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Brain injury rehabilitation in adults
12 Implementing the guideline
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This section provides advice on the resource implications associated with implementing the key clinical
recommendations, and advice on audit as a tool to aid implementation.
12.1 IMPlEMENTATIoN STRATEGy
Implementation of national clinical guidelines is the responsibility of each NHS Board and is an essential
part of clinical governance. Mechanisms should be in place to review care provided against the guideline
recommendations. The reasons for any differences should be assessed and addressed where appropriate.
Local arrangements should then be made to implement the national guideline in individual hospitals, units
and practices.
The National Managed Clinical Network for Acquired Brain Injury (SABIN) is a Scottish national network
established by the National Services Division in 2007. Its aim is to improve access to and the quality of
services for children and adults with ABI. The Network will support the launch of the SIGN guideline through
a combination of education events and other means of raising awareness and reference to the guideline.
Full details will be available from the SABIN website (www.sabin.scot.nhs.uk).
12.2 RESouRCE IMPlICATIoNS of KEy RECoMMENDATIoNS
No recommendations are considered likely to reach the £5 million threshold which warrants full cost impact
analysis.
12.3 AuDITING CuRRENT PRACTICE
A first step in implementing a clinical practice guideline is to gain an understanding of current clinical
practice. Audit tools designed around guideline recommendations can assist in this process. Audit tools
should be comprehensive but not time consuming to use. Successful implementation and audit of guideline
recommendations requires good communication between staff and multidisciplinary team working.
The NHSScotland National Managed Clinical Network for Acquired Brain Injury has developed clinical
standards for adults aged 16-65 years with TBI. 193 These standards define essential criteria which are expected
to be met where services for people with TBI are provided, and desirable criteria, which are being met in some
parts of the service, and which demonstrate levels of quality which other providers of a similar service should
strive to achieve. Desirable criteria should be regarded as developmental and should still be met, albeit in a
longer timescale to the essential criteria. Where criteria from these standards reflect recommendations from
this guideline, this is indicated with an asterisk below.
The guideline development group has identified the following as key points to audit to assist with the
implementation of this guideline:
y the proportion of patients managed by a dedicated multidisciplinary inpatient (or community based)
team*
y the proportion of patients with planned discharge from rehabilitation to home which is coordinated by
a designated member of the multidisciplinary team*
y the proportion of patients in states of disordered consciousness assessed using the Coma Recovery Scale*
y the proportion of patients recorded as having communication deficits on initial screening by admitting
staff that is then referred on to SLT
y a case-note review (eg last six months) of patients documented to have dysphagia, answering the following
questions: were there persisting concerns about the management of a patient’s dysphagia following
bedside assessment? If so, was the patient referred for instrumental assessment (eg videofluoroscopy
or FEES)? If not, why was the patient not referred for instrumental assessment?