Table 2. NICE Recommendations and Corresponding HELP Protocols.

NICE Clinical Factor	NICE Preventive Interventions	HELP Protocol
Cognitive Impairment or Disorientation	Provide lighting, signs, calendars and clocks. Reorient the patient to time, place, person and your role.	Orientation/Therapeutic activities protocols
	Introduce cognitively stimulating activities like reminiscence. Facilitate regular visits from family & friends.
Dehydration or Constipation	Encourage the patients to drink. Consider advising use of parenteral fluids if necessary. Seek advice regarding fluid balance in patients with comorbidities (heart failure, renal disease)	Expansion of Fluid Repletion Protocol*
Hypoxia	Assess for hypoxia and oxygen saturation.	Newly developed Hypoxia Protocol*
Immobility or Limited Mobility	Encourage early post-operative mobilization and regular ambulation. Keep walking aids (canes, walkers) nearby at all times. Encourage all patients to carry active, range-of-motion exercises.	Early Mobilization Protocol
Infection	Look for and treat infection. Avoid unnecessary catheterization. Implement infection-control procedures.	Newly developed HELP Infection Prevention Protocols (Hand hygiene, pneumonia, CAUTI)*
Multiple Medications	Review medication for both the type and the number of medications.	Psychoactive Medications Protocol
Pain	Assesses for pain especially in those who have communication difficulties. Begin and monitor pain management in those with known or suspected pain.	Newly developed HELP Pain Management Protocol*
Poor Nutrition	Follow general nutrition guidelines and seek advice from dietician as needed. Ensure proper fit of dentures.	Feeding Assistance Protocol
Sensory Impairment	Resolve reversible cause of the impairment. Ensure working hearing and visual aids are available and used by those who need them.	Vision protocol Hearing protocol
Sleep Disturbance	Avoid medical/nursing procedures during sleep if possible. Schedule meds to avoid disturbing sleep Reduce noise at night.	Sleep Enhancement Protocol

^*Four additional HELP Protocols were created in order to fulfill NICE intervention areas not previously addressed by separate HELP protocols.