Nursing Law and Ethics

questions can be formulated. This will be supported by identifying the best-related
evidence available from the literature, critically appraising the evidence for validity
and clinical usefulness and then implementing and incorporating findings into
practice. The loop must then be complete in terms of having ongoing measurement
of performance against expected outcomes or against peer review.
Figure 11.2 outlines a way in which these measurements can be formulated for
best results. In undertaking research and a literature review the most up-to-date
evidence based practice is obtained and this can be aplied within Integrated Care
Management 9ICM), Multidisciplinary Pathways of Care#9MPCs) and Clinical
Guidelines. This is one of the best ways of testing compliance and applicability of
the best practice and localising this to the organisation to ensure it is clinically
effective and produces the best clinical outcomes. The real test comes from the
audit and re-audit to ensure practice and behaviour changes in applying best
practice, are maintained and improved with clinical effectiveness and efficiency
with improved clinical outcomes.

11.9.1 National Institute of Clinical Excellence NICE)

The National Institute of Clinical Excellence has a single focus to promote clinical
and cost effectiveness through clinical guidelines, best practice and audit. The
functions of NICE centre around providing a single focus for work to promote
clinical and cost effectiveness, producing guidance on new and existing health
interventions such as therapies and drug treatments, and the production of
ongoing audit methodologies. Following a period of review, new treatments and
technologies could be proclaimed as a national standard and could therefore be
included within a National Service Framework. NICE is also responsible for the
dissemination of clinical guidelines, best practice and audit through education and
training of professionals and the production of appropriate patient information.

Evidence/

best practice

ICM/MPCs/

guidelines

Practice Audit

Effective

outcomes

Fig.11.2 Audit to find best clinical practice [7]. J.H. Wilson, 1999.

232 Nursing Law and Ethics