Practice Audit

You, as a practice, took this data and then did a month-long audit of the same day clinics in prescribing, because I think looking at this, you see that it’s the same day clinic is where most of your prescribing is happening. We decided to look into that and did an audit. And it was a prospective audit, because it seemed to us to be the easiest way. And I think when you’re looking at any of these things, it’s probably the simpler you can keep it, the better. And I think sometimes you just want to get on and do something, even if it’s not necessarily the perfect thing. Just do something initially, and then have a think about it.

Reflect on it, and then make some changes from there onwards. So what we did was we looked at all the antibiotic prescriptions that were generated from the same day team over a period of a month. And that was in April. And when we did that, most of our prescriptions were for trimethoprim and amoxicillin. Which fits in with the national– Yeah, which is what we would have expected. Isn’t that really what we found. We discussed that as a team. And we thought, we’ll look at the indications for trimethoprim. And most of those were actually when we looked at it for UTIs.

But looking at evidence-based guidelines for antibiotic prescriptions for UTIs, it really says, if a patient is symptomatic of a urinary tract infection, that you should treat anyway. And there’s a lot of discussion about whether you should dip the urine, or whether you should send the urine off. But generally speaking, if they’re symptomatic with a positive dip, we would prescribe. So the other area that we could look at was the 25 patients who received amoxicillin for chest infections. And we did that. We went through the notes and got all of the and looked back at the patient record for those patients. So I think most GPs nowadays would say it’s really helpful.

And most nurse prescribers would say it’s very helpful that if you’ve got some evidence-based guidelines that can be easily accessed, where somebody else has done all the reading and given you some recommendations that you can easily understand, they are incredibly helpful. And this is the information we used to when I reflected back on the patients’ consultations, where they’d received the amoxicillin prescriptions. What I did notice was that, generally speaking, I thought the prescription was justified, and that the patient had been seen, had had a face-to-face consultation, that a history had been taken, and the examination was done, which was clearly documented with clinical signs.

And most of the time, there was actually recognition that there was consolidation on the chest, and the antibiotic had been prescribed. But truthfully, there were a couple of occasions where the antibiotic had been given over the phone without the patient being seen. And quite often, that was with quite high patient expectation. And it did show us that we have got room to change. And we have got room to manoeuvre. And we can do better, which is not what we want to know, but what we want to know. So we got together as a team again following that survey.

And we decided to go forward and try and get ourselves a prescribing template so that if we were thinking about prescribing an antibiotic, we could actually look at some criteria on a template to say– a bit like the Centor or FeverPAIN Score, prescribing algorithms for sore throats, that we could develop something that will be practical and useful to us in the same way when prescribing for chests. So that is our work in process at the moment. Great. Brilliant. And hopefully, that will be effective in cutting down the amoxicillin prescriptions.

I think that’s a great example of going from this very high-level data, effectively all the way down to this very focused intervention which is– it’ll be great to see if it works. Interestingly, when Ian then– because we got together as a group and we presumed that most of our antibiotic prescribing would be done in the same day team, because that’s where we thought we were going to be seeing the most acute infection. However, when Ian re-ran the figures, probably only half of our antibiotics in that month were generated within the same day team framework. So I think we’ve got a lot of antibiotics that are probably on repeat prescription for COPD and exacerbations of, and those sorts of things.

So although we initially ran our audit on an assumption which was erroneous, I think we still got good information out of it. We’ve still got some areas where we can change. And I think we need to be quite easy with ourselves and say, look, you don’t have to get it right to start off with. Just do something. Start looking. And it has promoted change, which will be effective, even though it wasn’t necessarily borne from the right idea in the first place. And I think all that the evidence shows about practices that are low-prescribing practices, is they just have that culture of questioning what they do. So there’s a champion, usually, who says, I’m interested.

And I’m going to lead on it, and then the whole surgery working as a unit, really, around that. And that is when it’s effective. Rather than, how do I comply, it’s how do I improve? And I think that’s why I love working here for because I get very much that feeling.