NICE Quality Standards
"NICE quality standards are a set of specific, concise statements and associated measures. They set out aspirational, but achievable, markers of high-quality, cost-effective patient care, covering the treatment and prevention of different diseases and conditions. Derived from the best available evidence such as NICE guidance and other evidence sources accredited by NHS Evidence, they are developed independently by NICE, in collaboration with NHS and social care professionals, their partners and service users, and address three dimensions of quality: clinical effectiveness, patient safety and patient experience."
Inflammatory Bowel Disease (IBD)
The 2 main forms of inflammatory bowel disease are Crohn's disease and ulcerative colitis. Both are chronic diseases that cause inflammation of the digestive system. Crohn's disease typically involves the distal ileum or colon but can occur anywhere in the gastrointestinal tract, whereas ulcerative colitis usually affects the rectum and a variable extent of the colon proximal to the rectum.
In Crohn's disease, inflammation of the digestive system leads to diarrhoea, abdominal pain, tiredness and weight loss. Symptoms of active disease or relapse of ulcerative colitis include bloody diarrhoea, an urgent need to defecate and abdominal pain. People with inflammatory bowel disease can go for long periods with few or no symptoms (this is known as remission), but these can be followed by a period of active disease when symptoms flare up (this is sometimes called a relapse or an exacerbation).
Hepatitis B is a viral infection that is transmitted by contact with the blood or body fluids of an infected person and is also transmitted perinatally from mother to child (vertical transmission). Some adults have an acute infection, in which the virus is cleared from the body naturally, whereas other people develop a chronic infection. Rates of progression from acute to chronic infection vary according to age at the time of infection. About 85% of hepatitis B infections in newborn babies become chronic compared with 4% in adults (Hepatitis B and C [NICE public health guidance 43]).
Constipation in Children and Young People
Children and young people with constipation can present to different types of healthcare professionals in primary, community and secondary care. Once constipation in children and young people has been recognised it is important to ensure that underlying causes of constipation and 'red flag' symptoms are excluded. A diagnosis of idiopathic constipation, in which the constipation cannot be explained by anatomical or physiological abnormalities, can only be made through a full assessment, including detailed history-taking and a physical examination by a healthcare professional.
Faecal incontinence is a symptom, rather than a diagnosis. For many people faecal incontinence is the result of a complex interplay of contributing factors. Effective management depends on identifying the factors causing faecal incontinence for each person, and finding a combination of interventions that is acceptable to the person and that gives best control of incontinence. Between 1 and 10% of adults are affected by faecal incontinence, depending on the definition used. It is likely that 0.5–1.0% of adults experience regular faecal incontinence that affects their quality of life. Nearly two-thirds of people with faecal incontinence also have urinary incontinence (known as double incontinence) although management, including any specialist input, may be quite distinct. Faecal incontinence has remained a largely hidden problem, with many people feeling too embarrassed to describe their symptoms to health and social care practitioners, or even to family and friends. People with faecal incontinence often experience social exclusion, and frequently suffer from stress, anxiety and depression. Appropriate care for people with faecal incontinence should lead to improvements in quality of life. For some people with faecal incontinence (such as people with neurological injury or severe cognitive impairment, or frail older people), better management may also eliminate or delay the need for residential care.
Acute Upper Gastrointestinal Bleeding
Acute upper gastrointestinal bleeding is a common medical emergency that has a 10% hospital mortality rate. People with acute upper gastrointestinal bleeding develop haematemesis (vomiting of blood from the upper gastrointestinal tract) or melaena (black tarry stools). The most common causes are peptic ulcer and oesophagogastric varices. Although crude hospital mortality of acute upper gastrointestinal bleeding has not improved much over several decades, patients are now older and have many more comorbidities than in the past. In addition, the number of people with variceal bleeding has increased greatly as a consequence of alcohol misuse and obesity. The stable hospital mortality rate in the face of the increased incidence shows that management of acute upper gastrointestinal bleeding has improved substantially.
Nutrition Support in Adults
The quality standard for nutrition support in adults requires that all care services take responsibility for the identification of people at risk of malnutrition and provide nutrition support for everyone who needs it. An integrated approach to the provision of services is fundamental to the delivery of high-quality care to adults who need nutrition support. It is particularly important that nutrition support services are multidisciplinary and overseen and led by senior level staff from across settings, for example through nutrition steering groups or committees.
The quality standard should be read in the context of national and local guidelines on training and competencies. Implementation of this quality standard is dependent on all care professionals involved in providing nutrition support to adults being appropriately trained and competent to deliver the actions and interventions described in the quality standard.
The NICE colorectal cancer quality standard defines clinical best practice and provides specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.
It covers the diagnosis and management of adults (18 years and older) with newly diagnosed and recurring adenocarcinoma of the colon and rectum. It includes diagnosis of suspected colorectal cancer, staging of the disease, management of both local and metastatic disease, and follow-up and regular surveillance for those free from disease after treatment.
Alcohol Dependence and Harmful Alcohol Use
This quality standard covers the care of children (aged 10-15 years), young people (aged 16-17 years) and adults (aged 18 years and over) drinking in a harmful way and those with alcohol dependence in all NHS-funded settings. It also includes opportunistic screening and brief interventions for hazardous and harmful drinkers. The quality standard addresses the prevention and management of Wernicke's encephalopathy but does not cover the separate management of other physical and mental health disorders associated with alcohol use.