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Two pieces of draft safety solution guidance published today by NICE, in collaboration with the National Patient Safety Agency (NPSA), make important recommendations about the prevention of pneumonia in mechanically ventilated patients, and on how to improve processes to ensure that any medication patients are taking prior to admission to hospital is properly documented on admission. The draft guidance, which is out for public consultation until 10 October 2007, is the first of its kind from NICE to make recommendations on cost-effective interventions to prevent or mitigate patient harm in the NHS.

For the prevention of ventilator-associated pneumonia NICE has provisionally recommended that:

• Mechanically ventilated patients who are intubated should be positioned with their upper body elevated (semi-recumbent or sitting) for as much of the time as possible. For some patients this will not be appropriate (for example, those with spinal injuries).

• Oral antiseptics (for example, 2% chlorhexidine) should be included as part of the oral hygiene regimen for all patients who are intubated and receiving mechanical ventilation.

To improve medicines reconciliation at hospital admission NICE has provisionally recommended that:

• All individuals who prescribe to patients should be aware of what medications the patient is taking at admission, all hospital admitting units should put in place a policy for improving medicines reconciliation. In addition to specifying standardised systems for collecting and documenting information about current medications, the policy should ensure that:

- a pharmacist is involved in medicines reconciliation as soon as possible after hospital admission

- the responsibilities of pharmacists and other staff in medicines reconciliation are clearly defined; these responsibilities may differ between clinical areas
- strategies to assist those with communication difficulties in giving details of their medications are incorporated.

Andrew Dillon, Chief Executive of NICE said: “This is the first time NICE has developed guidance on safety issues within the NHS. Ventilator-associated pneumonia and ineffective medicines reconciliation at hospital admission are significant causes of patient morbidity and mortality and therefore present important safety concerns that need to be addressed. The core principals we apply to all guidance development and our extensive experience has enabled us to make strong recommendations that will help to improve patient safety in the NHS. We are keen to hear feedback on these draft recommendations and would urge people to send us their comments.”

Dr Helen Glenister, Deputy Chief Executive of the NPSA said: “Patient safety should be the top priority for everyone working in healthcare and we are delighted to be working with NICE on this new guidance. It’s an excellent opportunity for our two organisations to share our expertise and learn from each other for the benefit of frontline staff – and ultimately patients. We are building on our existing work in developing safety solutions and sharing this knowledge with NICE to reduce risk to patients in these two diverse areas.”

The draft guidance is available for public consultation on the NICE website until 10 October 2007. Comments received during this consultation will be reviewed at the next independent advisory committee meeting. NICE expects to issue final guidance to the NHS in December 2007.

About NICE
1. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

• public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector

 • health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS

• clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

About the NPSA
The National Patient Safety Agency (NPSA) helps the NHS in England and Wales learn from its mistakes so that it can improve patient safety. The NPSA does this by collecting reports on errors and other things that go wrong in healthcare so that it can recognise national trends and introduce practical ways of preventing problems. The NPSA doesn’t investigate individual cases or complaints, but it does listen to public concerns and use what the public says to improve safety.

About the patient safety pilot
3. As a result of the review of patient safety commissioned by the Chief Medical Officer1, the National Institute for Health and Clinical Excellence (NICE) and the National Patient Safety Agency (NPSA) were asked to develop and evaluate a pilot project for the production of a technical solution to address patient safety problems, which will form guidance for the NHS. NICE’s core principles of guidance development will be applied to the project. These principles include:

• A comprehensive evidence base
• Independent advisory committees
• Clinical and patient expert input
• Transparent process and decision making
• Genuine consultation
• Effective dissemination and implementation
• Regular review.

4. Medicines reconciliation is a long standing problem causing medication errors and potential harms to patients. It has been defined by Institute of Healthcare Improvement (IHI) as “being the process of identifying the most accurate list of a patient’s current medicines – including the name, dosage, frequency and route – and comparing them to the current list in use, recognising any discrepancies, and documenting any changes, thus resulting in a complete list of medications, accurately communicated.” (2005)

5. Ventilator-associated pneumonia is a primary problem in intensive care units, and causes complications in patients receiving mechanical ventilation. It is a medical condition that results from infection which floods the small, air-filled sacs (alveoli) in the lung responsible for absorbing oxygen from the atmosphere.

6. Draft recommendations and an overview of the patient safety pilot process can be found on the NICE website at http://www.nice.org.uk/PatientSafetyPilot.