The National Institute for Health and Care Excellence (NICE) has published its first three rapid guidelines on the active management of patients with COVID-19 (suspected and confirmed), and in patients without COVID-19.
They cover the management of patients in critical care, the management of patients who are having kidney dialysis and the management of patients who are receiving systemic anticancer treatments.
- The guideline on critical care says that all patients on admission to hospital, irrespective of COVID-19 status, should continue to be assessed for frailty using a recognised frailty score (for example, the Clinical Frailty Scale [CFS]).
It also says the risks, benefits and likely outcomes should be discussed with patients, carers or advocates and families using decision support tools (where available) so that they can make informed decisions about their treatment wherever possible.
- For patients with confirmed COVID-19, the guideline says decisions about admission to critical care should be made on the basis of medical benefit, taking into account the likelihood that the person will recover to an outcome that is acceptable to them and within a period of time consistent with the diagnosis.
- The rapid guideline on the delivery of systemic anticancer treatments says that where decisions need to be made about prioritising patients for treatment, these need to take into account the level of immunosuppression associated with individual treatments and cancer types, and any other patient-specific risk factors. They should also balance the risk from cancer not being treated optimally versus the risk of becoming seriously ill if they contract COVID-19 because of immunosuppression.
- Where changes need to be made to usual care because of system pressures, the guideline says consideration should be given to delivering treatment in different and less immunosuppressive regimens, different locations or via another route of administration.
- The guideline on dialysis says that patients with suspected COVID-19 should be assessed to see whether dialysis could be delayed until their COVID-19 status is known. It also recommends that outpatient transport services should get patients to their dialysis as scheduled to avoid their condition deteriorating. It should also be ensured that appropriate transport services are available by finding out what current transport providers are prepared to provide, and whether there are alternative providers if the current providers will not transport patients infected with COVID-19.
Further guidelines will be announced in due course but are likely to include: symptom management; patients receiving radiotherapy; and patients with rheumatoid arthritis. NICE will publish new guidelines each week until the full set has been completed, based on the priorities for patients and the NHS.
NICE will make the guidelines accessible on its website so that health systems around the world can see the approach the UK is taking.
The guidelines are being produced in collaboration with NHS England/Improvement and a cross-specialty clinical group, supported by the specialist societies and Royal Colleges.