Audit and Practice Survey Posters 221 – 226
221 Vital signs in febrile children; an audit of documentation in a General Practice
Abstract Background Fever is the commonest reason for a child to be taken to the doctor1 and is usually due to a self-limiting viral infection, however can be caused by serious bacterial illnesses1.
Aims To audit the process of vital sign documentation by general practitioners and nursing staff, focussing on children under 5 presenting with fever. To assess whether use of a pre-existing consultation template improves documentation rates.
Methods The standard was taken from NICE guideline CG1601. An EMIS database search was done for consultations between 15.01.13-15.01.16, using coding of:‘fever symptoms’‘feels hot/feverish’‘fever’ ‘on examination level of fever ’Adherence to the required documentation (temperature, heart rate, respiratory rate and capillary refill time) was recorded on a proforma.
Results Over the selected period, 35 patients had presented, producing a total of 95 consultations (some presented more than once). Overall, 28.4% of consultations recorded all four vital signs, with a higher rate (78.9%) in the sub-group (n=19) that used the template. Temperature was documented most often; as high as 94.7% in consultations with template use. Heart rate, respiratory rate and capillary refill time were measured less often – in 60%, 42.1% and 53.7% of all consultations respectively.
Conclusions There is good compliance to NICE guidelines for temperature assessment but other vital signs are recorded less often. The use of a template showed better rates of documentation, so use should be encouraged for future practice. References:NICE: Fever in under 5s: assessment and initial management (CG160). London: NICE; 2013.
222 Assessing baseline monitoring of liver function prior to statin therapy: an audit in general practice
Introduction: Statins are the most heavily dispensed drugs in the community. NICE and MHRA recommends baseline liver function testing (LFT) to avoid deranged liver function. In light of this, it is important to assess if baseline LFTs are performed on patients taking statins and if not why.
Methods: A retrospective audit identified patients taking statins without a recorded LFT. The standard was 0% as all patients should have had an LFT prior to commencement of a statin. The audit population was all active patients of the surgery. The audit period was 12 months prior to the audit date.
Outcomes: Of 7779 patients at this urban GP practice, 1293 patients were on a statin, 26 did not have an LFT on record. Of the 26, 22 joined the surgery already on a statin but this was not documented. Of the remaining 4, 3 patients had hospital admissions prior to statin commencement and received an LFT as an inpatient but this was not documented. The remaining 1 patient did not have any documented reason for the lack of LFT.
Discussion: A weakness in practice documentation was identified. When receiving new or hospital discharged patients, care is needed to ensure appropriate monitoring has taken place and this needs to be documented when (re)issuing statins. This is especially relevant as next year’s Quality and Outcomes Framework may significantly increase the number of patients receiving statin therapy but this also has a further reaching impact applicable to any treatment requiring monitoring.
223 Prediabetes practice audit: the conversion to normoglycaemia and prevention of diabetes
Tajinder Singh Parmar
Aims/Objectives To assess what is the conversion rate to diabetes and what is the conversion rate to normoglycaemia from patients who are diagnosed with prediabetes.
Content of Presentation All prediabetics in a 5000 patient practice were analysed over the past 18 months. This was before and after dietary advice. Patients excluded were those who had not had a repeat Hba1c within the past 12 months.
Results have shown that of 246 patients on the prediabetic register, 165 patients had a baseline and repeat Hba1c within the past 18 months.
Relevance/Impact £8.8 billion is spent on diabetes care in the UK at present rising to £17 billion in 25 years. Prediabetes has been shown to lead to diabetes in well established studies and equally can also reversed to normoglycaemia. The impact of this reversal and prevention of diabetic complications will have a significant effect on future NHS costs.OutcomesThe conversion rate to diabetes was 3/165 patients equating to 1% – this on it’s own has shown a reduction with simple intervention of the accepted 5-10% conversion rate. The conversion rate to normoglycaemia was 38%.
Discussion Most quoted studies have used fasting glycaemia or IGT to diagnose prediabetes. In those studies most showed a conversion rate to normoglycaemia to 40% over 8 years. The average per year being quoted as 5.8%.In our study we used Hba1c and have shown that within one year of primary care intervention the normoglycaemic rate is a substantial 38%.
223 An audit of patient access in General Practice
A survey of more than 700 GP surgeries by Pulse UK in May 2015 revealed 60% of GP surgeries reporting waiting times of longer than one week. Evidence suggests that enhancing patient flow increases patient safety and increases the likelihood of patients always receiving the right care, in the right place, at the right time.We present an audit cycle conducted over 15 months looking into access at our GP surgery.
The primary objective was to assess waiting times which were first assessed on 16293 clinical events. The improvement was the introduction of a telephone consultation and triage system after which waiting times were reassessed on 18520 clinical events. As a secondary objective, subjective views of the public and staff were added to the audit process via surveys.
We demonstrated a significant reduction in waiting times after introduction of the telephone consultation model. Waiting times reduced overall with 76.89% seen within 3 days of contact with GP in comparison to 50% of patients previously. There was also a significant increase in the amount of patient contact by the GP’s with this new model. The re-audit identified areas of further improvement required in the Practice.
The telephone consultation and triage system is likely to be increasingly implemented across the country and the best use of this system is still under discussion. The poster presentation would explore the audit cycle to create discussion regarding the telephone consultation system and other avenues that can be used to solve problems of patient access.
224 Development of a Paediatric Telephone Advice service for General Practitioners in a District General Hospital setting
Aims To seek evidence on changing service provision to Paediatric assessment in secondary care.Content: In order to improve rapid access to specialist Paediatric opinion without further burden on A&E we sought evidence to support a change in service provision.
Impact: Our DGH serves a population of 300,000 that is characterized by high ethnic diversity and a large percentage of under 16 year-olds. At present GPs have only two options when referring a child: telephone request for same-day (AE) assessment, or referral to the outpatient department (OPD) with an 8 week wait.
Results:10 OPD referrals (21%) were identified as being avoidable95 patients were referred to on-call team. 15 cases (16%) advice alone was given. 73 patients assessed in AE, 36 (49%) reviewed and discharged with no investigations30 local GP practices were surveyed. Average satisfaction score with speed of OPD assessment was 6.5 (1-10 scale). 28 practices stated they would benefit from a telephone advice service. GPs estimated taking over 5 minutes to connect to on-call registrar.
Discussion: Results identified high referral rate to AE for children who did not need admission. There was poor satisfaction among GPs with speed of outpatient review and delay in speaking to the on-call Paediatric registrar. This indicated a need for improved access to Paediatric advice; reducing ED and OPD referrals. We used this data to propose a Paediatric consultant-led telephone advice service be instituted for GPs. GPs have indicated they would find this beneficial, and it would reduce unnecessary referrals.
225 Questionnaire survey of awareness of the risk factors and consequences of type 2 diabetes (T2DM) in adult general practice (GP) attendees
Introduction: Although the number of patients suffering with Type 2 diabetes (T2DM) in the UK is increasing it is possible that many patients still do not know the risk factors and possible consequences.
Methods: We conducted a confidential questionnaire survey of knowledge of diabetes risk factors and possible consequences in consecutive patients aged ≥16 years sitting in the waiting room at a GP surgery. Patients were asked their age, gender, diabetic status, other diseases they had, ethnicity, occupation, weight and height, waist size, relatives with T2DM, and an open question asking if they knew one risk factor for T2DM and one resulting disease.
Results: The response rate was 82% (69/85). Mean age of responders was 44 years (range 16-82), 63% were female; and 70% described themselves as white, 15% black, 9% Indian and 6% as other ethnic group. Nine patients (13%) said they were diabetic. We found lack of awareness in the responders on the subject of T2DM. Only 32% (22/69) knew any risk factors (eg obesity, race, genetic); and only 27% (18/69) any diseases resulting from T2DM (eg eye, heart, kidney problems, stroke, amputation). Knowledge of risk factors and consequences was similar in diabetics and non-diabetics. Only 53% of those with a BMI of >25 considered themselves to be overweight. Discussion: While there have been many national audits on T2DM, this may be the first in UK GP attenders in 2015. We found low knowledge of T2DM even in those with the disease. GPs might consider putting up surgery posters and using opportunistic health promotion to help increase awareness of T2DM and risks of obesity.
226 Audit of antibiotic prescribing for acute otitis media in a semi-rural GP practice
Dr Annabelle Machin
Aims To audit antibiotic prescribing for acute otitis media (AOM) against NICE Guidelines (CG69) in children aged less than 18 years attending primary care.ContentAudit in one semi-rural general practice. Thirty consultation records for children coded as AOM between March and August 2015 reviewed to determine whether, from the records, a prescription seemed justified, if antibiotics were prescribed correctly and if self-care and safety netting advice was documented.An audit revealed that 10% had potentially unnecessary prescriptions. 73% were prescribed an incorrect antibiotic dose and almost half had no documented self-care and safety netting advice. An EMIS template for AOM was introduced with symptom codes, antibiotic indications and doses, and a leaflet containing self-care advice and red flags.In the re-audit period (September 2015-February 2016) the overall accuracy of antibiotic prescribing rose from 26% to 52% and recording of safety netting advice rose to 83%.
Relevance/ Impact Tackling overuse of antibiotics is a health care priority. AOM is a common presentation in primary care. Although antibiotics are indicated in certain circumstances, for the majority, symptoms settle spontaneously.
Outcomes Use of a consultation template for patients presenting with AOM can reduce unnecessary antibiotic prescriptions and improve provision of self-care advice.
Discussion Clinicians need to improve their awareness of AOM prescribing guidelines, and avoid prescribing antibiotics to systemically well patients with less than four days’ symptoms. Use of deferred antibiotic prescriptions supported by information leaflets needs to be promoted to educate the public and reduce the future burden of antibiotic resistance.