Sheffield CCG Clostridium Difficile Action Plan
Sheffield CCG Clostridium Difficile Action Plan
Quality Assurance Committee meeting
7 March 2014
Author(s)/Presenter and title / Nikki Littlewood, Lead Infection Prevention and Control NursePurpose of Paper
To provide assurance that the CCG C.Difficile action plan is being delivered.
What assurance does this report provide to the Quality Assurance Committee in relation to Assurance Framework objectives?
Assurance Framework Number and Title / Description of assurances for Quality Assurance Committee
AF 2. To improve the quality and equality of healthcare in Sheffield.
AF 2.1
Providers delivering poor quality care and not meeting quality targets / The following has been completed this quarter:
An external peer review of the action plan and previous 18 months Difficile reports has been undertaken and assurance received that the plan is very reasonable.
Improved engagement with the RCA process with GP Practices
Final draft of the Chapter 5 Infections section of the Sheffield Formulary and C.diff Good Practice points.
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Sheffield CCG C. difficile Action plan April 2013 to March 2014 (Updated February 7 2014)
Action / Lead / Deadline / Commentary1.Root Cause Analysis (RCA)
1.1 Continue to undertake RCA’s on all community attributable cases.
/ IPCN and Microbiologist / Continuous / C.diff 2013-14 report completed October 2013 Next report due April 2014
1.2 Establish a system to follow up community associated patients who have had recurrence of their C.difficile infection. / IPCN and Microbiologist / March 2014 / System to be set up January to March 2014
1.3 Improve GP participation in RCAs, including gaining support from Local Medical Committee.
/ IPCN / Completed December 2013 / GP practices generally are engaging well with the RCA process. LMC support has been sought previously so has not been requested again.
1.4 Engage with Public Health England to determine C.difficile carriage in the population and any further action that could be taken.
/ Microbiologist / Completed December 2013 / Advised there is no vaccine – likely to be available in the next 3-5 years.
2.Prescribing Practice
2.1 Undertake a review of community antibiotic formulary (chapter 5) and C.difficile Good Practice points and share with prescribers / Meds Management / Microbiologist / IPCN / January 2014 / Final draft in progress. To be publicised widely in primary care, First Point of Contact Nurses and Nurse Prescribers
2.2 Undertake a review of all long term prophylactic antibiotic (including Quinolones, Co-amoxiclav and Cephalosporin) for UTIs in every GP Practice.
/ Meds Management/Microbiologist / March 2014 / It is anticipated this review will commence in March.
2.3 Reduce the number of MSUs and CSUs sent to STHFT Medical Laboratories from GP Practices / IPCN/Microbiologist / March 2014 / Consider training and communications
2.4 Review antibiotic prescribing formulary for GP out of hours service / Meds Management / Completed October 2013 / This is has been undertaken. The out of hours service uses the Sheffield antibiotic prescribing formulary.
2.5 Review PGD’s for antibiotic prescribing for Nurse Prescribers / Meds Management / Completed 25.10.13 / Cepahelaxin removed
Augmentin has a c.diff exclusion attached to it.
2.6 Review prescribing of Proton Pump Inhibitors (PPIs) including recommendations for the frequency of medication reviews. / Meds Management / March 2014 / Scope of review to be defined
2.7 Deliver prescribing training/awareness re C.difficile management to First Point of Contact Nurses and Community Nursing Teams / Meds Management / Michelle Black at STHFT / March 2014
2.8 Update Induction packs for F1, F2 doctors and Registrars in General Practice regarding antibiotic prescribing and C.difficile management / Meds Management / Microbiologist/GP’s /IPCN / March 2014
2.9 Advocate prophylactic prescribing of Metronidazole 400mgs TDS for 14 days for patients with chest infections (on antibiotic therapy) who have Chronic Obstructive pulmonary Disease in General Practice / Microbiologist / March 2014
2.10 Attempt to reduce empiric prescribing of Cephalosporins in GP Practice via Nurse Practitioners / IPCN
/ January 2014 / Information to be included in the review of the Community Antibiotic Formulary (Section 5 Infections). To be sent via GP and Practice Nurse Bulletins.
3. Patient/Public and Professional Education
3.1 C.difficile cards to be distributed to patients with C.difficile in community and acute setting. / IPCN / March 2014 / Establish feasibility in Acute Hospital
4. Commissioning
4.1 Commission an external review of this Action Plan and General Management of C.difficile cases in the community / Microbiologist / Completed December 2013 / Microbiologist at LGI has reviewed the Action plan. No changes to action plan required. Good performing CCG’s to be contacted to establish best practice
4.2 Ensure STHFT deliver their action plan. / IPC Team / March 2014
4.3 Ensure SCHFT deliver their action plan. / IPC Team / March 2014
4.4 Provide advice and support to care homes - via the annual programme of assurance visits. / IPC Team / March 2014
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