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My experience of being involved in a NICE guideline committee as an early pregnancy sonographer

9 October, 2019

Author: Sandra Morrissey, Advanced Practitioner Sonographer, Mid Yorkshire Hospitals NHS Trust and Medical Ultrasound Lecturer, Leeds University

In September 2017 I saw an advertisement asking for an early pregnancy sonographer to be an expert advisor looking at the ultrasound appearances of tubal ectopic pregnancy for NICE Clinical Guideline 154. 

My reasons for wanting to be involved:

  • I believed I had the necessary skills and experience having set up and established the Early Pregnancy Unit at Leeds General Infirmary in 1992.
  • It was an opportunity to contribute to and improve clinical practice for the benefit of patients, staff, and commissioning organisations.
  • I had recently completed my MSc at Bradford University and was seconded to the Radiology Research Team at the Mid Yorkshire Trust, In addition, I was a member of the SoR Ultrasound Advisory Group.

I attended two meetings in London in November 2018 and January 2019. The review question we were addressing was: What ultrasound features are most diagnostic of a tubal ectopic pregnancy? This was to identify the ultrasound criteria to make a diagnosis.

The bulk of the work was carried out in advance of the meetings. My sub-committee comprised of two consultant obstetrician/gynaecologists, a lay member, and myself. Initially, we received queries to guide the systematic reviewers in their analysis and the members of the group collaborated via phone and email to provide information and guidance to specific questions.

The systematic reviewers are permanent NICE staff whose role is to use the review question and a protocol to examine published evidence, including performing suitable meta-analysis. Finally, they produce a report specifying papers reviewed, quality of evidence, specificity, sensitivity, and likelihood ratios.

From all this information we drafted recommendations, which were sent to the members of the committee who returned comments in advance of the meeting. The subcommittee agreed the final draft to be discussed at the meeting in November 2018.

The meetings were fascinating and instructive and included listening to the NICE systematic reviewers explain how they had carried out the review, critically analysed the data, and produced the evidence report.

The starting point draft document was discussed in great detail with the entire committee providing comments and insights, which were all equally valued. It was a true example of multidisciplinary, interprofessional teamwork and I felt very privileged to contribute as an AHP working alongside the NICE team, obstetricians, gynaecologists, lay members, and a midwife.

All changes to the document are tracked with notes made of what was discussed and how the final conclusion was reached. Our recommendations would go into the evidence review.

Alongside our subcommittee, the same work was going on in the many subgroups, all looking at different questions and documents such as hypertension in pregnancy, early pregnancy diagnosis and management of ectopic pregnancy, caesarean section deliveries, induction of labour, and preventing preterm labour. Work on other parts of the document including rationale and impact, quality of the evidence, benefit and harms, economic model, and resource impact.

Our recommendations were reworded into the NICE style by an editor and we had to check that the meaning of our recommendations had not changed during the editing process.

We were also asked to comment on associated documents; the NICE ectopic pregnancy and miscarriage pathway, and IFP (Information for the Public), as well as giving our views on potential impacts on resources, costs and savings. In addition we were asked to assess challenges to implementation.

The draft document was then sent out for stakeholder comments.

The final meeting was at the end of January 2019. We had been sent the documents in advance, the version that had been sent out for consultation, and the 27 pages of stakeholder comments.

At this meeting we went through the documents with a fine toothcomb, reviewed all the stakeholder feedback and either agreed to make changes, or disregarded the comments (all clearly documented as before).

At each stage, the document went backwards and forwards for checking with the NICE editors having input on the NICE way of writing recommendations, to eventual agreement of the final version. The document was published on 17 April 2019.

I really valued being involved in the whole project, gaining an understanding of the processes involved in producing evidence based NICE guidance, working as a valued member of an interprofessional multidisciplinary team, and having the opportunity to contribute to improving clinical practice.

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