Audit on compliance with NICE Clinical Guideline 50 (NCG 50): 'Recognition of and response to acute illness in adults in hospital'

Introduction

The clinical deterioration of patients is often heralded by a decline in physiological parameters by up to 24 hours [1]. NICE clinical guideline 50 (NCG 50) was published in July 2007 – 'Recognition of and response to acute illness in adults in hospital' – with the aim of improving the care of acutely ill patients. We undertook an audit to determine how our institution currently performed.

Methods

Case records were randomly collated documenting the management of 89 adult patients admitted to and discharged from critical care over a 2-month period. An audit tool was developed to compare these cases against all 25 NCG 50 standards using 50 complete and 39 incomplete datasets.

Results

One hundred per cent compliance with NCG 50 was achieved in 2/25 (8%) parameters – measurement of admission heart rate and physiological observations ≤ 12 hourly. Furthermore, 8/25 (36%) achieved 94% compliance including blood pressure measurement, oxygenation, response to deterioration and a written discharge plan. However, 4/25 (16%) parameters had ≤ 50% compliance including documentation of routine observations and their recording frequency.

Conclusion

This audit has shown that compliance with NCG 50 standards is excellent in several key areas. In order to improve where standard adherence was suboptimal we have introduced a novel strategy to ensure that ward-based documentation of the observation frequency is now mandatory, with specific guidelines for escalation dependent on the clinical scenario. We believe the results of this audit are likely to be applicable to other organisations and suggest that a similar action plan be considered to ensure NCG 50 goals are achieved.