How to Cite NICE Guidance Correctly in Clinical Audits (2025 Update)

Introduction: The Importance of Accurate NICE Citation

Accurate citation of NICE guidance is not merely an academic exercise; it is a cornerstone of robust clinical governance. It provides the essential link between national evidence-based standards and local clinical practice, forming the audit's benchmark. Incorrect or incomplete citations can lead to audit rejection by governance committees, undermine the project's credibility, and fail to provide a defensible standard for measuring care quality. For trainees, this is critical for successful e-Portfolio entries and ARCP outcomes.

What Constitutes a Valid NICE Citation for Audit?

Not all NICE products are designed to be used as direct clinical standards. Understanding which guidance types are appropriate for audit is the first critical step.

Primary Audit Standards: NICE Guidelines (NG) and Quality Standards (QS)

• NICE Guidelines (NG): These are the primary source of evidence-based recommendations for managing specific health conditions. They are the most commonly used benchmark for clinical audits.
  • Example: NG80 - Sepsis: recognition, diagnosis and early management.
  • Audit Use: Auditing the percentage of patients with suspected sepsis who received antibiotics within one hour.
• NICE Quality Standards (QS): These are concise sets of prioritised statements designed to drive measurable quality improvements. They are derived from NICE Guidelines and are excellent for audit as they are specifically designed to be measurable.
  • Example: QS204 - Osteoarthritis in over 16s.
  • Audit Use: Auditing the proportion of patients offered a core set of treatments (e.g., exercise, weight loss) before referral for surgical opinion.

Specialist Guidance: Technology Appraisals (TA) and Medical Technologies Guidance (MTG)

• NICE Technology Appraisals (TA): These provide guidance on the use of new and existing medicines and treatments within the NHS. They are valid for audit when the recommendation is a specific, measurable action.
  • Example: TA775 - Tepotinib for advanced non-small cell lung cancer with MET alterations.
  • Audit Use: Auditing the administration of tepotinib only to patients whose tumours have a confirmed MET exon 14 skipping alteration.
• NICE Medical Technologies Guidance (MTG): These assess the clinical and cost-effectiveness of medical devices, diagnostics, and digital health technologies. Use them for audit when the technology use is the specific focus.
  • Example: MTG64 - Placental growth factor-based testing to help diagnose pre-eclampsia.
  • Audit Use: Auditing the use of PlGF-based testing in women with suspected pre-eclampsia between 20 and 35 weeks gestation.

Correct Citation Formats for Different Outputs

The format of your citation should be adapted to the medium, but the core information must always be present.

Formal Audit Reports and Trust Committee Papers

This requires the most formal and complete citation format, typically following a version of Vancouver/AMA style.

Correct Format: National Institute for Health and Care Excellence (NICE). [Guidance Title]. [Guidance Type] [Number]. [Publication Date]. Available from: [URL] [Accessed Date].

Practical Example:

• National Institute for Health and Care Excellence (NICE). Hypertension in adults: diagnosis and management. NICE Guideline NG136. 28 March 2019 (last updated 23 August 2023). Available from: https://www.nice.org.uk/guidance/ng136 [Accessed 15 January 2025].

Key Elements:

• Full organisational name.
• Exact guidance title.
• Guidance type and number (e.g., NG136).
• Original publication date and 'last updated' date if applicable.
• Direct URL to the guidance page (not the NICE homepage).
• Date you accessed it (important for version control).

QI Posters and Presentation Slides

Space is limited, so a concise but unambiguous format is needed.

Correct Format: NICE. [Guidance Type] [Number]: [Shortened Title]. [Year of Publication/Update].

Practical Example:

• NICE. NG136: Hypertension in adults. 2023.
• Benchmark: NICE QS28: Asthma in adults. 2018.

e-Portfolio Entries (for Trainees)

For e-Portfolio audits, clarity and correctness are paramount for ARCP. Integrate the citation into the "Standards" section.

Template for e-Portfolio "Standards" Box:

Common Errors That Lead to Audit Rejection

Governance and audit committees frequently reject projects based on these fundamental citation errors.

Error	Example of Incorrect Citation	Correction & Rationale
Incorrect Guidance Code	"NICE Clinical Guideline CG127"	Use the current code. CG127 was superseded by NG136. Always check the NICE website for the latest active guidance.
Citing an Outdated/Superseded Guideline	Auditing against CG101 (2010) for COPD.	NG115 (2018) superseded CG101. Auditing against retired guidance invalidates your standard. The NICE page for an old guideline clearly states what replaced it.
Vague or Incomplete Citation	"As per NICE guidance on asthma."	Unacceptable. Must specify: NICE Quality Standard QS28: Asthma. The standard must be reproducible by the reader.
Failing to Cite the Specific Recommendation	Stating the audit is against "NG136" without specifying which part.	You must cite the specific recommendation number and text (e.g., "Recommendation 1.3.5: Offer ABPM..."). This defines your measurable criterion.
Using a Pathway or Summary Instead of the Guideline	"Standard: NICE Pathway on pneumonia."	The Pathway is a useful tool, but the formal standard is the underlying NG or QS. Cite the primary source.

Before-You-Submit Checklist

Use this actionable checklist prior to submitting your audit report, QI poster, or e-Portfolio entry.

Example for Different Training Stages

• F1/F2 Trainees: Focus on a single, clear recommendation from one NICE Guideline (NG) or Quality Standard (QS). This simplifies the audit and ensures a manageable project. Example: Auditing pre-operative HbA1c testing against QS6: Diabetes in adults.
• ST3+ Trainees & Audit Leads: Consider auditing against multiple recommendations within a Quality Standard (QS), which is designed for this purpose. This demonstrates a more comprehensive approach to service evaluation. Example: Auditing several statements from QS158: Bipolar disorder in adults.

Conclusion

Mastering the correct citation of NICE guidance is a fundamental clinical governance skill. It ensures the integrity of your clinical audit, provides a robust evidence base for quality improvement, and demonstrates to regulators, committees, and assessors that your work is grounded in national best practice. By adhering to the formats and checks outlined in this guide, clinicians and governance teams can be confident that their audits are built on a solid and defensible foundation.