13 Ensuring that published guidelines are current and accurate | Developing NICE guidelines: the manual | Guidance

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</p> </div> </div> </div> </div> </div> <div class="_ layout " aria-label="Main page content"> <div id="toTop"><span aria-hidden="true" class="icon-nice-chevron-up"></span></div> <div class="_"> <div class="content"> <div class="zone zone-content"> <div id="guidance-tabs-container" class="tabbable"> <ul class="nav nav-tabs" id="guidanceTabs-product"> <li class="active"> <a href="/process/pmg20">Process</a> </li> <li class=""> <a href="/process/pmg20/resources">Tools and resources</a> </li> </ul> <div class="tab-content"> <div class="tab-pane active gtm-guideline-page-tab" id="NICE-process-and-methods-Tab"> <div class="product product-guideline row"> <div class="sections span3 toresponsive"> <div id="overview-menu"> <div class="menu-container"> <ul class="nav nav-list" id="Overview-Menu"> <li class="sync "> <a href="/process/pmg20">Overview</a> </li> </ul> </div> </div> <div id='guidance-menu'> <div class='menu-container'> <ul class="nav nav-list" id="Guidance-Menu"> <li> <a href="/process/pmg20/chapter/introduction">1 Introduction</a> </li> <li> <a href="/process/pmg20/chapter/the-scope">2 The scope</a> </li> <li> <a href="/process/pmg20/chapter/decision-making-committees">3 Decision-making committees</a> </li> <li> <a href="/process/pmg20/chapter/developing-review-questions-and-planning-the-evidence-review">4 Developing review questions and planning the evidence review</a> </li> <li> <a href="/process/pmg20/chapter/identifying-the-evidence-literature-searching-and-evidence-submission">5 Identifying the evidence: literature searching and evidence submission</a> </li> <li> <a href="/process/pmg20/chapter/reviewing-evidence">6 Reviewing evidence</a> </li> <li> <a href="/process/pmg20/chapter/incorporating-economic-evaluation">7 Incorporating economic evaluation</a> </li> <li> <a href="/process/pmg20/chapter/linking-to-other-guidance">8 Linking to other guidance</a> </li> <li> <a href="/process/pmg20/chapter/interpreting-the-evidence-and-writing-the-guideline">9 Interpreting the evidence and writing the guideline</a> </li> <li> <a href="/process/pmg20/chapter/the-validation-process-for-draft-guidelines-and-dealing-with-stakeholder-comments">10 The validation process for draft guidelines, and dealing with stakeholder comments</a> </li> <li> <a href="/process/pmg20/chapter/finalising-and-publishing-the-guideline-recommendations">11 Finalising and publishing the guideline recommendations</a> </li> <li> <a href="/process/pmg20/chapter/support-for-putting-the-guideline-recommendations-into-practice">12 Support for putting the guideline recommendations into practice</a> </li> <li class="active"> <a href="/process/pmg20/chapter/ensuring-that-published-guidelines-are-current-and-accurate">13 Ensuring that published guidelines are current and accurate</a> </li> <li> <a href="/process/pmg20/chapter/updating-guideline-recommendations">14 Updating guideline recommendations</a> </li> <li> <a href="/process/pmg20/chapter/appendices">15 Appendices</a> </li> <li> <a href="/process/pmg20/chapter/glossary">Glossary</a> </li> <li> <a href="/process/pmg20/chapter/update-information">Update information</a> </li> </ul> </div> </div> </div> <div class="span9 tab-header"> <div class="share-links navbar pull-right"> <div class="navbar-inner"> <div class="unstyled"> <div class="dropdown"> <a href="/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869" id="nice-download" target="_blank" class="track-event btn-sharelink dropdown-toggle" title="Download (PDF)" data-track="guidancedownload" data-track-category="guidance download" data-track-action="clicked" data-track-label="/guidance/pmg20/resources/developing-nice-guidelines-the-manual-pdf-72286708700869"> <span>Download (PDF)</span> </a> </div> </div> </div> </div> <h2 id="tab-title" class="h3">NICE process and methods</h2> </div> <div class="content span9"> <div class="product-page summary"> <div class="navbar navbar-resources"> </div> </div> <div class="section-heading"> <ul class="pagination "> <li class="sectionmenu hidden-desktop hidden-tablet span8"></li> <li class="previous"><a href="/process/pmg20/chapter/support-for-putting-the-guideline-recommendations-into-practice" aria-label="Previous chapter"><span class="icon-nice-chevron-left"></span></a></li> <li class="next"><a href="/process/pmg20/chapter/updating-guideline-recommendations" aria-label="Next chapter"><span class="hidden-phone">Next </span><span class="icon-nice-chevron-right"></span></a></li> </ul> <h3 class="h2">13 Ensuring that published guidelines are current and accurate</h3> <ul class="unstyled sectiontitles"> <li><a href="#aims-of-surveillance">13.1 Aims of surveillance</a></li> <li><a href="#proactive-surveillance">13.2 Proactive surveillance</a></li> <li><a href="#surveillance-assessment-process">13.3 Surveillance assessment process</a></li> <li><a href="#references-and-further-reading-8">13.4 References and further reading</a></li> </ul> </div> <div class="section-summary web-viewer-content"> <div class="chapter" title="13 Ensuring that published guidelines are current and accurate" id="pmg20-ensuring-that-published-guidelines-are-current-and-accurate" xmlns="http://www.w3.org/1999/xhtml"> <h2 class="title" id="ensuring-that-published-guidelines-are-current-and-accurate">13 Ensuring that published guidelines are current and accurate</h2> <p>This chapter describes the process and methods for checking that published guidelines are current and deciding whether updates are needed (surveillance).</p> <div class="section" title="13.1 Aims of surveillance" id="pmg20-aims-of-surveillance"> <h3 class="title" id="aims-of-surveillance">13.1 Aims of surveillance</h3> <p>The aim of surveillance is to check that guidelines are up to date. This is done by exploring if there is any new evidence to contradict, reinforce or clarify guideline <a class="link" href="glossary#recommendations" target="_top" rel="internal" data-chapter="glossary" data-original-url="#recommendations">recommendations</a>. Surveillance also identifies new interventions that may need to be considered within the guideline. Finally, it explores changes in context that may mean modifications are needed, for example, changes in policy, infrastructure, legislation or costs.</p> <p>NICE has more than 350 published guidelines, so the number of checks needed is considerable. A proactive approach (with an assessment of priority) is used to respond to events that may impact guideline recommendations at any time after guideline publication (for example a safety alert, or publication of a key study)</p> </div> <div class="section" title="13.2 Proactive surveillance" id="pmg20-proactive-surveillance"> <h3 class="title" id="proactive-surveillance">13.2 Proactive surveillance</h3> <p>Some topic areas change frequently, and this increases the risk of guidelines having out-of-date recommendations. NICE takes a proactive approach to surveillance, and monitors key events (such as ongoing studies) that are judged to be relevant to the guideline. </p> <p>Events are identified through constant intelligence gathering. This starts during initial guideline development, as the guideline committee and stakeholders can flag up future events that need to be monitored for impact. Ongoing studies are typically identified through discussions with the National Institute for Health Research. This approach means that NICE can quickly identify changes in the evidence base, and assess the impact on recommendations and the need for any changes. </p> <p>An event that could affect the guideline could include:</p> <div class="itemizedlist"> <ul class="itemizedlist"> <li class="listitem"> <p>publication of a study that is directly relevant to <a class="link" href="glossary#nice-guidance" target="_top" rel="internal" data-chapter="glossary" data-original-url="#nice-guidance">NICE guidance</a> and has the potential to affect recommendations</p> </li> <li class="listitem"> <p>substantial changes in policy or legislation (an example includes changes to the <a class="link" href="https://www.gov.uk/government/collections/physical-activity-guidelines" target="_top">UK physical activity guidelines</a> by the Chief Medical Office)</p> </li> <li class="listitem"> <p>development of a related piece of NICE guidance that contradicts recommendations in another <a class="link" href="glossary#nice-guidelines" target="_top" rel="internal" data-chapter="glossary" data-original-url="#nice-guidelines">NICE guideline</a></p> </li> <li class="listitem"> <p>withdrawal of a drug from the market, or a clinically significant drug safety update from the Medicines and Healthcare products Regulatory Authority (MHRA) or the Commission on Human Medicines.</p> </li> </ul> </div> <p>This list is not exhaustive and individual events will be considered on a case-by-case basis. To make the most efficient use of resource, events are triaged, to determine whether surveillance assessment is needed</p> <div class="itemizedlist"> <ul class="itemizedlist"> <li class="listitem"> <p>If an assessment is needed these are prioritised based on:</p> <p> <div class="itemizedlist"> <ul class="itemizedlist"> <li class="listitem"> <p>safety (always prioritised first)</p> </li> <li class="listitem"> <p>health and social care system priorities</p> </li> <li class="listitem"> <p>burden on services</p> </li> <li class="listitem"> <p>population impact</p> </li> <li class="listitem"> <p>potential impact on addressing health inequalities</p> </li> <li class="listitem"> <p>evidence base: is it changing frequently and what is the degree of uncertainty?</p> </li> <li class="listitem"> <p>what value NICE could add by incorporating the new information into a guideline.</p> </li> </ul> </div> </p> </li> </ul> </div> </div> <div class="section" title="13.3 Surveillance assessment process" id="pmg20-surveillance-assessment-process"> <h3 class="title" id="surveillance-assessment-process">13.3 Surveillance assessment process</h3> <p>The NICE surveillance programme considers how an event could affect a guideline. This involves checking how the event could affect the guideline recommendations, and taking feedback from topic experts in the area. The check may include intelligence gathering and literature searches, if needed.</p> <p>Stakeholders are not normally consulted on the decision to update (or not update) a guideline in response to a surveillance check. This is because these checks usually focus only on one important event and potentially a small section of a guideline. The decisions are published on the NICE website.</p> <p>If the guideline needs updating, registered stakeholders are informed of the planned approach.</p> <div class="section" title="Topic expert engagement" id="pmg20-topic-expert-engagement"> <h4 class="title" id="topic-expert-engagement">Topic expert engagement</h4> <p>Topic experts (including members of NICE's <a class="link" href="glossary#expert-advisers-panel" target="_top" rel="internal" data-chapter="glossary" data-original-url="#expert-advisers-panel">Expert Advisers Panel</a>) are invited to participate in surveillance. They provide their views about how an event affects the recommendations, and their knowledge of recent developments in the topic area. If the response from topic experts is limited, or further specialist input is needed, we may seek input from other experts. This could include other government organisations, or representatives from a Quality Standards Advisory Committee.</p> </div> <div class="section" title="Intelligence gathering" id="pmg20-intelligence-gathering"> <h4 class="title" id="intelligence-gathering">Intelligence gathering</h4> <p>If needed, additional intelligence may be sought. This might include: </p> <div class="itemizedlist"> <ul class="itemizedlist"> <li class="listitem"> <p>feedback from internal teams within NICE who have expertise in the topic area (for example the NICE medicines or social care teams, if these are major areas in the guideline)</p> </li> <li class="listitem"> <p>asking stakeholders for their views, including organisations representing the interests of patients, people using services, carers, and the public</p> </li> <li class="listitem"> <p>external queries and comments received since publication of the guideline (these are collated in an issues log for consideration during surveillance)</p> </li> <li class="listitem"> <p>related NICE guidance and quality standards (including placeholder statements in NICE quality standards) developed since the guideline was published</p> </li> <li class="listitem"> <p>information about guideline <a class="link" href="glossary#implementation" target="_top" rel="internal" data-chapter="glossary" data-original-url="#implementation">implementation</a>, including evidence derived from analysis of primary data on the uptake of recommendations</p> </li> <li class="listitem"> <p>information about important ongoing studies in the area covered by the guideline (identified through searches of trial databases)</p> </li> <li class="listitem"> <p>changes in licensing status of medicines</p> </li> <li class="listitem"> <p>updated or new national policy.</p> </li> </ul> </div> </div> <div class="section" title="Literature searching" id="pmg20-literature-searching"> <h4 class="title" id="literature-searching">Literature searching</h4> <p>If needed, published evidence is identified by searching a range of bibliographic databases relevant to the topic. Surveillance searches generally use the same databases that were used during the development of the original guideline. The sources searched may vary depending on the topic. In general, MEDLINE, MEDLINE in Process, Embase, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL) would be considered.</p> <div class="section" title="Search approaches" id="pmg20-search-approaches"> <h5 class="title" id="search-approaches">Search approaches</h5> <p>The search approach will vary between topics. The following search approaches can be used:</p> <div class="itemizedlist"> <ul class="itemizedlist"> <li class="listitem"> <p>population or population/intervention search as needed for the guideline scope with:</p> <p> <div class="itemizedlist"> <ul class="itemizedlist"> <li class="listitem"> <p> <a class="link" href="glossary#randomised-controlled-trial" target="_top" rel="internal" data-chapter="glossary" data-original-url="#randomised-controlled-trial">randomised controlled trials</a> (RCTs) and <a class="link" href="glossary#systematic-review" target="_top" rel="internal" data-chapter="glossary" data-original-url="#systematic-review">systematic reviews</a> as a default</p> </li> <li class="listitem"> <p>if RCTs are not appropriate because of the topic or guideline (for example, purely diagnostic), then other study types will be considered</p> </li> </ul> </div> </p> </li> <li class="listitem"> <p>focused searches for a specific question or a new question, meaning that the study type searched for (RCTs or <a class="link" href="glossary#observational-study" target="_top" rel="internal" data-chapter="glossary" data-original-url="#observational-study">observational studies</a>) should reflect the type expected to address the question</p> </li> <li class="listitem"> <p>citation search forward or back (this option would be supplemented with either a restrictive full scope search or focused searches).</p> </li> </ul> </div> </div> <div class="section" title="Other considerations" id="pmg20-other-considerations"> <h5 class="title" id="other-considerations">Other considerations</h5> <p>It may be appropriate to consider setting limits for the searches, which could include, but are not limited to:</p> <div class="itemizedlist"> <ul class="itemizedlist"> <li class="listitem"> <p>study design using appropriate search filters</p> </li> <li class="listitem"> <p>date</p> </li> <li class="listitem"> <p>location</p> </li> <li class="listitem"> <p>populations and subpopulations</p> </li> <li class="listitem"> <p>intervention</p> </li> <li class="listitem"> <p>service delivery aspect</p> </li> <li class="listitem"> <p>prognostic factors.</p> </li> </ul> </div> </div> <div class="section" title="Search period" id="pmg20-search-period"> <h5 class="title" id="search-period">Search period</h5> <p>The search period will start at the:</p> <div class="itemizedlist"> <ul class="itemizedlist"> <li class="listitem"> <p>end of the search for the last update of the guideline</p> </li> <li class="listitem"> <p>end of the search for the last standard check.</p> </li> </ul> </div> <p>The search date ends on the date the search is conducted. </p> </div> </div> <div class="section" title="Decision making" id="pmg20-decision-making"> <h4 class="title" id="decision-making">Decision making</h4> <p>Proposals on the need to update a guideline are based on:</p> <div class="itemizedlist"> <ul class="itemizedlist"> <li class="listitem"> <p>an assessment of the event and any other relevant evidence published since guideline publication (abstracts of primary or secondary evidence)</p> </li> <li class="listitem"> <p>information from topic expert engagement </p> </li> <li class="listitem"> <p>if relevant, intelligence gathering and feedback from stakeholder consultation.</p> </li> </ul> </div> <p>The decision also includes an element of judgement.</p> <p>The possible decisions are:</p> <div class="itemizedlist"> <ul class="itemizedlist"> <li class="listitem"> <p>update (reviewing the evidence and producing either a full update that replaces the original guideline, or a partial update of defined sections of the guidelines) </p> </li> <li class="listitem"> <p>no update (this also includes a decision to defer the update until later)</p> </li> <li class="listitem"> <p>amend (making changes to the guideline without reviewing the evidence)</p> </li> <li class="listitem"> <p>withdraw (either some recommendations or the whole guideline).</p> </li> </ul> </div> <p>Unless the guideline is fully updated or completely withdrawn, there may also be a refresh (for more information on refreshing, see the <a class="link" href="updating-guideline-recommendations#refreshing-the-guideline-recommendations" target="_top" rel="internal" data-chapter="updating-guideline-recommendations" data-original-url="#refreshing-the-guideline-recommendations">section on refreshing the guideline recommendations in the chapter on updating guideline recommendations</a>).</p> <p>When a guideline is being updated, the original scope may be used (unchanged), the original scope may be modified (for example, where new areas have been identified that require an extension to the scope) or a new scope may be developed. See the <a class="link" href="the-scope#the-scope" target="_top" rel="internal" data-chapter="the-scope" data-original-url="#the-scope">chapters on the scope</a> and on <a class="link" href="updating-guideline-recommendations#updating-guideline-recommendations" target="_top" rel="internal" data-chapter="updating-guideline-recommendations" data-original-url="#updating-guideline-recommendations">updating guideline recommendations</a> for further details.</p> </div> <div class="section" title="Stakeholder consultation" id="pmg20-stakeholder-consultation"> <h4 class="title" id="stakeholder-consultation">Stakeholder consultation</h4> <p>Consultations on proposed decisions will be held if there is value in doing so (for example, when it is not clear to NICE if an update is needed or not). The consultation period will usually be 2 weeks.</p> </div> <div class="section" title="Signing off the final decision" id="pmg20-signing-off-the-final-decision"> <h4 class="title" id="signing-off-the-final-decision">Signing off the final decision</h4> <p>All surveillance proposals go through a validation and approval process at NICE, which includes signoff by the associate director and centre director.</p> </div> </div> <div class="section" title="13.4 References and further reading" id="pmg20-references-and-further-reading-8"> <h3 class="title" id="references-and-further-reading-8">13.4 References and further reading</h3> <p>Alderson LJ, Alderson P, Tan T (2014) <a class="link" href="https://www.ncbi.nlm.nih.gov/pubmed/24139089" target="_top">Median life span of a cohort of National Institute for Health and Care Excellence clinical guidelines was about 60 months</a>. Journal of Clinical Epidemiology 67: 52–5</p> <p>Shekelle P, Eccles MP, Grimshaw JM et al. (2001) <a class="link" href="http://www.bmj.com/content/323/7305/155" target="_top">When should clinical guidelines be updated?</a> British Medical Journal 323: 155–7</p> <p>Shekelle PG, Ortiz E, Rhodes S et al. (2001) <a class="link" href="http://www.ncbi.nlm.nih.gov/pubmed/11572738" target="_top">Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated?</a> JAMA 286: 1461–7</p> </div> </div> </div> <div class="product-footer"> </div> <br/> <div class="section-footer"> <ul class="pagination "> <li class="sectionmenu hidden-desktop hidden-tablet span8"></li> <li class="previous"><a href="/process/pmg20/chapter/support-for-putting-the-guideline-recommendations-into-practice" aria-label="Previous chapter"><span class="icon-nice-chevron-left"></span></a></li> <li class="next"><a href="/process/pmg20/chapter/updating-guideline-recommendations" aria-label="Next chapter"><span class="hidden-phone">Next </span><span class="icon-nice-chevron-right"></span></a></li> </ul> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </main> <div id="global-nav-footer"></div> <script> var global_nav_config = { service: "", header: { cookie: false, skipLinkId: "content-start", search: { url: "/search", autocomplete: "/autocomplete?ajax=ajax", }, auth: { environment: "live" } } }; </script>  <script src="https://cdn.nice.org.uk/global-nav/global-nav.min.js" type="text/javascript"></script> <script src="//cdn.nice.org.uk/V2/Scripts/twitter.bootstrap.min.js" type="text/javascript"></script> <script src="/Themes/NICE.Bootstrap/scripts/niceorg/NICE.TopScroll.js" type="text/javascript"></script> <script src="//cdn.nice.org.uk/V2/Scripts/NICE.bootstrap.min.js" type="text/javascript"></script> </body> </html>

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