Nice Standards Nice Compliance Standards Review Nice 'Literature Review' chapter

Excerpt from 'Literature Review' chapter :

NICE Standards

NICE Compliance Standards Review

NICE has developed a set of guidelines and standards to help minimize the risk of VTE and ensure healthcare protocols are in place to educate patients about the risks of VTE. The purpose of this literature review is to examine a tool to access a Hospital Trust compliance with the National Institute of Clinical Excellence (NICE) published standards on Venous thromboembolism (VTE) prevention. The tool will have the capability to monitor, report, and disseminate relevant information.

National Institute for Clinical Excellence

The National Institute for Health and Clinical Excellence, or NICE, is an institution whose goals including providing clinical quality guidelines and standards to help manage a nationwide database. The purpose of this database includes help improve total healthcare at multiple levels, including at the cardiovascular, vascular, mental, neurological at other levels of health (NICE, 2011). The goals of NICE include prevention of disease, treating disease, and monitoring ongoing care and remission.

NICE works to provide recommendations for multiple levels of care including: (1) new and emerging treatments, various procedures, and protocols for various medications; (2) provides information and guidance to organizations and facilities regarding caring and treating patients that have specific conditions including VTE; (3) making recommendations to the NHS regarding how public, private and other entities can improve overall healthcare; (4) how healthcare costs can be reduced; (5) how health services can be maintained; (6) how health services can be improved (NICE, 2011).

NICE Compliance

Compliance is a critical issue at all levels of care. NICE is working to establish compliance measures to ensure that all patients receive an adequate measure of care to help prevent illness and injury before, during, and post-treatment. This is essential to ensure the best quality care not just for patients, but also for the community. This will provide the most cost effective care, providing better opportunities for funding now, and into the future. It will allow professionals to see more patients, and allow them more opportunities to find funding for VTE and other areas of research in the future. Part of NICE compliance requires that patients and health providers research oral and written instructions. During discharge patients will receive follow up care and education regarding their treatment. This is critical to helping patients understand the type of illness or injury they have, and what they can do to help prevent relapse or post-operative complications, including death, in the case of VTE. Education is a key element to survival. Patients with risk factors are particularly in need of appropriate education so they can detect early warning signs of potential VTE complications


Each year thousands of people suffer from illness, injury and even death because of DVT and PE related deaths. Many people are also at risk for VTE. According to the House of Commons Health Committee, as published in a 2010 report by NICE, every year more than 25,000 people living in the UK die from venous thromboembolism (NICE, 2010, p. 4). This includes acute care patients and long-term surgical patients. This number is as high as the number of patients dying from serious illnesses including road traffic accidents and breast cancer patients (NICE, 2010). Because of this it is important to evaluate effective guidelines and establish a tool for minimizing the risk of VTE in patients admitted and at risk, and minimizes the risk for VTE post-discharge.

Oftentimes patients come in for medical care or planned surgeries, which should improve their lives, but several weeks following surgery they experience a life-threatening VTE. There are many factors that can lead to a pulmonary embolism or DVT, or other life-threatening condition.

The best chance for reducing their risk is to establish guidelines prior to admission and during admission, as well as regularly during a hospital stay to help balance the risk associated with limited mobility and bleeding, to help prevent VTE (NICE, 2010). For some time now physicians and surgeons have been aware of the dangers associated with VTE, as it has been a topic well noted for the last 40 years; many professionals have used physical tools including compression stockings and other devices, as well as pharmaceutical measures to help reduce the risk of VTE (NICE, 2010).

However, there is consistent evidence that there is still considerable risk and it is impossible to "adequately capture the tradeoff between risk and benefit, when there are infrequent clinical events or when manifestations of PE and DVT are delayed" (NICE, 2010, p.5). For this reason, it is critical to ascertain the potential benefit of a national tool that will help better regulate patient assessment and care, as well as risk, whether from mobility limitations and bleeding, to help preserve life and limit the risk of VTE or other adverse event. Clinical experience suggests VTE prophylaxis is "an ideal subject for an evidence-based guideline" (NICE, 2010).

Further evidence suggest that "mechanical methods have been proven to be effective for surgical patients" without adding additional risks, such as bleeding (NICE, 2010, p. 6). These methods are the best for lower-risk patients. These patients are not necessarily a benefit to all patients, including stroke patients (NICE, 2010). Pharmacological methods are better for patients with a higher risk for VTE, including surgical patients that require more than mechanical methods alone (NICE, 2010). Some patients may require additional medications including antiplatelet medication, aspirin, and other measures, in the short- and long-term (NICE, 2010, p. 6). Still others will require all of the above measures and early moblisation following surgery. Because it is such a complicated process, there is a high measure of evidence suggesting it is critical to assess all patients prior to admission, during admission, and following discharge. These measures are absolutely essential to help minimize patient risk. Not only is this essential, but follow up is essential to ascertain just how effective the tool is that health professionals are using to assess the results of the patient outcome before, during, and after the procedure.


NICE does not cover children under 18, outpatients, individuals that are in urgent or acute care that do not receive inpatient care, elderly patients that receive residential care or who are in residential care treatment programs, or individuals that are admitted to a hospital program because they are signs and symptoms of DVT or PE (NICE, 2011). It covers only adults that are ages 18 and over who receive admittance to the hospital as inpatients per the clinical guidelines outlined by CG92 issued January 2010. (NICE, 2010). It provides guidance to individuals who may be at risk for DVT while they are staying in the hospital in the NHS in England and in Wales (NICE, 2010). NICE guidance is available to Hospitals, patients, and local communities. The purpose of these programmes is to ensure that the best quality health care systems are put into practice to provide cost effective and efficient programmes for everyone. Why? There is evidence that such practices will limit risk, producing the best outcomes for patients, while improving the health services available to the community.

This will provide more funding for other health care products and services, allowing healthcare reform. It ensures that the people within the community will have equal healthcare access, while allowing researchers to continue to develop new and more effective treatments (NICE, 2011). Tools like those established for VTE will "empower patients to be accountable for their care, knowing they will be cared for in a consistent, evidence-based approach" which in turn helps boost self-esteem and confidence, not just for patients, but also for their caregivers, and the doctors doing research and making decisions behind the scenes (NICE, 2011).

Patients through proper risk assessment and a fast recovery begin learning how they can care for their own health in the long-term, and this sets an example for other members of their community and family. Health care officials stop making decisions on their own, and make evidence-based decisions; clinical professionals can meet standards by basing their choices on standards that are set by regulatory bodies that use guidance developed by NICE. This allows for better judgment, judgment that is made with confidence and careful consideration (NICE, 2011). Premiums are reduced because risk management is doing a more effective job (NICE, 2011). Local governments can "fulfill its remit to promote the economic and social well-being of its communities" (NICE, 2011).

Studies based on surveys in June of 2009 suggest patient, caregiving and voluntary organisations are actively "promoting and supporting the implementation of NICE guidance" and activities supporting NICE include "awareness raising campaigns and promotional activities" as well as direct support and training for healthcare organisations and professionals (NICE, 2011).

The scope of assessment of patients for VTE should including assessment of mobility and risk for thrombosis (DH, 2010). Additionally, risk factors should include assessment based on a national tool that accounts for the risk for thromboprophylaxis, which may pose additional risk; next the patient related factors against bleeding risk, which may "preclude pharmacological intervention" (DH, 2010). Risk assessment will include review…

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