LAP ref: - Devon LDC
Dental Clinical Audit
7. Antimicrobial Therapy
CAP ref:
Audit start date:
Completion date:
|Dental Clinical Audit report (tick) check list |
|All sections need to be completed and included when returning your report: |
|1. Antimicrobial Protocol | |
|2. Completed data capture sheets pages: 5 & 6 | |
|3. Results for the audit cycle page: 6 | |
|4. NHS England Area Team Mandatory Aims & Objectives page: 7 | |
|4.1 NHS England Mandatory Action Plan page: 7 | |
|Action Plan to include changes made after producing | |
|protocols and before audit cycle | |
|4.2 NHS England Mandatory Feedback section page: 7 | |
|(how useful you found the audit) | |
|5. Declaration Tick confirmation box and Date page: 8 | |
Structured Dental Clinical Audit
7. Antimicrobial & Anticoagulant Therapy
CLINICAL AUDIT FOR DENTAL PRACTITIONERS
:
7. Clinical Audit of Antimicrobial Therapy
Background
In primary care antibiotics are often prescribed for the treatment and prevention of odontogenic infections. However, there are relatively few indications for antibiotic prescribing in dentistry as the treatment of choice is usually local debridement or drainage.
National guidelines dictate that antibiotics are only needed if: there is spreading infection, full drainage could not be achieved or if the patient is medically compromised giving them a greater risk of infection.
Dental pain is primarily an inflammatory condition which can be managed by the appropriate use of analgesics and local measures to the site of pain It is important to educate and communicate with patients about the choices made for management of dental pain.
The Department of Health &Public Health England
[pic]
to be an Antibiotic Guardian
because antibiotic resistance is a catastrophic risk. At the current rate, Resistance will kill 10 Million people every year by 2050!!
At the cumulative total cost of 1.5 X today’s annual Global GDP = $10 trillion
A guardian’s role is to make better use of antibiotics and help save this vital medication from becoming obsolete.
Aims
• To highlight the use of antimicrobial in dental practice
• To ensure future records contain all relevant information
Objectives
• To ensure the practitioners have an antimicrobial protocol
• To help reduce the use of antimicrobials
The results of your audit will be recorded by the Panel who will feedback the overall findings for the area to yourself and the NHS England Area Team in an anonymous form. This will enable the NHS England Area Team to identify any areas that need support and enable you to compare your results with those of your local colleagues. Please return the completed mandatory NHS England Area Team page together, with your protocol and results pages to the Panel within three months.
Source material
FGDPUK - Standards for antimicrobial prescribing for the GDP 2012
Scottish Dental Clinical Effectiveness Programme - Drug Prescribing for Dentistry 2011
BNF
Cochrane Review - Antibiotics to prevent complications following tooth extractions 2012
Cochrane Review - Antibiotic use for severe toothache (irreversible pulpitis) 2013
Cochrane Review - Antibiotics for the prevention of bacterial endocarditis in dentistry 2013
Dental Protection Society. .uk :- Top right “search here” type Antibiotic Prescribing – look at Antibiotic Prophylaxis. Also go into “News and Events” position statements – Antibiotic Prophylaxis.
National Institute for Health & Clinical Excellence “NICE”
.uk/guidance
NICE guidelines by date, March 2008:- Prophylaxis against Infective Endocarditis
CQC Essential Standards of Quality and Safety - Outcome 9
2.
7. Clinical Audit of Antimicrobial Therapy
Method
This audit is useful for the whole Dental team and could be used at a Practice meeting.
1. Using guidance above devise a protocol for treatment of dental infections and include which antimicrobials used, the dose, duration and reason for its use
2. Then compare your existing use of Antimicrobials with your protocol by looking at the last 20 patients who you have prescribed antibiotics for – by using your practice log of prescriptions issued. Decide on changes that are necessary (retrospective audit)
3. Over the next 2 to 3 months check 20 patients where Antimicrobials are
prescribed to see if they match your protocol. (prospective reaudit)
If more than one dentist in the same practice completes the same audit, each dentist must complete their individual audit, data and feedback sheets.
3.
7. Clinical Audit of Antimicrobial therapy
PROTOCOL requirements
When preparing your Protocol consider how you would use of the following including the range of dose and duration
Penicillins, Metronidazole, Erythromycin, Clindamycin, Tetracyclines
Then Consider the use of above for the following conditions, what dose would you use and for how long?
Acute infections, chronic infections, oro-antral communications, Periodontal Disease, Endodontics,
• Send back your Protocol with your results
4.
7. Clinical Audit of Antimicrobial therapy
Antimicrobial Data capture sheet
|Patient |Clinical Evidence - Written on notes |Evidence on notes |Reason for |Prescription to include |Reason why if |Compliance |
| |P = Present | |Choice of | |Antimicrobial |With |
| |CNP=Checked Not Present |(B) |antibiotic |(C) |considered but not |protocol |
| |NR = Not recorded | | | |used | |
| |(A) | | | | | |
| |
|Were the following AIMS & OBJECTIVES ACHIEVED |Yes |No |
|AIMS |
|To highlight the use of antimicrobial treatment for patients in dental practice | | |
|To ensure future records contain all relevant information | | |
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|OBJECTIVES | | |
|To ensure the practitioners have an antimicrobial protocol | | |
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|To help reduce the use of antimicrobials | | |
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|Action Plan as a result of your Clinical Audit to include changes made after producing your protocols and before Audit cycle: |
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|How useful did you find this Dental Clinical Audit? |
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|Please tick one of the following: No use Useful Very Useful |
|Any comments on this Structured Dental Clinical Audit especially if you ticked no use: |
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7.
7. Clinical Audit of Antimicrobial therapy
|Dental Clinical Audit report check list |
|All sections need to be completed and included when returning your report: |
|1. Antimicrobial protocol: |
|2. Completed data capture sheets (pages 5 & 6) |
|3. Results for the audit cycle (page 6) |
|4. NHS England Area Team Mandatory page: Aims & Objectives |
|4.1 NHS England Mandatory page: Action Plan |
|Action Plan to include changes made after producing protocols and |
|before audit cycle |
|4.2 NHS England Mandatory page: Feedback |
|5. Declaration: Tick confirmation box and Date |
Please note: a copy of your completed Dental Clinical Audit should be retained by the practice
as part of your practice clinical governance portfolio. Your NHS England Area Team may wish to examine your audit during any Clinical Governance practice inspections that may take place.
I confirm that I have completed the enclosed Dental Clinical Audit activity
Date:
8.
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