1. Implementing NICE guidance
Venous thromboembolism: reducing the risk
Implementing NICE guidance
ABOUT THIS PRESENTATION:
This presentation has been written to help you raise awareness of the NICE clinical guideline on Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. This guideline has been written for healthcare teams responsible for the care of patients admitted to hospital.
This guidance is an update of NICE clinical guideline 46 (published April 2007) and replaces it.
The guideline is available in a number of formats, including a quick reference guide. See the end of the presentation for ordering details.
IMPORTANT
Because of the different recommendations within this guideline, based on the patient’s specific condition, proposed treatment and contraindications, it is essential to have copies of the quick reference guide available, particularly when presenting to a clinical audience.
You can add your own organisation’s logo alongside the NICE logo.
Where reference is made to slide numbers, these appear ONLY in the notes view and on printed notes. If slides are removed or added, it is the users responsibility to make the appropriate amendments to slide numbering.
We have included notes for presenters, broken down into ‘key points to raise’, which you can highlight in your presentation, and ‘additional information’ that you may want to draw on, such as a rationale or an explanation of the evidence for a recommendation. Where necessary, the recommendation will be given in full.
DISCLAIMER
This slide set is an implementation tool and should be used alongside the published guidance. This information does not supersede or replace the guidance itself.
PROMOTING EQUALITY
Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties.
January 2010
NICE clinical guideline 92

2. Updated guidance
This guideline updates ‘Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery’ (NICE clinical guideline 46, 2007).
NOTES FOR PRESENTERS:
This guideline updates and replaces the previous guideline ‘Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery’ (NICE clinical guideline 46, published April 2007).

3. What this presentation covers
Background
Scope
Definitions
Key priorities for implementation
Costs and savings
Discussion
Find out more
NOTES FOR PRESENTERS:
In this presentation we will start by providing some background to the guideline and why it is important.
We will then present the key priorities for implementation. The NICE guideline contains nine key priorities for implementation, which you can find on pages 7 and 8 of your quick reference guide.
The key priorities for implementation cover the following areas:
Assessing the risks of VTE and bleeding
Reducing the risk of VTE
Patient information and planning for discharge
Next, we will summarise the costs and savings that are likely to be incurred in implementing the guideline.
Then we will open the meeting up with a list of questions to help prompt a discussion on local issues for incorporating the guidance into practice.
Finally, we will end the presentation with further information about the support provided by NICE.

4. Background
It is estimated that 25,000 people in the UK die from preventable hospital-acquired venous thromboembolism (VTE) every year.
This includes patients admitted to hospital for medical care and surgery.
The inconsistent use of prophylactic measures for VTE in hospital patients has been widely reported. A UK survey suggested that 71% of patients assessed to be at medium or high risk of developing deep vein thrombosis did not receive any form of mechanical or pharmacological VTE prophylaxis. 
NOTES FOR PRESENTERS:
Additional information:
The House of Commons Health Committee reported in 2005 that 25,000 people in the UK die from preventable hospital-acquired venous thromboembolism (VTE) every year. This includes patients admitted to hospital for medical care and surgery. The inconsistent use of prophylactic measures for VTE in hospital patients has been widely reported. A UK survey suggested that 71% of patients assessed to be at medium or high risk of developing deep vein thrombosis did not receive any form of mechanical or pharmacological VTE prophylaxis.
VTE encompasses a range of clinical presentations. Venous thrombosis is often asymptomatic; less frequently it causes pain and swelling in the leg. Part or all of the thrombus can come free and travel to the lung as a potentially fatal pulmonary emboli . Symptomatic venous thrombosis carries a considerable burden of morbidity, including long-term morbidity because of chronic venous insufficiency. This in turn can cause venous ulceration and development of a post-thrombotic limb (characterised by chronic pain, swelling and skin changes).
VTE is an important cause of death in hospital patients, and treatment of non-fatal symptomatic VTE and related long-term morbidities is associated with considerable cost to the health service.
The risk of developing VTE depends on the condition and/or procedure for which the patient is admitted and on any predisposing risk factors (such as age, obesity and concomitant conditions).
House of Commons Health Committee (2005) The prevention of venous thromboembolism. London: The Stationery Office
Rashid ST, Thursz MR, Razvi NA et al. (2005) Venous thromboprophylaxis in UK medical inpatients. Journal of the Royal Society of Medicine 98 (11): 507–12

5. Scope
Adults (18 years and older), including pregnant women, admitted to hospital as inpatients, including:
surgical inpatients
inpatients with acute medical illness
trauma inpatients
patients admitted to intensive care units
cancer inpatients
people undergoing long-term rehabilitation in hospital
patients admitted to a hospital bed for day-case medical or surgical procedures
NOTES FOR PRESENTERS:
This guideline makes recommendations on assessing and reducing the risk of VTE in patients in hospital. It offers guidance on the most clinically and cost effective measures for VTE prophylaxis in these patients. The recommendations take into account the potential risks of the various options for prophylaxis and patient preferences.
Additional information:
The scope is shown on the slide.
Pregnant women admitted to hospital were identified as a group requiring special consideration and have specific recommendations in the guideline. This includes women admitted for management of pregnancy, including caesarean section as well as women admitted for other reasons other than their pregnancy.
During the review of the evidence, any additional groups that were shown to have particular clinical needs were given special consideration.
Groups that are not covered
a) People younger than 18 years.
b) People attending hospital as outpatients.
c) People presenting to emergency departments without admission.
d) Elderly or immobile people cared for at home, or in external residential accommodation, unless admitted to hospital.
e) Patients admitted to hospital with a diagnosis of, or suspected diagnosis of, deep vein thrombosis or pulmonary embolism.

6. Definitions VTE Significantly reduced mobility Major bleeding
Renal failure
Medicines licensing
NOTES FOR PRESENTERS:
VTE is a condition in which a blood clot (thrombus) forms in a vein. It most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. The thrombus may dislodge from its site of origin to travel in the blood – a phenomenon called embolism. VTE encompasses a range of clinical presentations. Venous thrombosis is often asymptomatic; less frequently it causes pain and swelling in the leg. Part or all of the thrombus can come free and travel to the lung as a potentially fatal pulmonary embolism. Symptomatic venous thrombosis carries a considerable burden of morbidity, including long-term morbidity because of chronic venous insufficiency. This in turn can cause venous ulceration and development of a post-thrombotic limb (characterised by chronic pain, swelling and skin changes).
Throughout this guidance ‘significantly reduced mobility’ is used to denote patients who are bedbound, unable to walk unaided or likely to spend a substantial proportion of the day in bed or in a chair.
‘Major bleeding’ refers to a bleeding event that results in one or more of the following:
death
a decrease in haemoglobin concentration of 2g/dl or more
transfusion of 2 or more units of blood
bleeding into a retroperitoneal, intracranial or intraocular site
a serious or life-threatening clinical event
a surgical or medical intervention.
‘Renal failure’ refers to an estimated glomeruler filtration rate (eGFR) of less than 30 ml/min/1.73m2 = CKD 4 or greater
The guideline assumes that prescribers will use a drug’s summary of product characteristics to inform decisions made with individual patients.
At the time of publication (January 2010) some types of Low molecular weight heparin (LMWH) do not have UK marketing authorisation for VTE prophylaxis in medical patients. Prescribers should consult the summary of product characteristics for the individual LMWH.

7. Patient admitted to hospital
Care pathway
Patient admitted to hospital
Assess VTE risk.
Assess bleeding risk
Balance risks of VTE and bleeding.
Offer VTE prophylaxis if appropriate. Do not offer pharmacological VTE prophylaxis if patient has any risk factor for bleeding and risk of bleeding outweighs risk of VTE.
Reassess risks of VTE and bleeding within 24 hours of admission and whenever clinical situation changes.

8. Key priorities for implementation
Assessing the risks of VTE and bleeding
Reducing the risk of VTE
Patient information and planning for discharge

9. Assessing the risks of VTE and bleeding
Assess all patients on admission to identify those who are at increased risk of VTE.
NOTES FOR PRESENTERS:
Additional information:
This supports the Chief Medical Officer’s recommendation that all patients admitted to hospital should have a VTE assessment. Details of the DH VTE working party can be found at
Recommendation in full: shown on slide

10. Assessing the risks of VTE – medical patients
Regard medical patients as being at increased risk of VTE if they:
have had or are expected to have significantly reduced mobility for 3 days or more or
are expected to have ongoing reduced mobility relative to their normal state and have one or more of the risk factors shown on slide 13
NOTES FOR PRESENTERS:
Recommendation in full: shown on slide (except that “slide 13” is “box 1” in the guideline and is shown on page 3 of the quick reference guide)

11. Assessing the risks of VTE – surgical patients
Regard surgical patients and patients with trauma as being at increased risk of VTE if they meet one of the following criteria:
surgical procedure with a total anaesthetic and surgical time of more than 90 minutes, or 60 minutes if the surgery involves the pelvis or lower limb
acute surgical admission with inflammatory or intra-abdominal condition
expected significant reduction in mobility
one or more of the risk factors shown on slide 13
NOTES FOR PRESENTERS:
Recommendation in full: shown on slide (except that “slide 13” is “box 1” in the guideline and is shown on page 3 of the quick reference guide)

12. Assessing the risks of bleeding and VTE prophylaxis
Assess all patients for risk of bleeding before offering pharmacological VTE prophylaxis. Do not offer pharmacological VTE prophylaxis to patients with any of the risk factors for bleeding shown on slide 13, unless the risk of VTE outweighs the risk of bleeding.
Reassess patients’ risks of bleeding and VTE within 24 hours of admission and whenever the clinical situation changes, to:
ensure that the methods of VTE prophylaxis being used are suitable
ensure that VTE prophylaxis is being used correctly
identify adverse events resulting from VTE prophylaxis.
NOTES FOR PRESENTERS:
Recommendations in full: shown on slide (except that “slide 13” is “box 2” in the guideline and is shown on page 3 of the quick reference guide)

13. Risk factors for VTE Active cancer or cancer treatment
Personal history or first-degree relative with a history of VTE
Age over 60 years
Use of hormone replacement therapy
Critical care admission
Use of oestrogen-containing contraceptive therapy
Dehydration
Varicose veins with phlebitis
Known thrombophilias
Obesity (BMI over 30 kg/m2)
One or more significant medical comorbidities
For women who are pregnant or have given birth within the previous 6 weeks see slide 15
Note – the order risk factors appear in these boxes is to best fit the space and not clinically significant. In CG92 they are listed in alphabetical order.
NOTES FOR PRESENTERS:
Key points to raise:
Significant medical comorbidities include: heart disease; metabolic, endocrine or respiratory pathologies; acute infectious diseases; inflammatory conditions
Recommendations in full: shown on slide (except that “slide 15” is “recommendations 1.6.4–1.6.6” in the guideline, shown on page 23 of the quick reference guide)

14. Risk factors for bleeding
Lumbar puncture/epidural/spinal anaesthesia within the previous 4 hours
Acquired bleeding disorders (such as acute liver failure)
Concurrent use of anticoagulants known to increase the risk of bleeding (such as warfarin with INR higher than 2)
Lumbar puncture/epidural/spinal anaesthesia expected within the next 12 hours
Untreated inherited bleeding disorders (such as haemophilia and von Willebrand’s disease)
Uncontrolled systolic hypertension (230/120 mmHg or higher)
Thrombocytopenia (platelets less than 75 x 109/l)
Acute stroke
Active bleeding
Note – the order risk factors appear in these boxes is to best fit the space and not clinically significant. In CG92 they are listed in alphabetical order.

15. Reducing the risk of VTE
Encourage patients to mobilise as soon as possible
Do not allow patients to become dehydrated unless clinically indicated.
Do not regard aspirin or other antiplatelet agents as adequate prophylaxis for VTE.
Consider temporary inferior vena caval filters for patients at high risk if mechanical and pharmacological VTE prophylaxis contraindicated
NOTES FOR PRESENTERS:
Only the first bullet point is a key recommendation, however the other three encompass the other general recommendations for reducing the risk
Recommendations in full:
Key recommendation
Encourage patients to mobilise as soon as possible [1.2.2]
Other recommendations:
Do not allow patients to become dehydrated unless clinically indicated [1.2.1]
Do not regard aspirin or other antiplatelet agents as adequate prophylaxis for VTE [1.2.3]
Consider offering temporary inferior vena caval filters to patients who are at very high risk of VTE (such as patients with a previous VTE event or an active malignancy) and for whom mechanical and pharmacological VTE prophylaxis are contraindicated [1.2.4]

16. Pregnancy and up to 6 weeks post partum
Risk factors
Use of LMWH
Use of mechanical prophylaxis
Use of combined methods
These are not key recommendations, but pregnancy and up to 6 weeks post partum was identified in the scope as an area for special consideration. There is an algorithm on page 23 of the quick reference guide.
Recommendations in full:
Pregnancy and up to 6 weeks post partum
Consider offering pharmacological VTE prophylaxis with LMWH (or UFH for patients with renal failure) to women who are pregnant or have given birth within the previous 6 weeks who are admitted to hospital but are not undergoing surgery, and who have one or more of the following risk factors:
expected to have significantly reduced mobility for 3 or more days age over 35 years
active cancer or cancer treatment critical care admission
excess blood loss or blood transfusion dehydration
obesity (pre-pregnancy or early pregnancy BMI over 30 kg/m2) known thrombophilias
personal history or a first-degree relative with a history of VTE varicose veins with phlebitis
one or more significant medical comorbidities (for example: heart disease; metabolic, endocrine or respiratory pathologies; acute infectious diseases; inflammatory conditions)
pregnancy-related risk factor (such as ovarian hyperstimulation, hyperemesis gravidarum, multiple pregnancy or pre-eclampsia) [1.6.4]
Consider offering combined VTE prophylaxis with mechanical methods and LMWH (or UFH for patients with renal failure) to women who are pregnant or have given birth within the previous 6 weeks who are undergoing surgery, including caesarean section. [1.6.5]
Offer mechanical and/or pharmacological VTE prophylaxis to women who are pregnant or have given birth within the previous 6 weeks only after carefully assessing the risks and benefits and discussing these with the woman and with healthcare professionals who have knowledge of the proposed method of VTE prophylaxis during pregnancy and post partum. Plan when to start and stop pharmacological VTE prophylaxis carefully to minimise the risk of bleeding. [1.6.6]

17. Reducing the risk of VTE in general medical patients
Offer pharmacological VTE prophylaxis to general medical patients assessed to be at increased risk of VTE.
Choose any one of :
fondaparinux sodium
low molecular weight heparin (LMWH)
unfractionated heparin (UFH) (for patients with renal failure).
Start pharmacological prophylaxis as soon as possible after risk assessment has been completed. Continue until the patient is no longer at increased risk of VTE.
NOTES FOR PRESENTERS:
Key points to raise:
It is important to note that section 1.1 of the guidance focuses on the assessment of risk of VTE and bleeding and that the choice of prophylaxis is based on both elements of assessment.
Recommendation in full:
Offer pharmacological VTE prophylaxis to general medical patients assessed to be at increased risk of VTE (see section 1.1). Choose any one of:
fondaparinux sodium
low molecular weight heparin (LMWH)
unfractionated heparin (UFH) (for patients with renal failure).
Start pharmacological VTE prophylaxis as soon as possible after risk assessment has been completed. Continue until the patient is no longer at increased risk of VTE.
At the time of publication (January 2010) some types of LMWH do not have UK marketing authorisation for VTE prophylaxis in medical patients. Prescribers should consult the summary of product characteristics for the individual LMWH. Informed consent for off-label use should be obtained and documented. [1.4.1]

18. Reducing the risk of VTE in other medical patients
Managing patients with:
Stroke
Cancer
Central venous catheters
Options for:
patients in palliative care
medical patients in whom pharmacological VTE prophylaxis is contraindicated
This slide relates to recommendations which are NOT key priorities for implementation, but is included to highlight the specific considerations for special patient groups.
NOTES FOR PRESENTERS:
The guideline, in recommendations to , makes recommendations for these specific groups of medical patients, indicating the appropriate use of
LMWH, unfractionated heparin and fondaparinux sodium
anti-embolism stockings (thigh or knee length)
foot impulse devices
intermittent pneumatic compression devices (thigh or knee length).
You should consult the quick reference guide for full details.

19. Surgical patients All surgery Cardiac Vascular
Gastrointestinal, gynaecological, thoracic and urological
Neurological (cranial or spinal)
Orthopaedic
elective hip replacement
elective knee replacement
hip fracture
other orthopaedic surgery
Day surgery and other surgery
This slide also relates to recommendations which are NOT key priorities for implementation , but is included to highlight the specific considerations for special patient groups.
NOTES FOR PRESENTERS:
The guideline, in recommendations to , makes recommendations for these specific groups of surgical patients, indicating the appropriate use of
LMWH, unfractionated heparin and fondaparinux sodium
dabigatran etexilate
anti-embolism stockings (thigh or knee length)
foot impulse devices
intermittent pneumatic compression devices (thigh or knee length).
You should consult the quick reference guide for full details.
ADDITIONAL INFORMATION
For all surgical patients
Advise patients to consider stopping oestrogen-containing oral contraceptives or hormone replacement therapy 4 weeks before elective surgery. If stopped, provide advice on alternative contraceptive methods.
[1.5.1]
Assess the risks and benefits of stopping pre-existing established antiplatelet therapy 1 week before surgery. Consider involving the multidisciplinary team in the assessment [1.5.2]
Consider regional anaesthesia for individual patients, in addition to other methods of VTE prophylaxis, as it carries a lower risk of VTE than general anaesthesia. Take into account patients’ preferences, their suitability for regional anaesthesia and any other planned method of VTE prophylaxis
[1.5.3]
If regional anaesthesia is used, plan the timing of pharmacological VTE prophylaxis to minimise the risk of epidural haematoma. If antiplatelet or anticoagulant agents are being used, or their use is planned, refer to the summary of product characteristics for guidance about the safety and timing of these agents in relation to the use of regional anaesthesia [1.5.4]
Do not routinely offer pharmacological or mechanical VTE prophylaxis to patients undergoing a surgical procedure with local anaesthesia by local infiltration with no limitation of mobility [1.5.5]

20. Other patient groups
Major trauma Spinal injury Lower limb plaster casts Critical care Patients already having antiplatelet agents or anticoagulation on admission or needing them for treatment
This slide also relates to recommendations which are NOT key priorities for implementation , but is included to highlight the specific considerations for special patient groups.
NOTES FOR PRESENTERS:
The guideline, in recommendations to and to (1.6.4 to relate to pregnancy and have been covered on slide 12), makes recommendations for these specific groups of patients, indicating the appropriate use of
LMWH, unfractionated heparin and fondaparinux sodium
anti-embolism stockings (thigh or knee length)
foot impulse devices
intermittent pneumatic compression devices (thigh or knee length).
You should consult the quick reference guide for full details.

21. Patient information
Before starting VTE prophylaxis, offer patients verbal and written information on:
the risks and possible consequences of VTE
the importance of VTE prophylaxis and its possible side effects
the correct use of VTE prophylaxis (for example, anti-embolism stockings, intermittent pneumatic compression or foot impulse devices)
how patients can reduce their risk of VTE (such as keeping well hydrated and, if possible, exercising and becoming more mobile).
NOTES FOR PRESENTERS:
Recommendation in full: shown on slide [1.7.2]
Other associated recommendations:
Be aware that heparins are of animal origin and this may be of concern to some patients. For patients who have concerns about using animal products, consider offering synthetic alternatives based on clinical judgement and after discussing their suitability, advantages and disadvantages with the patient.
See ‘Religion or belief: a practical guide for the NHS’, available from [1.7.1]
As part of the discharge plan, offer patients and/or their families or carers verbal and written information on:
the signs and symptoms of deep vein thrombosis and pulmonary embolism
the correct and recommended duration of use of VTE prophylaxis at home (if discharged with prophylaxis)
the importance of using VTE prophylaxis correctly and continuing treatment for the recommended duration (if discharged with prophylaxis)
the signs and symptoms of adverse events related to VTE prophylaxis (if discharged with prophylaxis)
the importance of seeking help and who to contact if they have any problems using the prophylaxis (if discharged with prophylaxis)
the importance of seeking medical help and who to contact if deep vein thrombosis, pulmonary embolism or other adverse events are suspected [1.7.3]

22. Planning for discharge
As part of the discharge plan, offer patients verbal and written information on:
the signs and symptoms of deep vein thrombosis and pulmonary embolism
the correct and recommended duration of use of VTE prophylaxis at home (if discharged with prophylaxis)
the importance of using VTE prophylaxis correctly and continuing treatment for the recommended duration (if discharged with prophylaxis)
the signs and symptoms of adverse events related to VTE prophylaxis (if discharged with prophylaxis)
the importance of seeking help and who to contact if they have any problems using the prophylaxis (if discharged with prophylaxis)
the importance of seeking medical help and who to contact if deep vein thrombosis, pulmonary embolism or another adverse event is suspected
NOTES FOR PRESENTERS:
Recommendation in full: shown on slide [1.7.3]
Other associated recommendations:
Ensure that patients who are discharged with anti-embolism stockings:
understand the benefits of wearing them
understand the need for daily hygiene removal
are able to remove and replace them, or have someone available who will be able to do this for them
know what to look for, such as skin marking, blistering or discolouration, particularly over the heels and bony prominences
know who to contact if there is a problem [1.7.4]
Ensure that patients who are discharged with pharmacological and/or mechanical VTE prophylaxis are able to use it correctly, or have arrangements made for someone to be available who will be able to help them [1.7.5]
Notify the patient’s GP if the patient has been discharged with pharmacological and/or mechanical VTE prophylaxis to be used at home [1.7.6]

23. Costs and savings per 100,000 population
Recommendations with significant costs
Costs per year (£)
Offer pharmacological VTE prophylaxis to general medical admissions assessed to be at risk of VTE
14,000
Offer VTE prophylaxis to admissions undergoing surgery
2,000
Estimated cost of implementation
16,000
Recommendations with significant savings
Savings per year (£)
Offer pharmacological VTE prophylaxis to general admissions patients assessed to be at risk of VTE – VTE events avoided
9,000
Offer VTE prophylaxis to admissions undergoing surgery –VTE events avoided
3,000
Estimated saving of implementation
12,000
ADAPTING THIS SLIDE FOR LOCAL USE:
The information on this slide has been extracted from the NICE costing report, which has been provided by NICE to support implementation of this guidance. It was developed after careful consideration of the available data and by working closely with the guideline developers and other people in the NHS. It is not NICE guidance. Assumptions used in this report are based on assessment of the national average and it is recognised that local practice or circumstances may differ from this. The costs published in this report are estimates only and are not to be taken as NICE’s view of desirable, or maximum or minimum figures.
We are aware that local factors such as incidence and baseline can vary considerably when compared with the national average. NICE has provided a costing template for you to calculate the financial impact this guideline will have locally. We encourage you to calculate the local impact of this guideline by amending the local variations in the template such as incidence, baseline and uptake. You can then remove the national figures from the table and replace them with your local figures to present to your colleagues.
NOTES FOR PRESENTERS:
NICE has worked closely with people within and outside the NHS to look at the major costs and savings related to implementing this guideline.
The estimated net costs per 100,000 population associated with implementing the venous thromboembolism guideline is £4,000. The costs and savings are summarised in the table above.
In addition, compliance with NICE guidance is one of the criteria indicating good risk reduction strategies, and in combination with meeting other criteria could lead to a discount on contributions to the NHS Litigation Authority schemes, including the clinical negligence scheme for trusts (CNST).
For further information please refer to the costing template and costing report for this guidance on the NICE website.

24. Discussion
How are different patient groups assessed on admission? How this need to change?
Are all eligible patient groups receiving the correct VTE prophylaxis?
What training do staff need to implement this guidance?
How do we need to improve discharge planning?
NOTES FOR PRESENTERS:
These questions are suggestions that have been developed to help provide a prompt for a discussion at the end of your presentation – please edit and adapt these to suit your local situation.
Additional /alternative questions :
What plans do we have to audit VTE risk assessment and prophylaxis?
What do different specialties need to do to identify their at-risk patients?
What standard or customised documentation do we need?

25. Find out more Visit www.nice.org.uk/guidance/CG92 for: the guideline
the quick reference guide
‘Understanding NICE guidance’
costing report and template
audit support
guide to resources
NOTES FOR PRESENTERS:
You can download the guidance documents from the NICE website.
The NICE guideline – all the recommendations.
A quick reference guide – a summary of the recommendations for healthcare professionals.
‘Understanding NICE guidance’ – information for patients and carers.
The full guideline – all the recommendations, details of how they were developed, and reviews of the evidence they were based on.
For printed copies of the quick reference guide or ‘Understanding NICE guidance’, phone NICE publications on or and quote reference numbers N2080 (quick reference guide) and/or N2081 (‘Understanding NICE guidance’).
NICE has developed tools to help organisations implement this guideline, which can be found on the NICE website.
Costing tools – a costing report gives the background to the national savings and costs associated with implementation, and a costing template allows you to estimate the local costs and savings involved.
Audit support – for monitoring local practice.
Guide to resources – to help guide people to resources that may support implementation