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 ofAntimicrobial 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

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 antimicrobialprotocol
  • 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 Teamin 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. :- 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”

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 aPractice meeting.

1. Using guidance above devise a protocol for treatment of dental infectionsand includewhich antimicrobials used, the dose, duration and reason for its use

2.Then compare your existing use of Antimicrobialswith 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 arenecessary (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
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 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
2 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
3 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
4 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
5 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
6 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
7 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
8 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
9 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
10 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
11 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
12 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
13 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
14 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
15 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
16 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
17 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
18 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
19 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
20 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
21 / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR / SelectPCNPNR
Total

5.

Results Page

Initial retrospective audit - % Antibiotics justified

% Antibiotics not justified

Prospective reaudit - % Antibiotics justified

% Antibiotics not justified

Discuss results and explain changes to be implemented in your practice

6.

7. Clinical Audit of Antimicrobialtherapy

Please complete this mandatory page as part of you Clinical Audit Activity.
7. Clinical Audit of AntimicrobialtherapyFeedback:
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

OBJECTIVES
  • To ensure the practitioners have an antimicrobial protocol
  • To help reduce the use of antimicrobials

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 thisDental Clinical Audit?
Please tick one of the following: No use Useful Very Useful
Any comments on this Structured Dental Clinical Auditespecially if you ticked no use:

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.