South west clinical audit and peer review assessment panel



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SOUTH WEST CLINICAL AUDIT AND PEER REVIEW

ASSESSMENT PANEL


Dental Clinical Audit

7. Antimicrobial & Anticoagulant Therapy

CAP ref:      



Audit start date:      

Completion date:      


Panel member contact: Stuart Chadwick email: - stuart.chadwick@nhs.net



Dental Clinical Audit report (tick) check list

All sections need to be completed and included when returning your report:

1. Antimicrobial , Anticoagulant and Bisphosphates Protocols:




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






Please note –when returning your audit do not include any Dentist, Practice or Patient demographic details.
2013 Structured Dental Clinical Audit
7. Antimicrobial & Anticoagulant Therapy
Prepared by: South West Clinical Audit & Peer Review Assessment Panel,

South West Commissioning Support (SWCS), Mallard Court, Express Park, Bristol Road, Bridgwater, Somerset,

TA6 4RN
CLINICAL AUDIT FOR DENTAL PRACTITIONERS
South West Clinical Audit and Peer Review Assessment Panel

:

7. Clinical Audit of Antimicrobial & Anticoagulant Therapy
Aims


  • To highlight the use of antimicrobial and treatment for patients on anticoagulant treatments and Bisphosphates




  • To ensure future records contain all relevant information


Objectives





  • To help reduce the use of antimicrobials




  • To show when treatment can be carried out on patients on anticoagulants and bisphosphates


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
Dental Protection Society. www.dentalprotection.org.uk :- Top right “search here” type Antibiotic Prescribing – look at Antibiotic Prophylaxis. Also go into “News and Events” position statements – Antibiotic Prophylaxis.

BDA - www.bda.org :- have to be a member and log inAdvice – scroll down to Law and Regulations then below to Prescribing, Dispensing and Dental Sales. At present under “welcome to the BDA website for dentists” Then go to “Prophylaxis Against Infective Endocarditis Guidelines published by NICE”

If a member log in and in search put bisphosphonates will bring up article
BNF 62 can be seen on line at www.bnf.org - these links will take you straight to the correct pages. http://bnf.org/bnf/bnf/current/3705.htm - http://bnf.org/bnf/bnf/current/102044.htm

If not registered will need to register, go to www.bnf.org – Prescribing in Dental Practice, Infective Endocarditis

Useful pages BNF 6, 13, 26-30, 318, 321, 324, and 959.

British Society for Antimicrobial Chemotherapy (BSAC) www.bsac.org.uk :- Latest News – Endocarditis Guidelines Published (21st April 2006) - The report of the Working Party of the British Society for Antimicobial Chemotherapy click on web site ie http://jac.oxfordjournals etc– free full text
Faculty of General Dental Practice UK t www.fgdp.org.uk :- Publications - Adult Antimicobial prescribing in Primary Dental Care for General Dental Practitioners. £15 for member’s £20 non-members. Useful to show uses of antibiotics in dental infections

National Institute for Health & Clinical Excellence “NICE”

www.nice.org.uk/guidance

NICE guidelines by date, March 2008:- Prophylaxis against Infective Endocarditis
American Association of Oral & Maxillo Facial Surgeons: - Position paper on Bisphosphate-Related Osteonecrosis of the Jaw. Web page www.aaoms.org then click on paper on the screen

Surgical Management of the Primary Care Dental Patient on Warfarin. Web page http://www.dundee.ac.uk/tuith/Static/info/warfarin.pdf


National Patient Safety Agency www.npsa.nhs.uk for Poster: - “Managing patients who are taking warfarin and undergoing dental treatment” type in search prescribing Warfarin then comes down to article

www.npsa.nhs.uk/health/alerts “Managing anticoagulants in patients requiring dental surgery “Type in search engine the title and find from there.

2.

South West Clinical Audit and Peer Review Assessment Panel
7. Clinical Audit of Antimicrobial & Anticoagulant Therapy

Method

This audit is useful for the whole Dental team and could be used at a Practice meeting.
1. Design and produce a protocol for treatment of dental infections and include which antimicrobials used, the dose, duration and reason for its use, to take account of the NICE guidelines (see page 4).
2. Design a protocol for treatment for patients on Anticoagulant Therapy, to include when to

refer.
3. Design a protocol for treatment for patients on Bisphosphates Therapy, to include when to

refer.
4. Then compare your existing use of Antimicrobials and Anticoagulant Therapy with your

Protocols and decide on changes that are necessary.


5. Over the next 2 to 3 months check up to 21 patients where Antimicrobials are considered or

prescribed and up to 6 patients on Anticoagulant Therapy to see if they match your protocol.



If more than one dentist in the same practice completes the same audit, each dentist must complete their individual audit, data and feedback sheets.

Timetable of activity:


  • Months one and two: to organise the protocol then compare to current use and decide on changes you feel may be needed.




  • Month three: implement any changes that were identified and audit the patients where antibiotics are considered, whether they are prescribed or not.


  • Send back your Protocols with your results

3.
South West Clinical Audit and Peer Review Assessment Panel



7. Clinical Audit of Antimicrobial & Anticoagulant Therapy

PROTOCOL

When preparing your Protocol consider how you would use of the following including the range of dose and duration
Penicillins, Metronidazole, Erythromycin, Clindamycin, Tetracyclines, Miconazole, Fluconazole, Nystatin.
Then Consider the use of above for the following conditions, what dose would you use and for how long?
Acute infections, chronic infections, OAF's, Antiviral Therapy, Periodontal Disease, Endodontics, Antifungal,
To also include the treatment you would give and when you would refer for patients who are on:-
Bisphosphonates, Anticoagulants,

4.
South West Clinical Audit and Peer Review Assessment Panel CAP Ref:      



7. Clinical Audit of Antimicrobial & Anticoagulant Therapy

Antimicrobial Data capture sheet

Patient

Clinical Evidence - Written on notes

P = Present

CNP=Checked Not Present

NR = Not recorded

(A)

Evidence on notes
(B)

Reason for

Choice of

antibiotic

Prescription to include
(C)



Reason why if Antimicrobial considered but not used

Compliance

With

protocol




Swelling

Pain

TTP

(Tender to pressure or percussion)



Temperature

Lymphadenitis

Justification for Antimicrobials

MH/

Allergy


Recent

Dose


(used within last month)

Antimicrobial

Dosage


Frequency


Duration

What treatment given i.e. RCT stated, local measures, extractions

Must have

A,B&C


1











     





     

     

     

     

     



2











     





     

     

     

     

     



3











     





     

     

     

     

     



4











     





     

     

     

     

     



5











     





     

     

     

     

     



6











     





     

     

     

     

     



7











     





     

     

     

     

     



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21











     





     

     

     

     

     



Total

  

  

  

  

  

  

  

  

  

  

  

  

  

  

5.

South West Clinical Audit and Peer Review Assessment Panel CAP Ref:      

7. Clinical Audit of Antimicrobial & Anticoagulant Therapy
ANTICOAGULANT DATA CAPTURE SHEET





INR

Treatment

Problems

Referred


1

s

     

     




2

     

     

     




3

     

     

    




4

     

     

     




5

     

     

     




6

     

     

     




Total

  

  

  

  


Results Page



Total for Audit

Number of patients=X


Percentage %=X*100/Y

Y=Number of patients in audit




Total number of patients seen during the study period relating to the protocol

     



Total number of patients meeting the antimicrobial protocol

     

     

Total number of patients not meeting the antimicrobial protocol

     

     

Total number of antimicrobial notes correctly written up

     

     

Total number of antimicrobial notes incorrectly written up

     

     

Total number of patients meeting anticoagulant Protocol

     

     

Total number of patients not meeting anticoagulant Protocol

     

     


6.
NHS ENGLAND AREA TEAM MANDATORY PAGE CAP Ref:      
South West Clinical Audit and Peer Review Assessment Panel

7. Clinical Audit of Antimicrobial & Anticoagulant Therapy



Please complete this mandatory page as part of you Clinical Audit Activity, which will be sent anonymously to your NHS England Area Team.


7. Clinical Audit of Antimicrobial & Anticoagulant Therapy Feedback:


Were the following AIMS & OBJECTIVES ACHIEVED

Yes

No

AIMS

  • To highlight the use of antimicrobial and treatment for patients on anticoagulant treatments and bisphosphates

  • To ensure future records contain all relevant information














OBJECTIVES







  • To ensure the practitioners have an antimicrobial, anticoagulant and bisphosphate protocols



  • To help reduce the use of antimicrobials




  • To show when treatment can be carried out on patients on anticoagulants

and bisphosphates
















Action Plan as a result of your Clinical Audit to include changes made after producing your protocols and before Audit cycle:
     






How useful did you find this Dental Clinical Audit?
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:

     


For Panel use only:


Approved 
     


Not Approved 
     


7.

South West Clinical Audit and Peer Review Assessment Panel CAP Ref:      


7. Clinical Audit of Antimicrobial & Anticoagulant Therapy
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 all the information in your report as detailed below within three months of the start date (If you would like longer than 3 months to complete your audit please contact Jackie).


Dental Clinical Audit report check list

All sections need to be completed and included when returning your report:


1. Antimicrobial , Anticoagulant and Bisphosphates Protocols:


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:      

Please e-mail your completed Dental Clinical Audit to Jackie Derrick at: Dentalclinicalaudit@somerset.nhs.uk

*Permission to reproduce any of the South West Clinical Audit & Peer Review Assessment Panel Structured Dental Clinical Audits will need to be obtained from the Panel.



8.



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