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Review
. 2014 Apr;62(4):754-61.
doi: 10.1111/jgs.12768. Epub 2014 Apr 2.

NICE to HELP: operationalizing National Institute for Health and Clinical Excellence guidelines to improve clinical practice

Jirong Yue  1 , Patricia Tabloski, Sarah L Dowal, Margaret R Puelle, Rakesh Nandan, Sharon K Inouye
Affiliations
Review

NICE to HELP: operationalizing National Institute for Health and Clinical Excellence guidelines to improve clinical practice

Jirong Yue et al. J Am Geriatr Soc. 2014 Apr.

Abstract

The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom developed guidelines for the diagnosis, prevention, and management of delirium in July 2010 that included 10 recommendations for delirium prevention. The Hospital Elder Life Program (HELP) is a targeted multicomponent strategy that has proven effective and cost-effective at preventing functional and cognitive decline in hospitalized older persons. HELP provided much of the basis for seven of the NICE recommendations. Given interest by new HELP sites to meet NICE guidelines, three new protocols addressing hypoxia, infection, and pain that were not previously included in the HELP program were developed. In addition, the NICE dehydration guideline included constipation, which was not specifically addressed in the HELP protocols. This project describes the systematic development of three new protocols (hypoxia, infection, pain) and the expansion of an existing HELP protocol (constipation and dehydration) to achieve alignment between the HELP protocols and NICE guidelines. Following the Institute of Medicine recommendations for developing trustworthy guidelines, an interdisciplinary group of experts conducted a systematic review of current literature, rated the quality of the evidence, developed intervention protocols based on the highest-quality evidence, and submitted the protocols first to internal review and then to external review by an interdisciplinary panel of experts. The protocols were revised based on the review process and incorporated into the HELP materials. Inclusion of these protocols enhances the scope of the HELP program and allows fulfillment of NICE guideline recommendations for delirium prevention. The rigorous process applied may provide a useful example for updating existing guidelines or protocols that may be applicable to a broad range of clinical applications.

Keywords: Hospital Elder Life Program; NICE guidelines; delirium; hospital care; prevention.

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Conflict of interest statement

Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.

This work is dedicated to the memory of Joshua Bryan Inouye Helfand.

Figures

Figure 1
Figure 1. Relationship between NICE Guidelines and HELP Protocols*
*Note: The HELP model includes many other protocols not included in NICE. See www.Hospitalelderlifeprogram.org for full details.
Figure 2
Figure 2. Flowchart of the Literature Review Process*
* See text for details
See this image and copyright information in PMC

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