1. Implementing NICE guidance
Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn’s disease or adenomas
Implementing NICE guidance
ABOUT THIS PRESENTATION:
This presentation has been written to help you raise awareness of the NICE clinical guideline on ‘Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn’s disease or adenomas’. This guideline has been written for healthcare professionals who care for people who are at higher risk of developing colorectal cancer than the general population in primary and secondary care settings and other staff who care for people with ulcerative colitis, Crohn’s disease or adenomas.
The guideline is available in a number of formats, including a quick reference guide. You may want to hand out copies of the quick reference guide at your presentation so that your audience can refer to it. See the end of the presentation for ordering details.
You can add your own organisation’s logo alongside the NICE logo.
We have included notes for presenters, broken down into ‘key points to raise’, which you can highlight in your presentation, and ‘additional information’ that you may want to draw on, such as a rationale or an explanation of the evidence for a recommendation. Where necessary, the recommendation will be given in full.
DISCLAIMER
This slide set is an implementation tool and should be used alongside the published guidance. This information does not supersede or replace the guidance itself.
PROMOTING EQUALITY
Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties.
March 2011
NICE clinical guideline 118

2. What this presentation covers
Background
Definitions
Epidemiology
Scope
Recommendations
Costs and savings
Discussion
Find out more
NOTES FOR PRESENTERS:
In this presentation we will start by providing some background to the guideline and why it is important.
We will then present the recommendations. The NICE guideline contains 18 recommendations, which you can find in the full guideline.
The recommendations cover the following areas:
People with inflammatory bowel disease
People with adenomas
Providing information and support.
Next, we will summarise the costs and savings that are likely to be incurred in implementing the guideline.
Then we will open the meeting up with a list of questions to help prompt a discussion on local issues for incorporating the guidance into practice.
Finally, we will end the presentation with further information about the support provided by NICE.

3. Background
Adults with inflammatory bowel disease (IBD) or with adenomas have a higher risk of developing colorectal cancer than the general population.
NICE has developed a short clinical guideline on the use of colonoscopic surveillance.
The recommendations are broadly consistent with those in the 2010 British Society of Gastroenterology guidelines.
NOTES FOR PRESENTERS:
Key points to raise:
Adults with or with adenomas have a higher risk of developing colorectal cancer than the general population.
Colonoscopic surveillance in people with inflammatory bowel disease (IBD, which covers ulcerative colitis and Crohn's disease) or adenomas can detect any problems early and potentially prevent progression to colorectal cancer. For people who are not in these high-risk groups, the NHS Bowel Cancer Screening Programme ( offers screening using faecal occult blood testing every 2 years to all men and women aged 60–74 years. People undergoing colonoscopic surveillance are not generally offered screening as part of the Bowel Cancer Screening programme.
In 2010, the British Society of Gastroenterology (BSG) issued updated guidelines for colonoscopic surveillance in people who have had adenomas removed and for people with IBD (Cairns et al. 2010). However, because of variations in clinical practice, NICE has developed this short clinical guideline on the use of colonoscopic surveillance. The evidence-based recommendations are broadly consistent with those in the 2010 BSG guidelines.
Additional information:
Throughout this guideline, ‘adenomas’ is used to refer to precancerous or non-precancerous types of polyp or adenoma. However, other terms have been used in the clinical studies included in the evidence review, for example ‘polyps’ or ‘adenomatous polyps’.
Polyps can be either precancerous (neoplastic adenomas) or nonprecancerous (non-neoplastic, including hyperplastic polyps).
Strong evidence suggests that detecting and removing adenomas reduces the risk of cancer. Small polyps are rarely malignant and are unlikely to progress to invasive cancers.

4. Definitions
Adenoma Baseline colonoscopy Bowel preparation Chromoscopy Crohn’s disease Colitis Colonoscopy Computed tomographic colonography (CTC) Inflammatory bowel disease Sigmoidoscopy
NOTES FOR PRESENTERS:
Adenoma
A benign tumour of a glandular structure or of glandular origin.
Baseline colonoscopy
A colonoscopic examination in which measurements are taken (after a run-in period where applicable). The results of subsequent colonoscopies can be compared with the baseline colonoscopy.
Bowel preparation
The use of various laxatives to clear out the bowel in preparation for lower gastrointestinal surgery or other bowel investigations, for example colonoscopy or barium enema.
Chromoscopy
Application of dyes onto the surface of the mucosal lining to enhance mucosal irregularities.
Crohn’s disease
Chronic inflammation that typically involves the distal portion of the small intestine, often spreads to the colon, and is characterised by diarrhoea, cramping, loss of appetite and weight and local abscesses and scarring.
Colitis
Inflammation of the part of the large intestine (colon) that extends from the caecum to the rectum.
Colonoscopy
The endoscopic examination of the large intestine (colon) and the distal part of the small bowel.
Computed tomographic colonography (CTC)
A medical imaging procedure that uses X-rays and computers to produce two- and three-dimensional images of the large intestine (colon) from the lowest part, the rectum, all the way to the lower end of the small intestine. The procedure is used to diagnose colon and bowel disease, including polyps, diverticulosis and cancer.
Inflammatory bowel disease
A group of inflammatory conditions of the colon and small intestine. In this guideline, inflammatory bowel disease refers to Crohn's disease and ulcerative colitis.
Sigmoidoscopy
A minimally invasive medical examination of the large intestine from the rectum through to the last part of the colon. There are two types of sigmoidoscopy, flexible sigmoidoscopy, which uses a flexible endoscope, and rigid sigmoidoscopy, which uses a rigid device.
Image of a polyp viewed using CT Colonograpy reproduced with kind permission of Dr Bruce Fox, Derriford Hospital, Plymouth.
Image reproduced with kind permission of Dr. Bruce Fox, Derriford Hospital, Plymouth

5. Epidemiology
The prevalence of ulcerative colitis is approximately 100–200 per 100,000 and the annual incidence is 10–20 per 100,000. The risk of developing colorectal cancer for people with ulcerative colitis is estimated as 2% after 10 years, 8% after 20 years and 18% after 30 years of disease. The prevalence of Crohn's disease is 50 –100 per 100,000 and the annual incidence is 5–10 per 100,000. The risk of developing colorectal cancer for people with Crohn's disease is considered to be similar to that for people with ulcerative colitis with the same extent of colonic involvement.
NOTES FOR PRESENTERS:
Colorectal cancer is the third most common cancer in the UK, with approximately 32,300 new cases diagnosed and 14,000 deaths in England and Wales each year. Around half of the people diagnosed with colorectal cancer survive for at least 5 years after diagnosis.
Expert opinion suggests that the annual incidence of adenomas is 1% of the adult population. For a population of 100,000, the number of adults in the age range 20–75 years is estimated to be 68,092. Therefore the annual incidence is estimated to be 681 per 100,000 per year.

6. Guideline Scope The guideline covers adults with:
inflammatory bowel disease
adenomas in the colon or rectum
The key issues covered are:
information and support needs of patients
colonoscopic surveillance (conventional colonoscopy or chromoscopy) for prevention and early detection of colorectal cancer
initiation of surveillance
frequency of ongoing surveillance
NOTES FOR PRESENTERS:
Additional information:
Groups covered
Adults (18 years and older) with IBD (defined as ulcerative colitis or Crohn's disease involving the large bowel).
Adults with adenomas (polyps) in the colon or rectum.
Key clinical issues covered
Colonoscopic surveillance (using conventional colonoscopy or chromoscopy) for prevention and early detection of colorectal cancer] compared with no surveillance or surveillance using other methods, such as flexible sigmoidoscopy, double-contrast barium enema, computed tomographic colonography, and tri-modal imaging (high-resolution white light endoscopy, narrow-band imaging and autofluorescence imaging).
Initiation of surveillance and the frequency of ongoing surveillance (considering factors including duration and extent of condition, number, size and location of polyps).
Information and support needs of people undergoing or considering undergoing colonoscopic surveillance.
Groups not covered
Children (younger than 18 years).
Adults with newly diagnosed or relapsed adenocarcinoma of the colon or rectum.
Adults with polyps that have previously been treated for colorectal cancer.
Adults with a genetic familial history of colorectal cancer: hereditary non-polyposis colorectal cancer.
Adults with a familial history of polyposis syndromes: familial adenomatous polyposis.
Clinical issues not covered
Diagnosis and assessment of IBD or polyps.
Diagnosis and management of colorectal cancer.

7. Guideline recommendations
The recommendations cover three key areas:
Providing information and support
people with IBD
people with adenomas.
NOTES FOR PRESENTERS:
The NICE guideline contains 18 recommendations about how care can be improved and for this presentation we have divided the recommendations into three areas.
We have chosen to cover providing information and support since it applies to both people with adenomas and people with IBD
Image of inflammatory polyp reproduced with kind permission of Professor Marco Novelli, University College London.
Image reproduced with kind permission of
Professor Marco Novelli,
University College London

8. Providing information and support: 1
Provide information tailored to the person’s needs.
What to discuss with people who are considering colonoscopic surveillance:
potential benefits, limitations and risks particularly
- early detection and prevention of colorectal cancer
- quality of life and psychological outcomes.
NOTES FOR PRESENTERS:
Recommendation in full: shown on slide
**note to editor – please see comments box on slide**

9. Providing information and support: 2
Inform people who have been offered colonoscopy, CTC, or barium enema about the procedure, including:
bowel preparation
impact on everyday activities
sedation
potential discomfort
risk of perforation and bleeding.
NOTES FOR PRESENTERS:
Recommendation in full: shown on slide

10. Providing information and support: 3
Discuss the potential benefits, limitations and risks of ongoing surveillance. Base a decision to stop surveillance on potential benefits for the person, their preferences and comorbidity. If findings at surveillance need treatment or referral, discuss options with the person and, if appropriate, their family or carers, giving them the opportunity to discuss any issues.
NOTES FOR PRESENTERS:
Recommendations in full:
After receiving the results of each surveillance test, discuss the potential benefits, limitations and risks of ongoing surveillance. Base a decision to stop surveillance on potential benefits for the person, their preferences and any comorbidities. Make the decision jointly with the person and if appropriate, their family or carers. [1.1.16]
If there are any findings at surveillance that need treatment or referral, discuss the options with the person and if appropriate, their family or carers. [1.1.17]
Throughout the surveillance programme, give the person and their family or carers the opportunity to discuss any issues with a healthcare professional. Information should be provided in a variety of formats tailored to the person’s needs and should include illustrations.
[1.1.18]

11. People with inflammatory bowel disease:1
Offer:
Baseline colonoscopy with chromoscopy and targeted biopsy of any abnormal areas to people with IBD who are being considered for colonoscopic surveillance to determine their risk of developing colorectal cancer (see table 1).
Colonoscopic surveillance to people with IBD whose symptoms started 10 years ago and who have:
ulcerative colitis (but not proctitis alone) or
Crohn’s colitis involving more than one segment of colon.
NOTES FOR PRESENTERS:
Additional information:
Table 1 is shown on slide 12.
Recommendations & in full: shown on slide

12. Risk of developing colorectal cancer in people with IBD
Low risk:
extensive but quiescent ulcerative colitis or
extensive but quiescent Crohn’s colitis or
left-sided ulcerative colitis (but not proctitis alone) or Crohn’s colitis of a similar extent.
Intermediate risk:
extensive ulcerative or Crohn’s colitis with mild active inflammation that has been confirmed endoscopically  or histologically or
post-inflammatory polyps or
family history of colorectal cancer in a first-degree relative aged 50 years or over.
High risk:
extensive ulcerative or Crohn’s colitis with moderate or severe active inflammation that has been confirmed endoscopically or histologically or
primary sclerosing cholangitis (including after liver transplant) or
colonic stricture in the past 5 years or
any grade of dysplasia in the past 5 years or
family history of colorectal cancer in a first-degree relative aged under 50 years.
NOTES FOR PRESENTERS:
Additional information:
Proctitis Inflammation of the anus and rectum.
Table 1

13. People with inflammatory bowel disease: 2
Offer surveillance using colonoscopy with chromoscopy to people with IBD, based on risk:
Low risk: offer at 5 years
Intermediate risk: offer at 3 years
High risk: offer at 1 year
Repeat colonoscopy if incomplete with more experienced colonoscopist if needed.
NOTES FOR PRESENTERS:
Key points to raise:
The Guideline Development Group recognised the significant inter-operator variability of colonoscopy. It recommended that if a colonoscopy is incomplete, a repeat colonoscopy should be undertaken, with a more experienced colonoscopist if appropriate.
Recommendations in full:
Offer colonoscopic surveillance to people with IBD as defined in based on their risk of developing colorectal cancer (see table 1), determined at the last complete colonoscopy:
Low risk: offer colonoscopy at 5 years.
Intermediate risk: offer colonoscopy at 3 years.
High risk: offer colonoscopy at 1 year.[1.1.3]
For people with IBD who have been offered colonoscopic surveillance, continue to use colonoscopy with chromoscopy as the method of surveillance.[1.1.4]
Offer a repeat colonoscopy with chromoscopy if any colonoscopy is incomplete. Consider whether a more experienced colonoscopist is needed. [1.1.5]
Image of Dysplasia-associated mass or lesion (DALM) reproduced with kind permission of Professor Marco Novelli, University College London.
Image reproduced with kind permission of
Professor Marco Novelli,
University College London

14. Click here Click here Click here
Offer colonoscopic surveillance to people whose symptoms started 10 years ago and who have:
ulcerative colitis (but not proctitis alone) or
Crohn’s colitis involving more than one segment of colon
Offer a baseline colonoscopy with chromoscopy and targeted biopsy of any abnormal areas to determine the risk of developing colorectal cancer
High risk
Extensive ulcerative or Crohn’s colitis with moderate or severe active inflammation (confirmed endoscopically or histologically) or
Primary sclerosing cholangitis (including after liver transplant) or
Colonic stricture in the past 5 years or
Any grade of dysplasia in the past 5 years or
Family history of colorectal cancer in a first-degree relative aged under 50
Low risk
Extensive but quiescent ulcerative or Crohn’s colitis or
Left-sided ulcerative colitis (but not proctitis alone) or Crohn’s colitis of a similar extent
Intermediate risk
Extensive ulcerative or Crohn’s colitis with mild active inflammation (confirmed endoscopically or histologically) or
Post-inflammatory polyps or
Family history of colorectal cancer in a first-degree relative aged 50 or over
Click here
Click here
Click here

15. Click here to go back to slide 14
Low risk
Left-sided ulcerative colitis (but not proctitis alone) or Crohn’s colitis of a similar extent or
Extensive but quiescent ulcerative or Crohn’s colitis
Follow-up
Offer colonoscopy with chromoscopy at 5 years
Offer a repeat colonoscopy with chromoscopy if incomplete. Consider whether a more experienced colonoscopist is needed
Findings at follow-up
Offer the next colonoscopy with chromoscopy based on the person’s risk at the last complete colonoscopy:
low risk – offer at 5 years
intermediate risk – offer at 3 years
high risk – offer at 1 year
Click here to go back to slide 14

16. Click here to go back to slide 14
Intermediate risk
Extensive ulcerative or Crohn’s colitis with mild active inflammation (confirmed endoscopically or histologically) or
Post-inflammatory polyps or
Family history of colorectal cancer in a first-degree relative aged 50 or over
Follow-up
Offer colonoscopy with chromoscopy at 3 years
Offer a repeat colonoscopy with chromoscopy if incomplete. Consider whether a more experienced colonoscopist is needed
Findings at follow-up
Offer the next colonoscopy with chromoscopy based on the person’s risk at the last complete colonoscopy:
low risk – offer at 5 years
intermediate risk – offer at 3 years
high risk – offer at 1 year
Click here to go back to slide 14

17. Primary sclerosing cholangitis (including after liver transplant) or
High risk
Extensive ulcerative or Crohn’s colitis with moderate or severe active inflammation (confirmed endoscopically or histologically) or
Primary sclerosing cholangitis (including after liver transplant) or
Colonic stricture in the past 5 years or
Any grade of dysplasia in the past 5 years or
Family history of colorectal cancer in a first-degree relative aged under 50
Follow-up
Offer colonoscopy with chromoscopy at 1 year
Offer a repeat colonoscopy with chromoscopy if incomplete. Consider whether a more experienced colonoscopist is needed
Findings at follow-up
Offer the next colonoscopy with chromoscopy based on the person’s risk at the last complete colonoscopy:
low risk – offer at 5 years
intermediate risk – offer at 3 years
high risk – offer at 1 year
Click here to go back to slide 14
Click here to move on to slide 18

18. People with adenomas: 1
Offer appropriate colonoscopic surveillance based on individual’s risk of developing colorectal cancer determined at initial adenoma removal.
NOTES FOR PRESENTERS:
Use the algorithm on slides (and in the QRG) to determine actions.
Recommendation in full:
Offer the appropriate colonoscopic surveillance strategy to people with adenomas based on their risk of developing colorectal cancer as determined at initial adenoma removal (see table 2).
Low risk: consider colonoscopy at 5 years:
if the colonoscopy is negative (that is, no adenomas are found) stop surveillance
if low risk, consider the next colonoscopy at 5 years (with follow-up surveillance as for low risk)
if intermediate risk, offer the next colonoscopy at 3 years (with follow-up surveillance as for intermediate risk)
if high risk, offer the next colonoscopy at 1 year (with follow-up surveillance as for high risk). 
Intermediate risk: offer colonoscopy at 3 years:
if the colonoscopy is negative, offer the next colonoscopy at 3 years. Stop surveillance if there is a further negative result
if low or intermediate risk, offer the next colonoscopy at 3 years (with follow-up surveillance as for intermediate risk)
High risk: offer colonoscopy at 1 year.
if the colonoscopy is negative, or low or intermediate risk, offer the next colonoscopy at 3 years (with follow-up surveillance as for intermediate risk)
if high risk, offer the next colonoscopy at 1 year (with follow-up surveillance as for high risk). [1.1.9]
Image of an adenoma reproduced with kind permission of Professor Marco Novelli, University College London.
Image reproduced with kind permission of
Professor Marco Novelli,
University College London

19. Risk of developing colorectal cancer in people with adenomas
Low risk:
one or two adenomas smaller than 10 mm.
Intermediate risk:
three or four adenomas smaller than 10 mm or
one or two adenomas if one is 10 mm or larger.
High risk:
five or more adenomas smaller than 10 mm or
three or more adenomas if one is 10 mm or larger.
Table 2 19

20. People with adenomas: 2
Use the findings at adenoma removal to determine people’s risk of developing colorectal cancer:
Offer colonoscopic surveillance to people who are at intermediate or high risk of developing colorectal cancer
Consider colonoscopic surveillance for people who are at low risk of developing colorectal cancer
NOTES FOR PRESENTERS:
Additional information:
Table 2 is shown on slide 19.
Recommendations in full:
Consider colonoscopic surveillance for people who have had adenomas removed and are at low risk of developing colorectal cancer (see table 2). [1.1.6]
Offer colonoscopic surveillance to people who have had adenomas removed and are at intermediate or high risk of developing colorectal cancer (see table 2). [1.1.7]
Use the findings at adenoma removal to determine people’s risk of developing colorectal cancer (see table 2). [1.1.8]
Low risk:
one or two adenomas smaller than 10 mm.
Intermediate risk:
three or four adenomas smaller than 10 mm or
one or two adenomas if one is 10 mm or larger.
High risk:
five or more adenomas smaller than 10 mm or
three or more adenomas if one is 10 mm or larger.

21. People with adenomas: 3
Repeat colonoscopy if incomplete, with more experienced colonoscopist if needed. If colonoscopy is not clinically appropriate consider CTC, if not available or appropriate, consider double contrast barium enema. Consider CTC or double contrast barium enema for ongoing surveillance if colonoscopy remains clinically inappropriate and discuss the risks and benefits with the person and their family or carers.
NOTES FOR PRESENTERS:
Recommendations in full:
Offer a repeat colonoscopy if any colonoscopy is incomplete. Consider whether a more experienced colonoscopist is needed. [1.1.10]
Consider computed tomographic colonography (CTC) as a single examination if colonoscopy is not clinically appropriate (for example, because of comorbidity or because colonoscopy cannot be tolerated). Computed tomographic colonography (virtual colonoscopy). NICE interventional procedure guidance 129 (2005).
[1.1.11]
Consider double contrast barium enema as a single examination if CTC is not available or not appropriate. [1.1.12]
Consider CTC or double contrast barium enema for ongoing surveillance if colonoscopy remains clinically inappropriate, but discuss the risks and benefits with the person and their family or carers. [1.1.13]

22. Click here end algorithm and move on to next section (slide 26)
For people who have had adenomas removed use the findings at removal to determine the risk of developing colorectal cancer
Low risk
One or two adenomas smaller than 10 mm
Intermediate risk
Three or four adenomas smaller than 10 mm or
One or two adenomas if one is 10 mm or larger
High risk
Five or more adenomas smaller than 10 mm or
Three or more adenomas if one is 10 mm or larger
Click here
Click here
Click here
Click here end algorithm and move on to next section (slide 26)

23. Click here to go back to slide 22
Low risk
One or two adenomas smaller than 10 mm
Follow-up
Consider colonoscopy at 5 years
Offer a repeat colonoscopy if incomplete. Consider whether a more experienced colonoscopist is needed.
If colonoscopy is not clinically appropriate, consider CTC. If CTC is not available or appropriate consider double contrast barium enema. Discuss the risks and benefits with the person and their family or carers if these techniques are being considered for ongoing surveillance
Findings at follow-up
No adenomas – stop surveillance
Low risk – consider the next colonoscopy at 5 years. Follow up as for low risk
Intermediate risk – offer the next colonoscopy at 3 years. Follow up as for intermediate risk
High risk – offer the next colonoscopy at 1 year. Follow up as for high risk
Click here to go back to slide 22

24. Click here to go back to slide 22
Intermediate risk
Three or four adenomas smaller than 10 mm or
One or two adenomas if one is 10 mm or larger
Follow-up
Offer colonoscopy at 3 years
Offer a repeat colonoscopy if incomplete. Consider whether a more experienced colonoscopist is needed.
If colonoscopy is not clinically appropriate, consider CTC. If CTC is not available or appropriate consider double contrast barium enema. Discuss the risks and benefits with the person and their family or carers if these techniques are being considered for ongoing surveillance
Findings at follow-up
No adenomas – offer the next colonoscopy at 3 years. Stop surveillance if there is a further negative result
Low or intermediate risk – offer the next colonoscopy at 3 years. Follow up as for intermediate risk
High risk – offer the next colonoscopy at 1 year. Follow up as for high risk
Click here to go back to slide 22

25. Five or more adenomas smaller than 10 mm or
High risk
Five or more adenomas smaller than 10 mm or
Three or more adenomas if one is 10 mm or larger
Follow-up
Offer colonoscopy at 1 year
Offer a repeat colonoscopy if incomplete. Consider whether a more experienced colonoscopist is needed
If colonoscopy is not clinically appropriate, consider CTC. If CTC is not available or appropriate consider double contrast barium enema. Discuss the risks and benefits with the person and their family or carers if these techniques are being considered for ongoing surveillance.
Findings at follow-up
No adenomas, or low or intermediate risk – offer the next colonoscopy at 3 years. Follow up as for intermediate risk
High risk – offer colonoscopy at 1 year. Follow up as for high risk
Click here to go back to slide 22
Click here to move on to next section (slide 26)

26. Costs and savings
Implementation of this guideline is considered unlikely to have a significant impact on NHS resources nationally where current BSG recommendations are being followed.
The guideline was developed because of variations in clinical practice nationally.
Organisations are therefore encouraged to review circumstances locally. A costing template has been developed to assist organisations in this process.
NOTES FOR PRESENTERS:
NICE has found that implementing this guideline is unlikely to result in any significant changes in resource use, based on national assumptions. However, different areas may vary from the national average and it is important to look at the recommendations most likely to have a resource impact to make sure that local practice matches the national average.
These recommendations are:
[INSERT FROM COSTING STATEMENT THE RECOMMENDATION AND RATIONALE.]

27. Discussion
How do we identify people who should be included in a surveillance programme?
Are the full range of tests, including CTC, available?
How do we discuss potential benefits, limitations and risks with people who are considering colonoscopic surveillance and is this in line with the guideline?
What information, including illustrations, is available about the surveillance programme?
NOTES FOR PRESENTERS:
These questions are suggestions that have been developed to help provide a prompt for a discussion at the end of your presentation – please edit and adapt these to suit your local situation.
Additional questions:
How do we identify and access a more experienced colonoscopist when needed? – if this question is used it is important to emphasise that this is not about length of experience.

28. Find out more Visit www.nice.org.uk/guidance/CG118 for: the guideline
the quick reference guide
‘Understanding NICE guidance’
costing report and template/costing statement
audit support and baseline assessment tool
NOTES FOR PRESENTERS:
You can download the guidance documents from the NICE website.
The full guideline – all the recommendations, details of how they were developed, and reviews of the evidence they were based on.
A quick reference guide – a summary of the recommendations for healthcare professionals.
‘Understanding NICE guidance’ – information for patients and carers.
For printed copies of the quick reference guide or ‘Understanding NICE guidance’, phone NICE publications on or and quote reference numbers N2353 (quick reference guide) and/or N2354 (‘Understanding NICE guidance’).
NICE has developed tools to help organisations implement this guideline, which can be found on the NICE website
Costing tools – a costing report gives the background to the national savings and costs associated with implementation, and a costing template allows you to estimate the local costs and savings involved.
Costing statement – details of the likely costs and savings when the cost impact of the guideline is not considered to be significant.
Audit support – for monitoring local practice.
The Baseline Assessment tool - an Excel spreadsheet that can be used by organisations to identify if they are in line with practice recommended in NICE guidance and to help them plan activity that will help them meet the recommendations.

29. What do you think?
Did the implementation tool you accessed today meet your requirements, and will it help you to put the NICE guidance into practice?
We value your opinion and are looking for ways to improve our tools. Please complete a short evaluation form by clicking here.
If you are experiencing problems accessing or using this tool, please
NOTES FOR PRESENTERS:
Additional information:
This final slide is not intended to be part of the presentation, it asks for feedback on whether this implementation tool meets your requirements and whether it will help you to put this NICE guidance into practice - your opinion would be appreciated.
To open the links in this slide set right click over the link and choose ‘open link’
To open the links in this slide set right click over the link and choose ‘open link’