Appendix 3 – Audit Report



Appendix 3 – Audit Report GDC number: 152253Date: 03/03/16IntroductionI hoped to assess my decision making, when it comes to emergency treatment of pain and swelling, in relation to the prescription of antibiotics. Reports indicate that antibiotic prescriptions are on the rise and infections related to antibiotic resistant bacteria are increasing due to this. I was keen to reduce my antibiotic prescribing, should I discover that I was choosing to prescribe rather than find an alternative initial treatment option.MethodEach time a patient is given a prescription, the patient’s name, prescriber initial, date and prescription code number are noted in a book. It was simple enough to look back and see which days I provided prescriptions and then checked the patient’s dental record to see why this was prescribed. This was then used to populate the fields in the data collection sheets.ResultsData collection highlighted that the most common reasons for patient attendance and prescription of antibiotics was due to swelling and dental abscess causing pain. Data was collected on patients going as far back as 9 months, to obtain 20 occasions that antibiotics were prescribed; therefore, it was quite uncommon.The most common antibiotic prescribed was Amoxicillin 500mg. Patients allergic to penicillin were prescribed Metronidazole. On one occasion, erythromycin was prescribed, and this was because the patient had recently had a course of penicillin and felt that metronidazole didn’t agree with themThere were several influences that encouraged the decision to prescribe antibiotics. The most common reason, seen in 12 out of 20 cases was due to the symptom being pain, of which 4 failed to respond to local measures previously (7 in total for study). Otherwise I would be unlikely to prescribe antibiotics, and instead have the patient return at a more convenient appointment for further treatment.Other considerations taken into account were noted in table 1 appendix 1b The second round of the audit only had 8 occasions of antibiotic prescribing. Similarly, pain and swelling were the most common features of the presenting complaint to those prescribed antibiotics, and even against my own advice of not to pander to patients who refuse any other treatment, there was one occasion when antibiotics were prescribed to a patient who refused to have the extraction; and one occasion where time pressures to carry out a root treatment during a 10 minute appointment were unlikely to improve the patient’s symptoms. Changes identified and action required/implementedThe majority of reasons for antibiotic prescription were justified, however in some cases antibiotics were prescribed “just in case” or because the patient refused to go ahead with treatment recommended. On these occasions it may be prudent to refuse antibiotic prescription.Difficulties or barriers to changeSome patient’s may take refusal to being prescribed antibiotics as offensive. In some cases a patient may refuse to have for example, an unrestorable tooth extracted, and would expect antibiotics as the alternative, at least as a short term measure. Refusing this may not be a practice builder, and turn certain types of patient against that particular dentist. Another barrier includes the appointment system- emergency appointments tend to be unplanned, and therefore more complex treatment i.e re-root canal treatment of an abscessed tooth take more time than the 10-20 minute appointment allocated to a dental emergency.Improvements madeIn the second round there were only 8 occasions when antibiotics were prescribed during the 3 month period. The majority were given on occasions where either local measures failed to eliminate the infection, or there was difficulty with providing local measures, until antibiotics were prescribed to reduce the level of infection. This is an improvement on the first round where more than one patient refused to have local measures carried out or requested antibiotics to “take on holiday just in case”. Even though my awareness of the potential for overprescribing antibiotics has increased as a result of this audit, I feel that my practice hasn’t changed, as I didn’t tend to “overprescribe”Results ................
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