Ensuring that mandatory guidance is being correctly implemented – experience of using the NICE technology appraisal audit tool from TA155

Swathi Panneerselvam, Brigid Ning, Yit C Yang, Nirodhini NarendranWolverhampton and Midland Counties Eye Infirmary, Wolverhampton, UKBackground: The National Institute for Clinical Excellence (NICE) Guidance TA155 for the treatment of wet age-related macular degeneration was issued in August 2008. In this work we describe our experience in the application of an audit tool for auditing the implementation of this guidance in our hospital setting and report on the specific and wider aspects of auditing guidance implementation.Method: Case notes of patients were retrospectively reviewed for compliance to the NICE Guidance TA155, using the audit tool provided, which investigated five domains. A full audit cycle was completed.Results: Our initial audit failed to reach a satisfactory level of compliance with NICE Guidance TA155 in one domain, which related to dissemination of patient information and documentation of treatment eligibility. To address this issue, we introduced specific changes to our processes, and on reaudit, were able to achieve a satisfactory level of compliance in all criteria.Conclusion: Audits on implementation of NICE guidance have not been widely reported in the clinical governance literature due to the specific relevance to individual departments. Our experience has demonstrated not only the usefulness of the audit tool in ensuring that our service was in adherence with NICE guidance but also, that as a result of introducing changes to ensure compliance, the quality of service provided to patients was further improved. Implementation of NICE guidance is an intrinsic part of the clinical governance process, and audits on the implementation of NICE guidance are requirements of all service providers, to ensure that there is uniform and systematic uptake of evidence-based medicine throughout the National Health Service.Keywords: ranibizumab, NICE, TA155, audit