involve developing a peer education or peer
                                      mediation approach. Note, young people who act as peer supporters
                                      need training and the support of staff and other professionals.
                                    Provide young people with clear and consistent information about the
                                      opportunities available for them to discuss personal issues and
                                      emotional concerns. Any support offered should take account of local
                                      community and education policies and protocols regarding
                                      confidentiality. Make young people aware of their rights on confidentiality
                                    Involve young people in the creation, delivery and evaluation of training
                                      and continuing professional development activities in relation to social
                                      and emotional wellbeing.




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                                                             NHS Sheffield
                                                       Framework of NICE Guidance
                                                            September 2009

Guideline   Title                  Summary                                                                        Implications   Review   Local
No                                                                                                                                Date    Action
                                   Recommendation 6 Training and continuing professional development
                                   Who is the target population?
                                    Professionals working with young people in secondary education.
                                    Governors.
                                   Who should take action?
                                    Those working in (and with) education, children’s and youth services
                                      (including healthy schools teams) within local authorities, primary care
                                      (including school nurses), child and adolescent mental health services
                                      and voluntary agencies.
                                    Head teachers in secondary education.
                                    Organisations concerned with the training and continuing professional
                                      development of those working in secondary education.
                                   What action should they take?
                                    Integrate social and emotional wellbeing within the training and
                                      continuing professional development of practitioners and governors
                                      involved in secondary education.
                                    Ensure practitioners have the knowledge, understanding and skills they
                                      need to develop young people’s social and emotional wellbeing. Training
                                    ay cover:
                                      – listening and facilitating skills and the ability to be non-judgemental
                                      – how to manage behaviours effectively, based on an understanding
                                           of the underlying issues
                                      – identifying and responding to the needs of young people who may
                                           be experiencing emotional and behavioural difficulties
                                      – how to access pastoral care based in secondary education or
                                           specialist services provided by other agencies, such as child and
                                           adolescent mental health services
                                      – the issues in relation to different medical conditions (such as
                                           diabetes, asthma and epilepsy) to ensure young people with these
                                           conditions are not bullied, inappropriately excluded from school
                                           activities or experience any undue emotional distress
                                      – opportunities to reflect upon and develop their own social and
                                           emotional skills and awareness.




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                                                             NHS Sheffield
                                                       Framework of NICE Guidance
                                                            September 2009

Guideline   Title                  Summary                                                                        Implications                       Review   Local
No                                                                                                                                                    Date    Action
PH 21       Reducing               Recommendation 1: immunisation programmes                                      NICE state that this guidance
            differences in the     Who is the target population?                                                  is for primary care, acute care,
            uptake of               Children and young people aged under 19 years, particularly those who        community services and local
            immunisations             may not have been immunised or may have only been partially                 government.
                                      immunised.
                                    Parents of children and young people aged under 19 years.                    NICE state that this guidance
                                   Who should take action?                                                        does not impact on PBR.
                                    Commissioners, managers and coordinators in primary care trusts
                                      (PCTs), children‘s services, children’s trusts, Sure Start children’s       NICE have not released any
                                      centres and services for vulnerable groups (including those run by family   definitive costing information
                                      nurse partnerships).                                                        at the time of producing this
                                    Health professionals responsible for children and young people’s             summary, but have provided a
                                      immunisation services including paediatricians, health visiting and         template on which local
                                      school nursing teams, GPs and practice nurses.                              calculations may be made.
                                    Directors of public health, immunisation coordinators and others who
                                      provide or commission immunisation services in PCTs and GP practices.
                                    Health protection specialists and immunisation leads in health protection
                                      units (HPUs).
                                    Children‘s service managers and nursing staff in hospital trusts,
                                      children‘s social care organisations and child and adolescent mental
                                      health services.
                                   What action should they take?
                                    Ensure Department of Health (DH) guidance and updates on
                                      immunisations (including official letters from the Chief Medical Officer,
                                      Chief Nursing Officer and Chief Pharmaceutical Officer) are
                                      disseminated to relevant professionals and implemented.
                                    Adopt a multifaceted, coordinated programme across different settings
                                      to increase timely immunisation among groups with low or partial uptake.
                                      The programme should form part of the local child health strategy and
                                      should include the following actions:
                                      – Monitor vaccination status as part of a wider assessment of children
                                           and young people’s health. Ensure there is an identified healthcare
                                           professional in the PCT and every GP practice who is responsible –
                                           and provides leadership – for the local childhood immunisation




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                                                             NHS Sheffield
                                                       Framework of NICE Guidance
                                                            September 2009

Guideline   Title                  Summary                                                                          Implications   Review   Local
No                                                                                                                                  Date    Action
                                           programme.
                                       –   Ensure all staff involved in immunisation services have access to
                                           the ‘Green book’. Also ensure updates to the childhood
                                           immunisation programme and schedule are monitored and services
                                           adapted appropriately.
                                       –   Improve access to immunisation services. This could be achieved
                                           by extending clinic times, ensuring children and young people are
                                           seen promptly and by making sure clinics are child- and family-
                                           friendly.
                                       –   Ensure enough immunisation appointments are available so that all
                                           local children and young people can receive the recommended
                                           vaccinations on time.
                                       –   Send tailored invitations for immunisation. When a child or young
                                           person does not attend appointments, send tailored reminders and
                                           recall invitations and follow them up by telephone or text message.
                                       –   Provide parents and young people with tailored information, advice
                                           and support to ensure they know about the recommended routine
                                           childhood vaccinations and the benefits and risks. This should
                                           include details on the infections they prevent. Information should be
                                           provided in different formats, for example, for those whose first
                                           language is not English.
                                       –   Ensure parents and young people have an opportunity to discuss
                                           any concerns they might have about immunisation. This could either
                                           be in person or by telephone and could involve a GP, community
                                           paediatrician, health visitor, school nurse or practice nurse.
                                       –   Ensure young people fully understand what is involved in
                                           immunisation so that those who are aged under 16, but considered
                                           sufficiently capable, can give their consent to vaccinations, as
                                           advised in the ‘Green book’.
                                       –   Ensure young people and their parents know how to access
                                           immunisation services.
                                       –   Consider home visits to discuss immunisation with parents who
                                           have not responded to reminders, recall invitations or appointments.
                                           Offer to give their children vaccinations there and then (or arrange a
                                           convenient time in the future). Such visits could include groups that




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                                                              NHS Sheffield
                                                        Framework of NICE Guidance
                                                             September 2009

Guideline   Title                  Summary                                                                           Implications   Review   Local
No                                                                                                                                   Date    Action
                                           may not use primary care services, for example, travellers or asylum
                                           seekers.
                                      – Check the immunisation status of children and young people at
                                           every appropriate opportunity. Checks should take place during
                                           appointments in primary care (for example, as part of a child health
                                           review),hospital in- or outpatient and accident and emergency
                                           departments, walk-in centres or minor injuries units. Use the
                                           personal child health record (PCHR, also known as the ‘Red book’)
                                           as appropriate. If any vaccinations are outstanding:
                                           o discuss them with the parent and, where appropriate, the young
                                                person. Where they have expressed concerns about
                                                immunisation and this is documented, these appointments
                                                should be used as an opportunity to have a further discussion
                                           o offer vaccinations by trained staff before they leave the
                                                premises, if appropriate. In such cases, notify the child or young
                                                person’s GP, health visitor or local child health information
                                                department so that records can be updated
                                           o and, if immediate vaccination is not possible, refer them to
                                                services where they can receive any outstanding
                                                immunisations.
                                   Recommendation 2: information systems
                                   Who is the target population?
                                    Children and young people aged under 19 years, particularly those who
                                      may not have been immunised or may have only been partially
                                      immunised.
                                    Parents of children and young people aged under 19 years.
                                   Who should take action?
                                    Those responsible for information services within PCTs, acute trusts and
                                      GP practices.
                                    Strategic health authority immunisation leads, PCT immunisation
                                      coordinators, directors of public health and community paediatricians.
                                    Health protection specialists and immunisation leads in health protection
                                      units.
                                    GPs, practice nurses, health visiting teams and those who commission




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                                                             NHS Sheffield
                                                       Framework of NICE Guidance
                                                            September 2009

Guideline   Title                  Summary                                                                         Implications   Review   Local
No                                                                                                                                 Date    Action
                                      or provide immunisation services.
                                    Independent and private sector providers of immunisation services.
                                   What action should they take?
                                    Ensure PCTs and GP practices have a structured, systematic method for
                                      recording, maintaining and transferring accurate information on the
                                      vaccination status of all children and young people. Vaccination
                                      information should be recorded in patient records, the personal child
                                      health record and the child health information system. The same data
                                      should be used when reporting vaccinations to the child health
                                      department and when submitting returns to the PCT for GP and practice
                                      payments. This will ensure records in both systems are reconciled and
                                      consistent.
                                    Encourage and enable private providers to give the relevant GP practice
                                      or PCT details of all vaccinations administered to children and young
                                      people, so they can be recorded in the appropriate information system.
                                    Record any factors which may make it less likely that a child or young
                                      person will be up-to-date with vaccinations in their patient records and
                                      the personal child health record. For example, note if children and young
                                      people are looked after, have special needs or have any
                                      contraindications to vaccination. Also note if the parents or young person
                                      have expressed concerns about vaccination.
                                    Regularly update and maintain the databases for recording children and
                                      young people’s immunisation status. For example, ensure records are
                                      transferred when a child or young person moves out of the area, ensure
                                      information is not duplicated and follow up on any missing data.
                                    Ensure up-to-date information on vaccination coverage is available and
                                      disseminated to all those responsible for the immunisation of children
                                      and young people. This includes those who are delivering the
                                      vaccinations.
                                    Use recorded information on immunisation, together with surveillance
                                      data on the incidence of infection, to inform local and joint strategic
                                      needs assessments and health equity audits. These data should also be
                                      used to support delivery of an immunisation programme for children and
                                      young people.




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                                                             NHS Sheffield
                                                       Framework of NICE Guidance
                                                            September 2009

Guideline   Title                  Summary                                                                      Implications   Review   Local
No                                                                                                                              Date    Action
                                     Monitor the age composition of the practice population so that there is
                                      enough capacity to provide timely immunisations. Waiting lists are
                                      unacceptable.
                                   Recommendation 3: training
                                   Who is the target population?
                                    Those who advise on and provide immunisation services including:
                                      – GPs, health visitors, practice nurses, community nurses (including
                                           school nurses), midwives and nurses working in neonatal care,
                                           nurseries, child and adolescent mental health services, young
                                           offender institutions and secure units.
                                      – PCT immunisation coordinators and public health professionals.
                                      – Hospital and community paediatricians, nursing staff in hospital
                                           trusts and walk-in centres and pharmacists.
                                      – NHS health trainers.
                                      – NHS support staff, including clinic clerks and receptionists.
                                      – Managers of children’s services and children’s centres, social care
                                           workers (working with children) and those with parental
                                           responsibility for looked after children.
                                   Who should take action?
                                    Professional bodies, skills councils and other organisations responsible
                                      for setting competencies and developing continuing professional
                                      development programmes for health professionals.
                                    Health protection units.
                                    Employers and managers in PCTs and strategic health authorities,
                                      including GPs whose staff are involved in immunisation services.
                                    Private and independent sector providers of immunisation services for
                                      children and young people aged under 19 years.
                                   What action should they take?
                                    Ensure all staff involved in immunisation services are appropriately
                                      trained. Training should be regularly updated. It should be tailored to
                                      individual needs to ensure staff have the necessary skills and
                                      knowledge, for example, communications skills and the ability to answer
                                      questions about different vaccinations.
                                    Ensure health professionals who deliver vaccinations have received




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                                                             NHS Sheffield
                                                       Framework of NICE Guidance
                                                            September 2009

Guideline   Title                  Summary                                                                         Implications   Review   Local
No                                                                                                                                 Date    Action
                                       training that complies with the ‘National minimum standard for
                                       immunisation training’.
                                    Professional bodies should ensure health professionals working with
                                       children and young people have the appropriate knowledge and skills to
                                       give advice on the benefits and risks of immunisation. Specifically, they
                                       should be well-versed in the core topics defined in the Health Protection
                                       Agency’s ‘Core curriculum for immunisation training’.
                                    Ensure staff are appropriately trained to document vaccinations
                                       accurately in the correct records.
                                   Recommendation 4: contribution of nurseries, schools, colleges of
                                   further education
                                   Who is the target population?
                                    Children and young people aged under 19 years attending nurseries,
                                       schools and colleges of further education, particularly those who may
                                       not have been immunised or may have only been partially immunised.
                                    Parents of children and young people aged under 19 years.
                                   Who should take action?
                                    PCT directors of public health, immunisation coordinators and
                                       community paediatricians.
                                    Health visiting and school nursing teams, GPs and those involved in
                                       family nurse partnerships.
                                    Head teachers, school governors and heads of further education
                                       colleges and pupil referral units.
                                    Nursery, pre-school and early years providers.
                                    Managers, nurses and early years support staff in Sure Start children’s
                                       centres and children’s services.
                                   What action should they take?
                                    The Healthy Child team, led by a health visitor working with other
                                       practitioners, should check the immunisation record (including the
                                       personal child health record) of each child aged up to 5 years. They
                                       should carry out this check when the child joins a day nursery, nursery
                                       school, playgroup, Sure Start children’s centre or when they start
                                       primary school. The check should be carried out in conjunction with
                                       childcare or education staff and the parents.




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Guideline   Title                  Summary                                                                          Implications   Review   Local
No                                                                                                                                  Date    Action
                                     School nursing teams, working with GP practices and schools, should
                                      check the vaccination status of children and young people when they
                                      transfer to a new school or college. Working with the PCT, they should
                                      also advise young people and their parents about the vaccinations
                                      recommended at secondary school age.
                                    If children and young people are not up-to-date with their vaccinations,
                                      school nursing teams, in conjunction with nurseries and schools, should
                                      explain to parents why immunisation is important. Information should be
                                      provided in an appropriate format (for example, as part of a question and
                                      answer session). School nursing teams should offer vaccinations to help
                                      them catch up, or refer them to other immunisation services.
                                    Head teachers, school governors, managers of children’s services and
                                      PCT immunisation coordinators should work with parents to encourage
                                      schools to become venues for vaccinating local children. This would
                                      form part of the extended school role.
                                   Recommendation 5: targeting groups at risk of not being fully
                                   immunised
                                   Who is the target population?
                                    Children and young people aged under 19 years at risk of not being
                                      immunised or only being partially immunised.
                                    Parents of these children and young people.
                                   Who should take action?
                                    Commissioners, managers and coordinators of children’s services in
                                      PCTs, children’s trusts, Sure Start children’s centres and immigration
                                      services.
                                    Health professionals responsible for children’s immunisation services
                                      including directors of public health, paediatricians, GPs, practice nurses,
                                      school nursing teams, health visiting teams and those involved in family
                                      nurse partnerships7.
                                    Nurses working in child and adolescent mental health services, young
                                      offender institutions and secure units.
                                    Other health professionals who have contact with children and young
                                      people aged under 19 years.
                                    Immunisation coordinators and others who work in immunisation




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                                                       Framework of NICE Guidance
                                                            September 2009

Guideline   Title                  Summary                                                                         Implications   Review   Local
No                                                                                                                                 Date    Action
                                      services within PCTs and GP practices.
                                     Managers of children’s services and children’s centres.
                                     Social care workers responsible for children and those with parental
                                      responsibility for looked after children.
                                   What action should they take?
                                    Improve access to immunisation services for those with transport,
                                      language or communication difficulties, and those with physical or
                                      learning disabilities. For example, provide longer appointment times,
                                      walk-in vaccination clinics, services offering extended hours and mobile
                                      or outreach services. The latter might include home visits or vaccinations
                                      at children’s centres.
                                    Provide accurate, up-to-date information in a variety of formats on the
                                      benefits of immunisation against vaccine-preventable infections. This
                                      should be tailored for different communities and groups, according to
                                      local circumstances. For example, offer translation services and provide
                                      information in multiple languages (this information is available from
                                      www.immunisation.nhs.uk/Library/Publications/Translations).
                                    Consider using pharmacies, retail outlets, libraries and local community
                                      venues to promote and disseminate accurate, up-to-date information on
                                      childhood immunisation.
                                    Health professionals should check the immunisation history of new
                                      migrants, including asylum seekers, when they arrive in the country.
                                      They should discuss outstanding vaccinations with them and, if
                                      appropriate, their parents, and offer the necessary vaccinations
                                      administered by trained staff.
                                    Prison health services should check the immunisation history of young
                                      offenders. They should discuss any outstanding vaccinations with the
                                      young person and, if appropriate, their parents, and offer appropriate
                                      vaccines administered by trained staff.
                                    Check the immunisation status of looked after children during their initial
                                      health assessment, the annual review health assessment and statutory
                                      reviews. Ensure outstanding immunisations are addressed as part of the
                                      child’s health plan. Offer opportunities to have any missed vaccinations,
                                      as appropriate, in discussion with the child or young person and those




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                                                            September 2009

Guideline   Title                  Summary                                                                         Implications   Review   Local
No                                                                                                                                 Date    Action
                                      with parental responsibility for them.
                                   Recommendation 6: hepatitis B
                                   immunisation for infants
                                   Who is the target population?
                                    Children born to mothers who are hepatitis B-positive.
                                    Parents of children who are hepatitis B-positive.
                                   Who should take action?
                                    GPs, health visitors, midwives, neonatal and community paediatricians,
                                      nursery and neonatal nurses, support workers and those involved in
                                      family nurse partnerships.
                                    PCT directors of public health and immunisation coordinators.
                                    Managers and family health and support teams in children’s services.
                                    Managers, health professionals and early years support staff in Sure
                                      Start children’s centres.
                                    Commissioners and providers of immunisation services.
                                   What action should they take?
                                    PCTs should have an identified person responsible for coordinating the
                                      local hepatitis B vaccination programme for babies at risk of hepatitis B
                                      infection. The person should also be responsible for scheduling and
                                      follow-up to ensure babies at risk are vaccinated at the right time. This
                                      may involve working within and across several PCT areas.
                                    A clear process for the local infant hepatitis B vaccination programme
                                      should be developed and implemented. Antenatal, postnatal, neonatal,
                                      paediatric, primary care and community support teams should
                                      communicate effectively and share information so that the children and
                                      families affected can be contacted and followed up.
                                    Babies born to hepatitis B-positive mothers should be given the first
                                      dose of the vaccine promptly, whether they are delivered in hospital or at
                                      home. They should then receive all other recommended doses, a blood
                                      test to check for infection and, where appropriate, hepatitis B
                                      immunoglobulin, in line with the ‘Green book9’.
                                    Health professionals should record the mother’s hepatitis B status in the
                                      personal child health record as soon as possible after birth, before the
                                      midwife hands over care of the baby to the health visitor. The mother’s




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                                                              September 2009

Guideline   Title                    Summary                                                                          Implications      Review     Local
No                                                                                                                                       Date      Action
                                         hepatitis B status should also be entered on the child’s record in the
                                         local Child Health Information System.
                                      Health professionals should provide parents with information, advice and
                                         support on how to prevent the transmission of hepatitis B. They should
                                         emphasise the importance of ensuring babies complete the
                                         recommended vaccination course at the right time. In addition, they
                                         should assess whether or not the baby’s siblings need to be immunised
                                         against hepatitis B or tested for infection and should offer them
                                         vaccinations and blood tests if necessary.
                                      Health professionals should ensure administered doses of hepatitis B
                                         vaccination are recorded in the patient records and the personal child
                                         health record.
                                      All the above actions should be integrated into the local care pathway for
                                         infant hepatitis B. (See also NICE clinical guideline 62 on antenatal care
                                         atwww.nice.org.uk/CG62).
IPG315      Hysteroscopic            This document replaces previous guidance on hysteroscopic                        Acute care only     -
            sterilisation by tubal   sterilisation by tubal cannulation and placement of intrafallopian
            cannulation and          implants (interventional procedure guidance 44).
            placement of             Current evidence on the safety and efficacy of hysteroscopic sterilisation
            intrafallopian           by tubal cannulation and placement of intrafallopian implants is adequate
            implants                 to support the use of this procedure provided that normal arrangements
                                     are in place for clinical governance and audit.
                                     During the consent process clinicians wishing to undertake hysteroscopic
                                     sterilisation by tubal cannulation and placement of intrafallopian implants
                                     should take the following action.
                                     Ensure that patients understand that additional contraception must be
                                     used until appropriate imaging has been done; and that there is a small
                                     risk of pregnancy in the longer term after any form of tubal occlusion
                                     procedure. Patients should be provided with clear written information.
IPG316      Extracorporeal           This document replaces previous guidance on extracorporeal albumin               Acute care only     -
            albumin dialysis for     dialysis for acute-on-chronic liver failure (interventional procedure
            acute liver failure      guidance 45).
                                      The evidence on extracorporeal albumin dialysis for acute liver
                                          failure raises no major safety concerns. However, current evidence




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                                                            September 2009

Guideline   Title                   Summary                                                                      Implications      Review     Local
No                                                                                                                                  Date      Action
                                        on its efficacy is inadequate in quality and quantity. Therefore, this
                                        procedure should only be used with special arrangements for clinical
                                        governance, consent and audit or research.
                                       Clinicians wishing to undertake extracorporeal albumin dialysis for
                                        acute liver failure should take the following actions.
                                        – Inform the clinical governance leads in their Trusts.
                                        – Ensure that patients and their carers understand the uncertainty
                                             about the procedure’s efficacy and provide them with clear
                                             written information (subject to the requirement for an emergency
                                             procedure).
                                        – Audit and review clinical outcomes of all patients having
                                             extracorporeal albumin dialysis for acute liver failure.
                                       NICE encourages further research into extracorporeal albumin
                                        dialysis for acute liver failure. This should describe clearly the
                                        indications for treatment. Short- and longer-term survival and the
                                        numbers of patients ‘bridged to transplant’ should be documented
                                        and compared with standard treatments. Further information about
                                        the utility of biochemical markers to guide the frequency of treatment
                                        would be helpful. NICE may review the procedure on publication of
                                        further evidence.
IPG317      Individually               Current evidence on the safety and efficacy of individually magnetic     Acute care only     -
            magnetic resonance          resonance imaging (MRI)-designed unicompartmental interpositional
            imaging-designed            implant insertion for osteoarthritis of the knee is inadequate in
            unicompartmental            quantity and quality. Therefore, this procedure should only be used
            interpositional             in the context of research studies. These should include clear
            implant insertion for       descriptions of patient selection; and should report both objective
            osteoarthritis of the       and patient-reported outcomes and the length of time before joint
            knee
                                        replacement is required.
                                       NICE may review the procedure on publication of further evidence.




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