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News – December 2011
NICE provides guidance for management of self-harm
Self-harm is a common problem among young people with one survey estimating that 10% of girls and 3% of boys aged 15–16 years self-harmed in the previous year. The annual prevalence among all age groups is 0.5%. Self-harm is associated with psychiatric problems such as schizophrenia, bipolar disorder, and depression, and it greatly increases the probability that the person will eventually commit suicide.
NICE has published a guideline on the longer-term care of people who self-harm, which aims to help healthcare professionals support these people in reducing and stopping their behaviour. The key recommendations include:
- working with people who self-harm, and developing a trusting and supportive relationship with them, while being aware of the stigma and discrimination that can be associated with this condition
- offering an integrated and comprehensive psychosocial assessment of needs and risks
- identifying the specific risks for the person who self-harms by taking into account methods and patterns of past self-harm, specific risk and protective factors that may increase or decrease self-harm, and accounting for coping strategies that the person has used to successfully limit or avert self-harm
- developing multidisciplinary care plans that identify realistic long-term goals, including employment and occupation, and short-term treatment goals and how to achieve them. Risk management should be clearly identified and addressed within the care plan
- offering three to twelve sessions of a psychological intervention that aims to reduce self-harm and is tailored to individual need
- providing psychological, pharmacological, and psychosocial interventions for any associated conditions such as borderline personality disorder and bipolar disorder.
This guidance follows on from NICE Clinical Guideline 16 on short-term physical and psychological management and secondary prevention of self-harm.
Guidance on colorectal cancer published by NICE
NICE has recently published a guideline on diagnosing and managing colorectal cancer. The recommendations cover topics, such as:
- performing diagnostic investigations, such as colonoscopies and biopsies
- offering contrast-enhanced computed tomography to estimate disease stage
- providing regular surveillance after apparently curative surgery
- offering chemotherapy for advanced and metastatic colorectal cancer
- providing information on treatment, risks, benefits, and possible effect on bowel function.
People at risk of COPD should receive a spirometry test
Several charities, including the British Lung Foundation, are urging people at risk of chronic obstructive pulmonary disease (COPD) to visit their doctor and have a spirometry test.
Of the 3 million people in the UK estimated to have COPD, only 900,000 have been diagnosed. The British Lung Foundation states that early diagnosis of the condition can delay disease progression through provision of prompt interventions, and avoid the use of expensive emergency care. The NICE guideline on COPD provides further information on when healthcare professionals should consider a diagnosis.
NICE releases new quality standard for end-of-life care
Around half a million people die each year in England, and preparation for death, appropriate communication with carers and physicians, and being treated with dignity and respect are important issues that need to be addressed. The new quality standard from NICE includes 16 statements on the care of adults coming to the end of their lives as well as support for their families and carers. The statements include offering:
- information in an accessible and sensitive way in response to the needs and preferences of the person approaching end of life and their family and carers
- appropriate spiritual and religious support to people approaching the end of life
- coordinated care for people in the last days of life that is delivered in accordance with their personalised care plan.
Advanced kidney disease: end-of-life care guide available
Managing a patient with advanced kidney disease at the end of their life can be very challenging for a GP, particularly relating to uncertainty about drug choice and dosage. NHS Kidney Care has produced a guide for primary care healthcare professionals to provide high-quality end-of-life care for people with advanced kidney disease. The 10 top tips include information on:
- identifying patients who may be nearing the end of their lives and informing local out-of-hours and ambulance services about them
- using non-steroidal anti-inflammatory drugs at the end of life in advanced kidney disease if they ease symptoms, but avoiding them in early treatment as they may lead to further deterioration in renal function
- identifying and treating restless leg syndrome.
Guide released on using quality improvement tools
Healthcare Quality Improvement Partnership has released a Guide to using quality improvement tools to drive clinical audits, to help improve health services by applying these tools to the clinical audit process. The guide is for people involved with managing, leading, facilitating, or carrying out clinical audits in healthcare organisations.
Nearly 10 years ago the clinical audit process was redefined as a quality improvement process by NICE. Yet many clinical services have continued to carry out clinical audits using the old model, which does not refer explicitly to the quality improvement process. The new guidance describes how quality improvement approaches can be applied to clinical audits and how specific quality improvement tools can be used in the clinical audit process.
News in brief: NICE does not recommend the use of ranibizumab for the treatment of visual impairment resulting from diabetic macular oedema
People currently receiving ranibizumab for this indication should have the option to continue treatment until they and their clinicians consider it appropriate to stop.
News in brief: The NICE guideline on caesarean section has been updated
It includes advice on the risks and benefits of planned caesarean section compared with vaginal birth, specific indications for a caesarean section, interventions on reducing morbidity, and management strategies to avoid surgical intervention.
News in brief: The Department of Health has published the NHS Outcomes Framework 2012/13
The framework describes the changes that have been made to the indicators and has been designed to help organisations focus on outcomes in practical terms.
News in brief: The Equality Delivery System has been launched to promote equality and fairness in the NHS
This toolkit will support the delivery of personal, fair, and more diverse health services. It will also make the NHS more accountable to the communities it serves.
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Guidelines in Practice, December
2011, Volume 14 (15)
© 2011 MGP
Ltd
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