A-Z
Topics
Latest
A
- Abdominal aortic aneurysm
- Abortion care
- Accident prevention (see unintentional injuries among under-15s)
- Acute coronary syndromes: early management
- Acute coronary syndromes: secondary prevention and rehabilitation
- Acute heart failure
- Acute hospitals (adult inpatient wards), safe staffing for nursing
- Acute hospitals (adult inpatient wards), safe staffing for nursing
- Acute kidney injury
- Acute myocardial infarction (see acute coronary syndromes: early management)
- Acute pancreatitis (see pancreatitis)
- Acute upper gastrointestinal bleeding
- Acutely ill patients in hospital
- ADHD (see attention deficit hyperactivity disorder)
- Adult carers (see supporting adult carers)
- Advanced breast cancer
- Adverse drug reactions (see drug allergy)
- Age-related macular degeneration
- Aggression and violence
- Agoraphobia (see panic disorder)
- Air pollution
- Alcohol-use disorders
- Allergy, drug (see drug allergy)
- Allergy, food (see food allergy in children and young people)
- Allergy, severe reaction (see anaphylaxis)
- Alzheimer's disease (see dementia)
- Amyotrophic lateral sclerosis (see motor neurone disease)
- Anaemia management in people with chronic kidney disease
- Anaphylaxis: assessment and referral after emergency treatment
- Ankylosing spondylitis (see spondyloarthritis)
- Anorexia (see eating disorders)
- Antenatal and postnatal mental health
- Antenatal care for uncomplicated pregnancies
- Antibiotic prescribing for diabetic foot infections (see foot care for people with diabetes)
- Antibiotic prescribing for pneumonia
- Antibiotics for early-onset neonatal infection (see early-onset neonatal infection)
- Antibiotics in respiratory tract and ear infections
- Antimicrobial prescribing for common infections
- Antimicrobial stewardship
- Antimicrobials for bites and stings
- Antimicrobials for bronchiectasis (non-cystic fibrosis)
- Antimicrobials for cellulitis and erysipelas
- Antimicrobials for impetigo
- Antimicrobials for leg ulcer infection
- Antimicrobials for prostatitis
- Antisocial behaviour and conduct disorders in children and young people
- Antisocial personality disorder (see personality disorders)
- Anxiety (see generalised anxiety disorder)
- Aortic aneurysm, abdominal
- Aortic aneurysms
- Arthritis, osteoarthritis
- Arthritis, rheumatoid
- Asthma
- Atopic dermatitis (see eczema)
- Atopic eczema (see eczema)
- Atrial fibrillation
- Attachment difficulties in children and young people
- Attention deficit hyperactivity disorder
- Autism spectrum disorder
- Axial spondyloarthritis (see spondyloarthritis)
- Back pain, low
- Bacterial meningitis and meningococcal septicaemia in under 16s
- Barrett’s oesophagus
- Bed sores (see pressure ulcers)
- Bedwetting in children and young people
- Behaviour change
- Behaviour that challenges and learning disabilities
- Benign prostatic hyperplasia (see lower urinary tract symptoms in men)
- Bipolar disorder
- Bites and stings – antimicrobial prescribing
- Blackouts (see transient loss of consciousness)
- Bladder cancer
- Bladder infection (see urinary tract infections)
- Blood and bone marrow cancers
- Blood and immune system conditions
- Blood poisoning
- Blood pressure, high (see hypertension)
- Blood transfusion
- Body dysmorphic disorder (see obsessive-compulsive disorder)
- Borderline personality disorder (see personality disorders)
- Bowel cancer (see colorectal cancer)
- Bowel cancer prevention (see colonoscopic surveillance)
- Bowel incontinence (see faecal incontinence)
- Brain cancer (see brain tumours and metastases)
- Brain tumours and metastases
- Breast cancer, advanced
- Breast cancer, early and locally advanced
- Breast cancer, familial
- Breast conditions
- Breast milk, donor banks
- Breastfeeding (see maternal and child nutrition)
- Bronchiectasis (non-cystic fibrosis) – antimicrobial prescribing
- Bronchiolitis in children
- Bulimia (see eating disorders)
- Caesarean section
- Cancer of unknown primary origin (see metastatic malignant disease of unknown primary origin)
- Cancer, suspected
- Cannabis-based medicinal products
- Cardiovascular disease prevention
- Cardiovascular disease: identifying and supporting people most at risk of dying early
- Care and support of people growing older with learning disabilities
- Care homes, managing medicines
- Care homes, oral health
- Carers (see supporting adult carers)
- Cataracts
- Catheter-associated UTIs (see urinary tract infections)
- Cellulitis and erysipelas – antimicrobial prescribing
- Cerebral palsy
- Cervical cancer
- Challenging behaviour and learning disabilities
- Changing behaviour
- Chest pain
- Child abuse and neglect
- Child growth, faltering
- Child maltreatment (see child abuse and neglect)
- Childbirth (see fertility, pregnancy and childbirth)
- Children's attachment (see attachment difficulties in children and young people)
- Children's palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions)
- Cholelithiasis, cholecystitis and choledocholithiasis (see gallstone disease)
- Chronic fatigue syndrome myalgic encephalomyelitis
- Chronic heart failure
- Chronic kidney disease
- Chronic kidney disease, anaemia management
- Chronic kidney disease, hyperphosphataemia
- Chronic obstructive pulmonary disease
- Chronic pancreatitis (see pancreatitis)
- Cirrhosis
- Cluster headache (see headaches)
- Cochlear implants (see hearing loss)
- Coeliac disease
- Coexisting severe mental illness and substance misuse: assessment and management in healthcare settings
- Coexisting severe mental illness and substance misuse: community health and social care services
- Cold homes, reducing preventable excess winter deaths (see excess winter deaths and illnesses associated with cold homes)
- Colonoscopic surveillance
- Colorectal cancer
- Colorectal cancer prevention (see colonoscopic surveillance)
- Common mental health disorders in primary care
- Community engagement
- Community pharmacies: promoting health and wellbeing
- Community-acquired pneumonia (see pneumonia)
- Complex fractures (see trauma)
- Complex psychosis, rehabilitation for adults (see rehabilitation for adults with complex psychosis)
- Complex social factors and pregnancy: service provision
- Concussion and coma (see head injury)
- Conduct disorders and antisocial behaviour in children and young people
- Constipation
- Contraception
- Contraceptive services for under 25s
- Controlled drugs: safe use and management
- Cough (see self-limiting respiratory tract and ear infections – antibiotic prescribing)
- Criminal justice system, health of people in
- Critical illness rehabilitation
- Crohn’s disease
- Cycling and walking
- Cystic fibrosis
- Cystitis (see urinary tract infections)
- Deafness (see hearing loss)
- Decision-making and mental capacity
- Deep vein thrombosis (see venous thromboembolism)
- Delirium
- Dementia
- Dementia, disability and frailty in later life: mid-life approaches to delay or prevent onset
- Dental and oral health
- Dental perioperative care (see perioperative care)
- Dental services, local authority improvement approaches (see oral health improvement for local authorities and their partners)
- Depression
- Depression in children and young people
- Developmental follow-up of children and young people born preterm
- Diabetes
- Diabetes (type 2) prevention
- Diabetes in children and young people
- Diabetes in pregnancy
- Diabetic foot care
- Diarrhoea and vomiting in children
- Diet
- Diverticular disease
- Diverticulitis (see diverticular disease)
- Diverticulosis (see diverticular disease)
- Domestic violence and abuse
- Domiciliary care for older people
- Donor breast milk banks
- Drug allergy
- Drug misuse management in over 16s
- Drug misuse prevention
- Dual diagnosis (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings)
- Dual diagnosis (see coexisting severe mental illness and substance misuse: community health and social care services)
- Dyspepsia and gastro-oesophageal reflux disease
- Ear, nose and throat conditions
- Early and locally advanced breast cancer
- Early-onset neonatal infection
- Earwax removal (see hearing loss)
- Eating disorders
- Ectopic pregnancy and miscarriage
- Eczema
- Emergency and acute medical care in over 16s: service delivery and organisation
- End of life care for infants, children and young people (see end of life care for people with life-limiting conditions)
- End of life care for people with life-limiting conditions
- Endocarditis prophylaxis (see prophylaxis against infective endocarditis)
- Endocrine cancers
- Endocrine, nutritional and metabolic conditions
- Endometriosis
- Enteral nutrition (see nutrition support in adults)
- Epilepsy
- Excess winter deaths and illnesses associated with cold homes
- Exercise (see physical activity)
- Eye conditions
- Faecal incontinence
- Falls in older people (see preventing falls in older people)
- Faltering growth
- Familial breast cancer
- Familial hypercholesterolaemia
- Fatty liver disease, non-alcoholic
- Fertility
- Fertility, pregnancy and childbirth
- Fever in under 5s
- Feverish illness in children
- Fibroids, uterine (see heavy menstrual bleeding)
- Flu vaccination (see influenza)
- Food allergy in under 19s
- Foot care for people with diabetes
- Fractured neck of femur (see hip fracture)
- Fractures (see trauma)
- Fragility fractures (see osteoporosis)
- Gallstone disease
- Gastric cancer (see oesophageal and gastric cancer)
- Gastroenteritis in children (see diarrhoea and vomiting in children)
- Gastrointestinal bleeding, acute upper
- Gastrointestinal cancers
- Gastrointestinal conditions
- Gastro-oesophageal reflux disease and dyspepsia
- Generalised anxiety disorder
- Genomic biomarker-based treatment for solid tumours
- Gestational diabetes
- Glaucoma
- Glue ear (see surgical management of otitis media with effusion in children)
- Goitre (see thyroid disease)
- Graves' disease (see thyroid disease)
- Growth, faltering
- Gynaecological conditions (see urogenital conditions)
- Haematemesis (see acute upper gastrointestinal bleeding)
- Haematological cancers (see blood and bone marrow cancers)
- Harmful sexual behaviour among children and young people
- Head injury
- Headaches
- Health of people in the criminal justice system
- Health services, adult user experience
- Healthcare-associated infections, prevention and control
- Hearing loss
- Heart defects, structural
- Heart failure, acute
- Heart failure, chronic
- Heart rhythm conditions
- Heartburn (see dyspepsia and gastro-oesophageal reflux disease)
- Heavy menstrual bleeding
- Hepatitis B (chronic)
- Hepatitis B and C testing
- High blood pressure (see hypertension)
- Hip fracture
- Hip replacement (see joint replacement)
- Histology-independent treatment for solid tumours
- HIV testing and prevention
- Home care for older people
- Hospital-acquired pneumonia (see pneumonia)
- Human and animal bites
- Hypercholesterolaemia, familial (see familial hypercholesterolaemia)
- Hypercholesterolaemia, non-familial (see cardiovascular disease prevention)
- Hyperkinetic disorder (see attention deficit hyperactivity disorder)
- Hyperparathyroidism (primary)
- Hyperphosphataemia in chronic kidney disease
- Hypertension
- Hypertension in pregnancy
- Hyperthyroidism (see thyroid disease)
- Hypothyroidism (see thyroid disease)
- Idiopathic pulmonary fibrosis
- Immune system and blood conditions
- Immunisations for under 19s
- Impetigo
- Inadvertent perioperative hypothermia
- Incontinence, faecal
- Incontinence, urinary
- Incontinence, urinary in neurological disease
- Independence and mental wellbeing in older people
- Indoor air quality at home (see air pollution)
- Induction of labour
- Infant feeding (see maternal and child nutrition)
- Infant growth, faltering
- Infections, antimicrobials for common
- Infective endocarditis, prophylaxis
- Inflammatory bowel disease (see Crohn's disease)
- Inflammatory bowel disease (see ulcerative colitis)
- Influenza
- Injuries, multiple serious (see trauma)
- Insect bites and stings
- Intermediate care including reablement
- Interstitial lung disease (see idiopathic pulmonary fibrosis)
- Intraoperative care (see perioperative care)
- Intrapartum care
- Intrapartum care for women with existing medical conditions
- Intrapartum care for women with obstetric complications
- Intravenous fluid therapy in hospital
- Irritable bowel syndrome in adults
- Jaundice, neonatal
- Joint replacement
- Kidney cancer (see renal cancer)
- Kidney conditions
- Kidney disease, chronic
- Kidney injury, acute
- Kidney stones
- Knee replacement (see joint replacement)
- Labour (see intrapartum care)
- Labour, care for women with existing medical conditions (see intrapartum care for women with existing medical conditions)
- Labour, care for women with obstetric complications (see intrapartum care for women with obstetric complications)
- Labour, induced
- Larynx, mouth and throat cancer (see upper aerodigestive tract cancer)
- Learning disabilities and behaviour that challenges
- Learning disabilities, mental health problems
- Learning disabilities, older people
- Leg ulcers
- Leukaemia (see blood and bone marrow cancers)
- Life-limiting conditions, end of life care (see end of life care for people with life-limiting conditions)
- Lifestyle weight management services for overweight or obese adults
- Lifestyle weight management services for overweight or obese children and young people
- Lipid modification (see cardiovascular disease prevention)
- Liver cancers
- Liver conditions
- Liver disease, non-alcoholic fatty
- Local formulary development
- Long-term sickness absence and capability to work
- Looked-after babies, children and young people
- Low back pain and sciatica
- Lower limb peripheral arterial disease
- Lower urinary tract symptoms in men
- Lung cancer
- Lyme disease
- Lymphoma (see blood and bone marrow cancers)
- Lymphoma, non-Hodgkin's
- Macular degeneration, age-related
- Managing long-term sickness absence and capability to work
- Managing medicines for people receiving social care in the community
- Managing medicines in care homes
- Manic depression (see bipolar disorder)
- Maternal and child nutrition
- Maternity settings, safe midwifery staffing
- Medicines adherence (see medicines optimisation)
- Medicines optimisation
- Melanoma
- Meningitis, bacterial and meningococcal septicaemia
- Menopause
- Menorrhagia (see heavy menstrual bleeding)
- Mental capacity and decision-making
- Mental health disorders (common) in primary care
- Mental health problems in people with learning disabilities
- Mental health services, adult service user experience
- Mental health, antenatal and postnatal
- Mental illness (severe) and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services)
- Mental wellbeing and independence in older people
- Mental wellbeing at work
- Metabolic conditions (see endocrine, nutritional and metabolic conditions)
- Metastatic malignant disease of unknown primary origin
- Metastatic spinal cord compression
- Migraine (see headaches)
- Miscarriage and ectopic pregnancy
- Monitoring ill patients (see acutely ill patients in hospital)
- Motor neurone disease
- Mouth, larynx and throat cancer (see upper aerodigestive tract cancer)
- Multimorbidity
- Multiple long-term conditions (see multimorbidity)
- Multiple pregnancy (see twin and triplet pregnancy)
- Multiple sclerosis
- Multiple serious injuries (see trauma)
- Musculoskeletal conditions
- Myalgic encephalomyelitis, chronic fatigue syndrome
- Myeloma
- Myocardial infarction, secondary prevention and rehabilitation (see acute coronary syndromes: secondary prevention and rehabilitation)
- Needle and syringe programmes
- Neonatal infection (see early-onset neonatal infection)
- Neonatal jaundice
- Neonatal parenteral nutrition
- Neurological conditions
- Neurological disease, urinary incontinence
- Neuropathic pain
- Neutropenic sepsis
- Nocturnal enuresis (see bedwetting in children and young people)
- Non-alcoholic fatty liver disease
- Non-Hodgkin’s lymphoma
- Non-STEMI (see acute coronary syndromes: early management)
- Nose conditions (see ear, nose and throat conditions)
- NTRK fusion-positive solid tumours
- Nutrition support in adults
- Nutritional conditions (see endocrine, nutritional and metabolic conditions)
- Obesity
- Obesity: working with local communities
- Obsessive-compulsive disorder and body dysmorphic disorder
- Oesophageal and gastric cancer
- Older people with social care needs and multiple long-term conditions (see social care for older people with multiple long-term conditions)
- Older people, learning disabilities
- Older people: independence and mental wellbeing
- Opioids for pain relief in palliative care
- Oral and dental health
- Oral health for adults in care homes
- Oral health improvement for local authorities and their partners
- Organ donation for transplantation
- Osteoarthritis
- Osteoporosis
- Otitis media (acute) (see self-limiting respiratory tract and ear infections – antibiotic prescribing)
- Otitis media with effusion, surgical management in children
- Outdoor air quality and health (see air pollution)
- Ovarian cancer
- Overactive bladder (see urinary incontinence)
- Overweight or obese adults, lifestyle weight management services
- Overweight or obese children and young people, lifestyle weight management services
- Pain, neuropathic
- Palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions)
- Palliative care, opioids
- Pancreatic cancer
- Pancreatitis
- Panic disorder
- Parenteral nutrition (see nutrition support in adults)
- Parkinson’s disease
- Patient experience in adult NHS services
- Patient group directions
- Pelvic organ prolapse
- People with learning disabilities, mental health problems
- People’s experience in adult social care services
- Perioperative care
- Perioperative hypothermia, inadvertent
- Peripheral arterial disease, lower limb
- Personality disorders
- Physical activity
- Pneumonia
- Postnatal and antenatal mental health
- Postnatal care
- Postoperative care (see perioperative care)
- Post-traumatic stress disorder
- Pre-eclampsia (see hypertension in pregnancy)
- Pregnancy (see fertility, pregnancy and childbirth)
- Pregnancy and complex social factors: service provision
- Pregnancy, diabetes
- Pregnancy, hypertension
- Pregnancy, preventing teenage (see preventing sexually transmitted infections and under-18 conceptions)
- Pregnancy, twins and triplets (see twin and triplet pregnancy)
- Premature labour and birth (see preterm labour and birth)
- Premature ovarian insufficiency (see menopause)
- Preoperative care (see perioperative care)
- Preoperative tests
- Pressure ulcers
- Preterm labour and birth
- Preventing falls in older people
- Preventing sexually transmitted infections and under-18 conceptions
- Preventing suicide
- Preventing type 2 diabetes
- Prevention and control of healthcare-associated infections
- Primary hyperparathyroidism
- Prison, health of people in
- Promoting mental wellbeing at work
- Prophylaxis against infective endocarditis
- Prostate cancer
- Prostatitis – antimicrobial prescribing
- Psoriasis
- Psoriatic arthritis (see spondyloarthritis)
- Psychosis and schizophrenia
- Psychosis with coexisting substance misuse (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings)
- Psychosis, complex, rehabilitation for adults (see rehabilitation for adults with complex psychosis)
- Pulmonary embolism (see venous thromboembolism)
- Pyelonephritis (see urinary tract infections)
- Reablement (see intermediate care)
- Reactive arthritis (see spondyloarthritis)
- Rehabilitation after critical illness
- Rehabilitation for adults with complex psychosis
- Renal and ureteric stones
- Renal cancer
- Renal conditions
- Renal failure, acute (see acute kidney injury)
- Renal failure, established (see chronic kidney disease)
- Renal replacement therapy (see chronic kidney disease)
- Respiratory conditions
- Respiratory syncytial virus infection (see bronchiolitis in children)
- Respiratory tract and ear infections (self-limiting), antibiotic prescribing
- Rheumatoid arthritis
- Safe midwifery staffing for maternity settings
- Safe staffing for nursing in adult inpatient wards in acute hospitals
- Sarcoma
- Schizophrenia and psychosis
- Sciatica and low back pain
- Sedation in children and young people
- Seizures (see epilepsy)
- Self-harm
- Self-limiting respiratory tract and ear infections – antibiotic prescribing
- Sepsis
- Septicaemia, meningococcal and bacterial meningitis (see bacterial meningitis and meningococcal septicaemia)
- Service user experience in adult mental health services
- Severe mental illness and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services)
- Sexual behaviour, harmful
- Sexually transmitted infections, prevention
- Shoulder replacement (see joint replacement)
- Sickle cell disease: acute painful episode
- Sinusitis (see self-limiting respiratory tract and ear infections – antibiotic prescribing)
- Skin cancer
- Skin cancer prevention (see sunlight exposure: risks and benefits)
- Skin conditions
- Skin damage (see skin conditions)
- Smokeless tobacco cessation: South Asian communities
- Smoking
- Smoking cessation in secondary care
- Smoking: tobacco harm-reduction approaches
- Social and emotional wellbeing for children and young people
- Social anxiety disorder
- Social care for older people with multiple long-term conditions
- Social care services, people's experience
- Social factors (complex) in pregnancy: service provision
- Sore throat (see self-limiting respiratory tract and ear infections – antibiotic prescribing)
- Spasticity in children and young people
- Specialist neonatal respiratory care in preterm babies
- Spinal cord compression, metastatic (see metastatic spinal cord compression)
- Spinal injury (see trauma)
- Spondyloarthritis
- STEMI (see acute coronary syndromes: early management)
- Stomach cancer (see oesophageal and gastric cancer)
- Stroke
- Structural heart defects
- Substance misuse and severe mental illness, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services)
- Suicide prevention
- Sunlight exposure: risks and benefits
- Supporting adult carers
- Surgical care (see perioperative care)
- Surgical management of otitis media with effusion in children
- Surgical site infection (see prevention and control of healthcare-associated infections)
- Suspected cancer recognition and referral
- Suspected neurological conditions recognition and referral (see neurological conditions)
- Teenage pregnancy prevention (see preventing sexually transmitted infections and under-18 conceptions)
- Termination of pregnancy (see abortion care)
- Throat conditions (see ear, nose and throat conditions)
- Throat, larynx and mouth cancer (see upper aerodigestive tract cancer)
- Thyroid disease
- Thyrotoxicosis (see thyroid disease)
- Tinnitus
- Tissue viability (see pressure ulcers)
- Tobacco (see smoking)
- Tobacco cessation (smokeless): South Asian communities
- Tobacco harm reduction approaches
- Transfusion (see blood transfusion)
- Transient ischaemic attack (see stroke)
- Transient loss of consciousness
- Transition between community or care home and inpatient mental health settings
- Transition between inpatient hospital settings and community or care home settings for adults with social care needs
- Transition from children's to adults' services
- Trauma
- Triplet and twin pregnancy
- Tuberculosis
- Twin and triplet pregnancy
- Type 1 and type 2 diabetes in children and young people
- Type 1 diabetes in adults
- Type 2 diabetes in adults
- Type 2 diabetes prevention
- Ulcerative colitis
- Unintentional injuries among under-15s
- Unstable angina (see acute coronary syndromes: early management)
- Upper aerodigestive tract cancer
- Upper gastrointestinal bleeding, acute
- Ureteric stones
- Urinary incontinence and pelvic organ prolapse in women
- Urinary incontinence in neurological disease
- Urinary tract infections
- Urinary tract symptoms in men, lower
- Urogenital conditions
- Urological conditions (see urogenital conditions)
- Vaccinations (see immunisation for children and young people)
- Varicose veins in the legs
- Venous thromboembolism
- Violence and aggression
- Vitamin D: supplement use in specific population groups
- Vomiting and diarrhoea in children
- Walking and cycling
- Weight management services (lifestyle) for overweight or obese adults
- Weight management services (lifestyle) for overweight or obese children and young people
- Winter deaths and illnesses associated with cold homes (see excess winter deaths and illnesses associated with cold homes)
- Workplace health: policy and management practices
- Young offender institutions, health of people in
-
Conditions and diseases
-
Blood and immune system conditions
- Allergies
- Anaphylaxis: assessment and referral after emergency treatment
- Blood and bone marrow cancers
- Blood conditions
- Coeliac disease
- Breast conditions
-
Cancer
- Bladder cancer
- Blood and bone marrow cancers
- Brain tumours and metastases
- Breast cancer
- Cervical cancer
- Complications of cancer
- Endocrine cancers
- Gastrointestinal cancers
- Genomic biomarker-based treatment for solid tumours
- Liver cancers
- Lung cancer
- Metastatic malignant disease of unknown primary origin
- Ovarian cancer
- Pancreatic cancer
- Prostate cancer
- Renal cancer
- Sarcoma
- Skin cancer
- Suspected cancer recognition and referral
- Upper aerodigestive tract cancer
-
Cardiovascular conditions
- Acute coronary syndromes
- Aortic aneurysms
- Cardiovascular disease: identifying and supporting people most at risk of dying early
- Chest pain
- Heart failure
- Heart rhythm conditions
- Hypertension
- Lipid disorders
- Lower limb peripheral arterial disease
- Prophylaxis against infective endocarditis
- Stable angina
- Stroke
- Structural heart defects
- Varicose veins in the legs
- Venous thromboembolism
- Chronic fatigue syndrome myalgic encephalomyelitis
- Diabetes and other endocrine, nutritional and metabolic conditions
-
Digestive tract conditions
- Acute upper gastrointestinal bleeding
- Barrett’s oesophagus
- Coeliac disease
- Constipation
- Cystic fibrosis
- Diarrhoea and vomiting in children
- Diverticular disease
- Dyspepsia and gastro-oesophageal reflux disease
- Faecal incontinence
- Gallstone disease
- Gastrointestinal cancers
- Gastrointestinal conditions
- Inflammatory bowel disease
- Irritable bowel syndrome in adults
- Pancreatitis
- Upper aerodigestive tract cancer
- Ear, nose and throat conditions
- Eye conditions
-
Fertility, pregnancy and childbirth
- Contraception
- Fertility
- Intrapartum care
-
Postnatal care
- Antenatal and postnatal mental health
- Developmental follow-up of children and young people born preterm
- Donor breast milk banks
- Early-onset neonatal infection
- Faltering growth
- Maternal and child nutrition
- Neonatal jaundice
- Neonatal parenteral nutrition
- Specialist neonatal respiratory care in preterm babies
- Pregnancy
- Genetic conditions
- Gynaecological conditions
-
Infections
-
Antibiotic use
- Antimicrobial prescribing for common infections
- Antimicrobial stewardship
- Bites and stings – antimicrobial prescribing
- Bronchiectasis (non-cystic fibrosis) – antimicrobial prescribing
- Cellulitis and erysipelas – antimicrobial prescribing
- Early-onset neonatal infection
- Foot care for people with diabetes
- Impetigo
- Leg ulcers
- Pneumonia
- Prophylaxis against infective endocarditis
- Prostatitis – antimicrobial prescribing
- Self-limiting respiratory tract and ear infections – antibiotic prescribing
- Urinary tract infections
- Bacterial meningitis and meningococcal septicaemia in under 16s
- Fever in under 5s
- Hepatitis
- HIV testing and prevention
- Influenza
- Lyme disease
- Preventing sexually transmitted infections and under-18 conceptions
- Prevention and control of healthcare-associated infections
- Sepsis
- Tuberculosis
-
Antibiotic use
- Injuries, accidents and wounds
- Kidney conditions
-
Liver conditions
- Alcohol-use disorders
- Chronic liver disease
- Hepatitis
- Liver cancers
-
Mental health and behavioural conditions
- Alcohol-use disorders
- Antenatal and postnatal mental health
- Antisocial behaviour and conduct disorders in children and young people
- Anxiety
- Attachment difficulties in children and young people
- Attention deficit hyperactivity disorder
- Autism spectrum disorder
- Bipolar disorder
- Common mental health disorders in primary care
- Decision-making and mental capacity
- Delirium
- Dementia
- Depression
- Depression in children and young people
- Eating disorders
- Harmful sexual behaviour among children and young people
- Health of people in the criminal justice system
- Learning disabilities and behaviour that challenges
- Mental health problems in people with learning disabilities
- Personality disorders
- Post-traumatic stress disorder
- Psychosis and schizophrenia
- Rehabilitation for adults with complex psychosis
- Self-harm
- Service user experience in adult mental health services
- Transition between community or care home and inpatient mental health settings
- Violence and aggression
- Multiple long-term conditions
- Musculoskeletal conditions
- Neonatal parenteral nutrition
-
Neurological conditions
- Brain tumours and metastases
- Cerebral palsy
- Delirium
- Dementia
- Epilepsy
- Faecal incontinence
- Headaches
- Metastatic spinal cord compression
- Motor neurone disease
- Multiple sclerosis
- Neuropathic pain
- Parkinson’s disease
- Spasticity in children and young people
- Transient loss of consciousness
- Trauma
- Urinary incontinence
- Oral and dental health
- Respiratory conditions
- Skin conditions
- Urogenital conditions
- Urological conditions
-
Blood and immune system conditions
-
Health protection
- Communicable diseases
- Drug misuse
- Environment
-
Lifestyle and wellbeing
- Air pollution
- Alcohol
- Behaviour change
- Cardiovascular disease: identifying and supporting people most at risk of dying early
- Community pharmacies: promoting health and wellbeing
- Diet, nutrition and obesity
- Drug misuse
-
Mental health and wellbeing
- Antenatal and postnatal mental health
- Cardiovascular disease: identifying and supporting people most at risk of dying early
- Decision-making and mental capacity
- Health of people in the criminal justice system
- Mental wellbeing and independence in older people
- Promoting mental wellbeing at work
- Social and emotional wellbeing for children and young people
- Oral and dental health
- Physical activity
- Sexual health
- Smoking and tobacco
- Suicide prevention
- Sunlight exposure
-
Population groups
- Adult carers
- Behaviour change
- Black and minority ethnic groups
-
Children and young people
- Alcohol-use disorders
- Antisocial behaviour and conduct disorders in children and young people
- Asthma
- Attachment difficulties in children and young people
- Attention deficit hyperactivity disorder
- Autism spectrum disorder
- Bedwetting in children and young people
- Bronchiolitis in children
- Cerebral palsy
- Child abuse and neglect
- Constipation
- Depression in children and young people
- Diabetes in children and young people
- Diarrhoea and vomiting in children
- Dyspepsia and gastro-oesophageal reflux disease
- Eczema
- End of life care for people with life-limiting conditions
- Faltering growth
- Fever in under 5s
- Food allergy in under 19s
- Harmful sexual behaviour among children and young people
- Immunisations for under 19s
- Intravenous fluid therapy in hospital
- Lifestyle weight management services for overweight or obese children and young people
- Looked-after babies, children and young people
- Pneumonia
- Preventing sexually transmitted infections and under-18 conceptions
- Psychosis and schizophrenia
- Sedation in children and young people
- Sepsis
- Social and emotional wellbeing for children and young people
- Spasticity in children and young people
- Suicide prevention
- Surgical management of otitis media with effusion in children
- Transition between community or care home and inpatient mental health settings
- Transition from children's to adults' services
- Unintentional injuries among under-15s
- Urinary tract infections
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Infants and neonates
- Cerebral palsy
- Developmental follow-up of children and young people born preterm
- Diarrhoea and vomiting in children
- Dyspepsia and gastro-oesophageal reflux disease
- Early-onset neonatal infection
- End of life care for people with life-limiting conditions
- Faltering growth
- Fever in under 5s
- Looked-after babies, children and young people
- Maternal and child nutrition
- Neonatal jaundice
- Postnatal care
- Sedation in children and young people
- Sepsis
- Specialist neonatal respiratory care in preterm babies
-
Older people
- Care and support of people growing older with learning disabilities
- Cataracts
- Dementia
- Dementia, disability and frailty in later life: mid-life approaches to delay or prevent onset
- End of life care for people with life-limiting conditions
- Excess winter deaths and illnesses associated with cold homes
- Hearing loss
- Home care for older people
- Mental wellbeing and independence in older people
- Preventing falls in older people
- Social care for older people with multiple long-term conditions
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People with learning disabilities
- Cardiovascular disease: identifying and supporting people most at risk of dying early
- Care and support of people growing older with learning disabilities
- Harmful sexual behaviour among children and young people
- Learning disabilities and behaviour that challenges
- Mental health problems in people with learning disabilities
-
Vulnerable groups
- Cardiovascular disease: identifying and supporting people most at risk of dying early
- Coexisting severe mental illness and substance misuse: community health and social care services
- Decision-making and mental capacity
- Domestic violence and abuse
- Harmful sexual behaviour among children and young people
- Health of people in the criminal justice system
- Influenza
- Intrapartum care for women with existing medical conditions
- Intrapartum care for women with obstetric complications
- Looked-after babies, children and young people
- People’s experience in adult social care services
- Pregnancy and complex social factors: service provision
- Suicide prevention
- Tuberculosis
-
Service delivery, organisation and staffing
- Acute and critical care
-
Adult social services
- Coexisting severe mental illness and substance misuse: community health and social care services
- Domestic violence and abuse
- Home care for older people
- Intermediate care including reablement
- Managing medicines for people receiving social care in the community
- Social care for older people with multiple long-term conditions
- Transition between community or care home and inpatient mental health settings
- Transition between inpatient hospital settings and community or care home settings for adults with social care needs
- Transition from children's to adults' services
- Contraception
- End of life care
-
Maternity services
- Intrapartum care
- Postnatal care
- Pregnancy
- Safe midwifery staffing for maternity settings
-
Medicines management
-
Antibiotics
- Antimicrobial prescribing for common infections
- Antimicrobial stewardship
- Bites and stings – antimicrobial prescribing
- Bronchiectasis (non-cystic fibrosis) – antimicrobial prescribing
- Cellulitis and erysipelas – antimicrobial prescribing
- Early-onset neonatal infection
- Foot care for people with diabetes
- Impetigo
- Leg ulcers
- Pneumonia
- Prophylaxis against infective endocarditis
- Prostatitis – antimicrobial prescribing
- Self-limiting respiratory tract and ear infections – antibiotic prescribing
- Urinary tract infections
- Cannabis-based medicinal products
- Controlled drugs: safe use and management
- Drug allergy
- Intravenous fluid therapy in hospital
- Local formulary development
- Managing medicines for people receiving social care in the community
- Managing medicines in care homes
- Medicines optimisation
- Patient group directions
-
Antibiotics
- Oral and dental health
- Organ and tissue transplantation
- Patient and service user care
- Safeguarding
-
Service transition
- Health of people in the criminal justice system
- Intermediate care including reablement
- Transition between community or care home and inpatient mental health settings
- Transition between inpatient hospital settings and community or care home settings for adults with social care needs
- Transition from children's to adults' services
- Staffing
- Suicide prevention
- Surgical care
-
Settings
- Accident and injury prevention
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Care homes
- Attachment difficulties in children and young people
- Delirium
- Dementia
- Harmful sexual behaviour among children and young people
- Learning disabilities and behaviour that challenges
- Looked-after babies, children and young people
- Managing medicines in care homes
- Oral health for adults in care homes
- Pneumonia
- Pressure ulcers
- Prevention and control of healthcare-associated infections
- Suicide prevention
- Transition between community or care home and inpatient mental health settings
- Transition between inpatient hospital settings and community or care home settings for adults with social care needs
- Urinary tract infections
-
Communities
- Air pollution
- Cardiovascular disease: identifying and supporting people most at risk of dying early
- Care and support of people growing older with learning disabilities
- HIV testing and prevention
- Managing medicines for people receiving social care in the community
- Obesity: working with local communities
- People’s experience in adult social care services
- Suicide prevention
- Transition between community or care home and inpatient mental health settings
- Transition between inpatient hospital settings and community or care home settings for adults with social care needs
- Community engagement
- Community pharmacies: promoting health and wellbeing
- Drug misuse
- Environment
-
Home
- Care and support of people growing older with learning disabilities
- Excess winter deaths and illnesses associated with cold homes
- Home care for older people
- Intermediate care including reablement
- People’s experience in adult social care services
- Pneumonia
- Suicide prevention
- Supporting adult carers
- Urinary tract infections
-
Hospitals
- Acutely ill patients in hospital
- Intermediate care including reablement
- Intravenous fluid therapy in hospital
- Pneumonia
- Pressure ulcers
- Prevention and control of healthcare-associated infections
- Sedation in children and young people
- Sepsis
- Smoking cessation in secondary care
- Transition between community or care home and inpatient mental health settings
- Transition between inpatient hospital settings and community or care home settings for adults with social care needs
- Urinary tract infections
-
Prisons and other secure settings
- Alcohol-use disorders
- Cardiovascular disease: identifying and supporting people most at risk of dying early
- Coexisting severe mental illness and substance misuse: assessment and management in healthcare settings
- Common mental health disorders in primary care
- Controlled drugs: safe use and management
- Drug misuse
- Health of people in the criminal justice system
- Hepatitis B and C testing
- HIV testing and prevention
- Immunisations for under 19s
- Looked-after babies, children and young people
- Personality disorders
- Preventing type 2 diabetes
- Smoking
- Smoking: tobacco harm-reduction approaches
- Suicide prevention
- Tuberculosis
- Type 1 diabetes in adults
- Violence and aggression
-
Schools and other educational settings
- Alcohol-use disorders
- Attachment difficulties in children and young people
- Attention deficit hyperactivity disorder
- Autism spectrum disorder
- Child abuse and neglect
- Harmful sexual behaviour among children and young people
- Immunisations for under 19s
- Looked-after babies, children and young people
- Preventing sexually transmitted infections and under-18 conceptions
- Smoking
- Social and emotional wellbeing for children and young people
- Unintentional injuries among under-15s
- Transport
- Workplaces
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Cataracts
About
What is covered
This NICE Pathway covers managing cataracts in adults aged 18 and over. It aims to improve care before, during and after cataract surgery by optimising service organisation, referral and surgical management, and reducing complications. It further aims to improve the availability of information for people with cataracts before, during and after cataract surgery.
Updates
Updates to this NICE Pathway
11 February 2019 Serious eye disorders (NICE quality standard 180) added.
Person-centred care
People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
Your responsibility
Guidelines
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.
Technology appraisals
The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.
Medical technologies guidance, diagnostics guidance and interventional procedures guidance
The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.
Short Text
What is covered
This NICE Pathway covers managing cataracts in adults aged 18 and over. It aims to improve care before, during and after cataract surgery by optimising service organisation, referral and surgical management, and reducing complications. It further aims to improve the availability of information for people with cataracts before, during and after cataract surgery.
Updates
Updates to this NICE Pathway
11 February 2019 Serious eye disorders (NICE quality standard 180) added.
Sources
NICE guidance and other sources used to create this interactive flowchart.
Cataracts in adults: management (2017) NICE guideline NG77
Implantation of multifocal (non-accommodative) intraocular lenses during cataract surgery (2008) NICE interventional procedures guidance 264
Implantation of accommodating intraocular lenses for cataract (2007) NICE interventional procedures guidance 209
Serious eye disorders (2019) NICE quality standard 180
Related
Quality standards
Serious eye disorders
These quality statements are taken from the serious eye disorders quality standard. The quality standard defines clinical best practice for serious eye disorders and should be read in full.
Quality statements
Referral – chronic open angle glaucoma and related conditions
This quality statement is taken from the serious eye disorders quality standard. The quality standard defines clinical best practice for serious eye disorders and should be read in full.
Quality statement
Adults with signs of possible glaucoma or related conditions on a routine sight test have additional tests before they are referred for a diagnosis.
Rationale
Accurate diagnosis of chronic open angle glaucoma (COAG) or related conditions is important because they can lead to irreversible damage to the optic nerve and sight loss. As well as the routine sight test, additional tests are needed for people with possible glaucoma to support more accurate referrals for further investigation and diagnosis. They ensure that adults with COAG or related conditions have prompt diagnosis and treatment and people who do not need referral avoid unnecessary investigations.
Quality measures
Structure
a) Evidence of the availability of equipment for performing the additional tests needed before referral for further investigation and diagnosis of COAG or related conditions.
Data source: Local data collection, for example, service specifications.
b) Evidence of the availability of staff trained to perform the additional tests needed before referral for further investigation and diagnosis of COAG or related conditions.
Data source: Local data collection, for example, staff rotas and staff training records.
Process
Proportion of adults with signs of possible glaucoma on a routine sight test who had additional tests before referral for further investigation and diagnosis of COAG or related conditions.
Numerator – the number in the denominator who had additional tests before referral for further investigation and diagnosis of COAG or related conditions.
Denominator – the number of adults with signs of possible glaucoma on a routine sight test referred for further investigation and diagnosis of COAG or related conditions.
Data source: Local data collection, for example, patient records and referral records.
Outcome
Rates of false-positive referrals for further investigation and diagnosis of COAG or related conditions.
Data source: Local data collection, for example, patient records and referral records.
What the quality statement means for different audiences
Service providers (such as community optometry services) ensure that equipment, staff training and local referral pathways support adults with possible glaucoma to have additional tests after the routine sight test and before referral for further investigation and diagnosis of COAG or related conditions.
Healthcare professionals (such as community optometrists) ensure additional tests are performed when signs of possible glaucoma are detected on a routine sight test and refer on the basis of these results.
Commissioners (clinical commissioning groups and NHS England) ensure that services have agreed protocols and ensure service availability to support accurate referral into hospital eye services for adults with possible COAG or related conditions. They monitor referrals.
Adults with possible glaucoma have a range of tests after the routine sight test and before they are referred to hospital eye services. This means that only people needing further investigations are referred, which may reduce waiting times.
Source guidance
Glaucoma: diagnosis and management. NICE guideline NG81 (2017), recommendation 1.1.1
Definitions of terms used in this quality statement
Possible glaucoma or related conditions
Signs of possible glaucoma or related conditions include:
- a glaucomatous-type visual field defect
- visible structural damage to the optic nerve head
- an intraocular pressure of 24 mmHg or more.
[Adapted from NICE’s guideline on glaucoma, recommendation 1.1.5, and expert opinion]
Additional tests
If a routine sight test suggests signs of possible glaucoma, all of the following additional tests should be undertaken before referral:
- central visual field assessment using standard automated perimetry (full threshold or supra threshold)
- optic nerve assessment and fundus examination using stereoscopic slit lamp biomicroscopy (with pupil dilatation if necessary), and optical coherence tomography (OCT) or optic nerve head image if available
- intraocular pressure measurement using Goldmann-type applanation tonometry
- peripheral anterior chamber configuration and depth assessments using gonioscopy or, if not available or the person prefers, the van Herick test or OCT.
[NICE’s guideline on glaucoma, recommendation 1.1.1]
Referral for cataract surgery
This quality statement is taken from the serious eye disorders quality standard. The quality standard defines clinical best practice for serious eye disorders and should be read in full.
Quality statement
Adults with cataracts are not refused surgery based on visual acuity alone.
Rationale
The decision to undertake cataract surgery should be based on discussions with the person about the effect of cataract on their quality of life, the risks and benefits of surgery and what may happen if they choose not to have surgery. Measurement of visual acuity often fails to detect vision problems that may benefit from cataract surgery (for example, glare and loss of colour vision). The decision should include consideration of a patient’s quality of life and symptoms such as difficulty with reading, night driving, work or home activities, glare and loss of contrast, despite appropriate optical correction. Restricting access to surgery based on visual acuity alone has an impact on quality of life for some people with cataracts. The decision to undertake cataract surgery should be made on the same basis for first and second eyes.
Quality measures
Structure
Evidence of local agreements to include vision difficulties affecting quality of life in the criteria for referral and access to cataract surgery. The same criteria should be used for first- and second-eye cataract surgery.
Data source: Local data collection, for example, service specifications and local commissioning agreements for cataract surgery.
Process
a) Proportion of presentations of cataract where the person has a discussion about how their vision affects their quality of life.
Numerator – the number in the denominator where the person has a discussion about how their vision affects their quality of life.
Denominator – the number of presentations of cataract.
Data source: Local data collection, for example, patient records.
b) Proportion of presentations of cataract that are refused referral for surgery based on visual acuity alone.
Numerator – the number in the denominator that are refused referral for surgery based on visual acuity alone.
Denominator – the number of presentations of cataract.
Data source: Local data collection, for example, patient records or referral records.
c) Proportion of referrals for cataract surgery that are not accepted based on visual acuity alone.
Numerator – the number in the denominator that are not accepted based on visual acuity alone.
Denominator – the number of referrals for cataract surgery.
Data source: Local data collection, for example, patient records or referral records.
Outcome
Health-related quality of life for adults with cataracts.
Data source: Local data collection, for example, results from a questionnaire or patient-reported outcome measure on self-reported improvement after surgery, such as the Cat-PROM5 questionnaire (National Cataract Surgery Audit – Cat-PROM5 currently being piloted).
What the quality statement means for different audiences
Service providers (such as community optometry practices, referral management centres and NHS hospital trusts) ensure that referral pathways for cataract surgery are based on criteria that include vision difficulties affecting quality of life, and not just visual acuity alone. The decision to undertake cataract surgery should be made on the same basis for first and second eyes.
Healthcare professionals (such as ophthalmologists, optometrists, orthoptists and advanced nurse practitioners) base decisions about cataract surgery on a discussion with the person of the impact of the cataract(s) on their quality of life and the risks and benefits of having, and not having, surgery. Visual acuity should not be used as the sole basis for deciding to refer for or perform surgery. The decision to undertake cataract surgery should be made on the same basis for first and second eyes.
Commissioners (clinical commissioning groups and NHS England) commission services that provide access for adults to cataract surgery based on criteria other than visual acuity alone. The other criteria include vision difficulties affecting quality of life. They monitor services to ensure that this is happening. The decision to undertake cataract surgery should be made on the same basis for first and second eyes.
Adults with cataracts are involved in discussion of how cataracts affect their everyday life, how they affect their vision, the risks and benefits of surgery, and what would happen if they chose not to have surgery. Referral for cataract surgery is based on this discussion, and not only on the clarity and sharpness (particularly fine details) with which they can see objects. The decision to perform cataract surgery on the second eye should be made on the same basis.
Source guidance
Cataracts in adults: management. NICE guideline NG77 (2017), recommendations 1.2.1 and 1.2.2
Definitions of terms used in this quality statement
Based on visual acuity alone
The decision to refer an adult with cataracts for surgery should be based on a discussion with the person of the issues listed below, not on visual acuity alone:
- how the cataract affects the person's vision and quality of life
- whether 1 or both eyes are affected
- what cataract surgery involves, including possible risks and benefits
- how the person's quality of life may be affected if they choose not to have cataract surgery
- whether the person wants to have cataract surgery.
[NICE’s guideline on cataracts in adults, recommendation 1.2.1]
Treatment – late age-related macular degeneration (wet active)
This quality statement is taken from the serious eye disorders quality standard. The quality standard defines clinical best practice for serious eye disorders and should be read in full.
Quality statement
Adults with late age-related macular degeneration (AMD) (wet active) start treatment within 14 days of referral to the macular service.
Rationale
Late AMD (wet active) can deteriorate rapidly. Any delay to starting treatment may lead to a worsening of outcomes over the long term. Minimising delays in starting treatment increases the chances of preserving vision and so quality of life.
Quality measures
Structure
Evidence of local arrangements and clinical protocols to ensure that adults with late AMD (wet active) start treatment within 14 days of referral to the macular service.
Data source: Local data collection, for example, referral pathways.
Process
Proportion of adults with late AMD (wet active) who start treatment within 14 days of referral to the macular service.
Numerator – the number in the denominator who start treatment within 14 days.
Denominator – the number of adults with late AMD (wet active) referred to the macular service.
Data source: Local data collection, for example, patient records, referral records and appointment systems.
Outcomes
a) Loss of vision (changes to visual acuity) of people with late AMD (wet active).
Data source: Database audit – National Electronic AMD Audit feasibility report contains: mean change in visual acuity between baseline and month 12 (figure 7) and percentage of eyes losing ≥3 LogMAR lines between baseline and month 12 (figure 8). Data, collected from 40 centres dating from January 2012 to December 2013 (8 had low numbers and the data were excluded) were last collected in 2016. Available from the National Ophthalmology Database Audit.
b) Health-related quality of life of adults with late AMD (wet active).
Data source: Local data collection, for example, a questionnaire.
What the quality statement means for different audiences
Service providers (NHS hospital trusts) have agreed protocols to ensure that adults with late AMD (wet active) start treatment within 14 days of referral to the macular service.
Healthcare professionals (such as ophthalmologists, advanced nurse practitioners, optometrists and orthoptists working in secondary care) treating late AMD (wet active) in adults adhere to local protocols and start treatment within 14 days of referral to the macular service.
Commissioners (clinical commissioning groups) monitor providers to ensure that treatment for adults with late AMD (wet active) starts within 14 days of referral to the macular service.
Adults with late AMD (wet active) start their treatment within 14 days of being referred to the specialist service so that they have the best possible chance of keeping their sight.
Source guidance
Age-related macular degeneration. NICE guideline NG82 (2018), recommendation 1.4.10
Monitoring late age-related macular degeneration (wet active)
This quality statement is taken from the serious eye disorders quality standard. The quality standard defines clinical best practice for serious eye disorders and should be read in full.
Quality statement
Adults with late age-related macular degeneration (AMD) (wet active) have monitoring for both eyes.
Rationale
Monitoring of late AMD (wet active) in both eyes is important for identifying changes that are associated with the condition. Monitoring supports treatment planning, which helps to avoid under-treatment, which could result in loss of vision, and over-treatment (unnecessary anti-VEGF injections), which could be associated with harm and affect quality of life. The interval between appointments should be determined by the healthcare professional responsible for planning the person’s care.
Quality measures
Structure
Evidence of local arrangements to ensure that adults with late AMD (wet active) have monitoring for both eyes.
Data source: Local data collection, for example, service specifications and local protocols for monitoring appointments for adults with late AMD (wet active).
Process
a) Proportion of adults with late AMD (wet active) who have a monitoring appointment scheduled.
Numerator – the number in the denominator who have a monitoring appointment scheduled.
Denominator – the number of adults with late AMD (wet active).
Data source: Local data collection, for example, patient records and appointment systems.
b) Proportion of scheduled monitoring appointments for adults with late AMD (wet active) that are cancelled or delayed by the hospital.
Numerator – the number in the denominator that are cancelled or delayed by the hospital.
Denominator – the number of scheduled monitoring appointments for adults with late AMD (wet active).
Data source: Local data collection, for example, patient records and appointment systems.
c) Proportion of hospital appointments for adults with late AMD (wet active) that occur within 25% of their intended monitoring period, including rescheduling of hospital cancellations and non-attendance by adults with late AMD (wet active).
Numerator – the number in the denominator that occur within 25% of their intended monitoring period.
Denominator – the number of monitoring appointments scheduled, including those rescheduled after hospital-initiated cancellation and non-attendance by adults with late AMD (wet active).
Data source: Local data collection: Portfolio of Indicators for eye health and care - indicator 11 for the System and assurance framework for eye health (SAFE), which has been adopted as an outcome measure by NHS England's Elective care transformation programme: Transforming elective care services: ophthalmology.
Outcome
Loss of vision (changes to visual acuity) in adults with late AMD (wet active).
Data source: Database audit – National Electronic AMD Audit feasibility report contains: mean change in visual acuity between baseline and month 12 (figure 7), percentage of eyes losing ≥3 LogMAR lines between baseline and month 12 (figure 8), visual acuity change from month 3 to month 12 (figure 10) and percentage of patients retaining visual acuity of 70 letters/LogMAR visual acuity of 0.3 or better (at 1 year; figure 11). Data, collected from 40 centres dating from January 2012 to December 2013 (8 had low numbers and the data were excluded) were last collected in 2016. Available from the National Ophthalmology Database Audit.
What the quality statement means for different audiences
Service providers (NHS hospital trusts) ensure that they have agreed protocols for adults with late AMD (wet active) to have monitoring of both eyes at clinically appropriate intervals determined by the healthcare professional responsible for planning their care.
Healthcare professionals (such as ophthalmologists, advanced nurse practitioners, optometrists and orthoptists working in secondary care) monitor both eyes of adults with late AMD (wet active) at intervals determined by the healthcare professional responsible for planning their care.
Commissioners (clinical commissioning groups) ensure that services provide monitoring of both eyes for adults with late AMD (wet active) at intervals determined by the healthcare professional responsible for planning their care.
Adults with late AMD (wet active) have both their eyes monitored regularly so that treatment can be planned to preserve their sight and quality of life. The time between appointments is determined by the healthcare professional responsible for planning their care.
Source guidance
Age-related macular degeneration. NICE guideline NG82 (2018), recommendation 1.7.8
Reassessment – chronic open angle glaucoma or related conditions
This quality statement is taken from the serious eye disorders quality standard. The quality standard defines clinical best practice for serious eye disorders and should be read in full.
Quality statement
Adults with chronic open angle glaucoma (COAG) or related conditions have reassessment at specific intervals.
Rationale
Reassessment is important for identifying clinically significant changes in adults with COAG or adults at risk of conversion from ocular hypertension (OHT) or suspected COAG to COAG. Reassessment also supports maintaining a consistent intraocular pressure (IOP). Providing tailored treatment in response to disease progression and maintaining IOP levels reduces the risk of significant sight loss, and reduced quality of life.
Quality measures
Structure
Evidence of local arrangements to ensure that adults with COAG or related conditions have reassessment appointments scheduled at specific intervals, according to their risk of conversion to COAG or progression to sight loss.
Data source: Local data collection, for example, service specifications and local protocols.
Process
a) Proportion of adults with COAG or related conditions who have reassessment at specific intervals.
Numerator – the number in the denominator who have reassessment at specific intervals.
Denominator – the number of adults with COAG or related conditions.
Data source: Local data collection, for example, patient records and appointment systems.
b) Proportion of scheduled reassessment appointments for COAG or related conditions that are cancelled or delayed by the service provider.
Numerator – the number in the denominator that are cancelled or delayed by the service provider.
Denominator – the number of scheduled reassessment appointments for COAG or related conditions.
Data source: Local data collection, for example, patient records and appointment systems.
c) Proportion of hospital appointments for adults with COAG or related conditions that occur within 25% of their intended reassessment period, including rescheduling of hospital cancellations and non-attendance by adults with COAG or related conditions.
Numerator – the number in the denominator that occur within 25% of their intended reassessment period.
Denominator – the number of reassessment appointments scheduled, including those rescheduled after hospital-initiated cancellation and non-attendance by adults with COAG or related conditions.
Data source: Local data collection: Portfolio of Indicators for eye health and care - indicator 11 for the System and assurance framework for eye health (SAFE), which has been adopted as an outcome measure by NHS England's Elective care transformation programme: Transforming elective care services: ophthalmology.
Outcomes
a) Loss of vision for adults with COAG or related conditions (visual field loss, changes to visual acuity).
Data source: Database audit – National Electronic Glaucoma Surgery and Visual Field Preservation Audit feasibility report contains: rates of visual field loss in the worst eyes (figure 44), speed of visual field progression (figure 45), and loss of sight years (table 11). Data were last collected in 2015 from 5 major glaucoma centres. Available from the National Ophthalmology Database Audit.
Local data collection, for example, patient records and local ophthalmology records of patient safety incidents.
b) Health-related quality of life for adults with COAG or related conditions.
Data source: Local data collection, for example, a questionnaire.
What the quality statement means for different audiences
Service providers (NHS hospital trusts and community optometry services) have agreed protocols to ensure that adults with COAG or related conditions have reassessment at specific intervals, according to their risk of progressive sight loss.
Healthcare professionals (such as ophthalmologists, advanced nurse practitioners, optometrists and orthoptists) carry out reassessment for adults with COAG or related conditions at specific, clinically appropriate intervals, according to their risk of progressive sight loss.
Commissioners (clinical commissioning groups) ensure that services provide reassessment for adults with COAG or related conditions at specific intervals, according to their risk of progressive sight loss.
Adults with glaucoma, suspected glaucoma or ocular hypertension have regular assessments to minimise their risk of sight loss. How often they have an assessment will depend on how well the treatment seems to be working.
Source guidance
Glaucoma: diagnosis and management. NICE guideline NG81 (2017), recommendations 1.4.9, 1.4.11, 1.4.12 and 1.4.13
Definitions of terms used in this quality statement
Specific intervals for reassessment of COAG or related conditions
Specific intervals for reassessment depend on the risk of progression to sight loss, as set out in tables 1 to 3 of NICE’s guideline on glaucoma. Clinical judgement is used to decide when the next appointment should take place within the recommended interval.
Certificate of vision impairment
This quality statement is taken from the serious eye disorders quality standard. The quality standard defines clinical best practice for serious eye disorders and should be read in full.
Quality statement
Adults with serious eye disorders are given a certificate of vision impairment (CVI) as soon as they are eligible.
Rationale
A CVI allows easier access to services and support for adults with serious eye disorders. Making a person aware of the benefits associated with a CVI, and giving them the choice of having a CVI as soon as they are eligible, rather than waiting for treatment to finish, allows earlier access to services and support. This can help people retain or regain their independence and improve their wellbeing and quality of life.
Quality measures
Structure
Evidence of local arrangements to ensure that adults with serious eye disorders are given information about the CVI and those meeting the eligibility criteria are given a certificate.
Data source: Local data collection, for example, a service protocol.
Process
Proportion of adults with serious eye disorders that meet the eligibility criteria for a CVI who are given a CVI.
Numerator – the number in the denominator who are given a CVI.
Denominator – the number of adults with serious eye disorders that meet the eligibility criteria for a CVI.
Data source: Local data collection, for example, patient records.
Outcome
Health-related quality of life for adults with serious eye disorders.
Data source: Local data collection, for example, a questionnaire.
What the quality statement means for different audiences
Service providers (NHS hospital trusts and community optometry practices) have systems in place to ensure that adults with serious eye disorders are given information about the support and services associated with certification. They ensure that adults can engage in the process as soon as they meet the eligibility criteria, including while they are having treatment. Services make sure people know about the benefits of certification, and know that they have a choice to have a CVI or not.
Healthcare professionals (optometrists, and ophthalmologists, orthoptists and nurses working in secondary care) make sure that people with serious eye disorders know about the benefits of certification and that they can have a CVI if they choose as soon as they are eligible. This includes while they are having treatment. Professionals give information about the support and services associated with certification. Ophthalmologists sign the certificate to formally certify adults with serious eye disorders as visually impaired.
Commissioners (clinical commissioning groups) ensure that providers have the capacity and resources to give information about the support and services associated with certification to adults with serious eye disorders as soon as they meet the eligibility criteria.
Adults with serious eye disorders are given a certificate of vision impairment as soon as they are eligible. This may be while they are still having treatment. They are also told about support and services, which can help them improve or regain their independence and wellbeing.
Source guidance
- Age-related macular degeneration. NICE guideline NG82 (2018), recommendation 1.6.4
- Glaucoma: diagnosis and management. NICE guideline NG81 (2017), recommendation 1.7.1
Definitions of terms used in this quality statement
Certificate of vision impairment
See the Department of Health and Social Care’s Certificate of vision impairment: explanatory notes for consultant ophthalmologists and hospital eye clinic staff in England, executive summary, sections 4, 9, 21, 29 to 34 inclusive.
Equality and diversity considerations
Healthcare professionals should adapt their communication to the needs of adults with sight difficulties so that they have the opportunity to be involved in decisions relating to certification of vision impairment. This includes being made aware of the benefits associated with having a CVI.
Physical or learning disabilities, hearing problems and difficulties with reading or speaking English, which may affect the patient's involvement in the consultation, should also be considered.
For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.
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Implementation
NICE has produced resources to help implement its guidance on:
Information for the public
NICE has written information for the public on each of the following topics.
Pathway information
Person-centred care
People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
Your responsibility
Guidelines
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.
Technology appraisals
The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.
Medical technologies guidance, diagnostics guidance and interventional procedures guidance
The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.
Supporting information
Glossary
non-steroidal anti-inflammatory drugs
Paths in this pathway
Pathway created: October 2017 Last updated: October 2020
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