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Improving clinical practice and service delivery
P129 Improving clinical standards in GU medicine: a retrospective audit of Neisseria gonorrhoeae
  1. S R Sharp,
  2. S Allan
  1. Coventry and Warickshire Hospital, Coventry, UK

Abstract

Objectives This was a retrospective analysis of clinic performance in the management and treatment of Neisseria gonorrhoeae (GC) according to BASHH guidelines.

Methods All cases of GC diagnosed at our clinic between 1 January and 30 June 2011 were identified. The case notes were reviewed and assessed against current BASHH criteria. This was compared to data collected in the same clinic from 1 January to 30 June in 2007, 2008 and 2009. The number of cases identified for 2007, 2008, 2009 and 2011 was 41, 61, 78 and 75 respectively.

Criterion2007 (%)2008 (%)2009 (%)2011 (%)
CR1 >95% of genital GC cases should be cured by first line therapy779610097
CR2 100% patients with GC should be screened for Chlamydia trachomatis or receive presumptive treatment10010010098.6
CR3 100% patients should have at least one documented interview with a partner notification trained health professional82959292
CR4 100% patients identified should receive written information about STI's and their prevention32648161
CR5 100% treated patients should have a test of cure (TOC)36
CR6 For each case at least 0.6 sexual partners should be verified as having been satisfactorily managed within 4 weeks0.410.330.360.5

Discussion The number of cases cured by first line therapy improved by 20% between 2007 and 2011, but had decreased by 3% from 2009 to 2011 (CR1). The percentage of patients seeing a health advisor remains the same as in 2009 at 92% (CR3). Supply of written documentation dropped by 20% since 2009 (CR4). Chlamydia screening or treatment decreased by 1.4% from 2009 due to one case (CR2). TOC was poor at 36% but this was due to the guidelines during the data collection time period not requiring a TOC (CR5). Sexual partner notification was still below the expected 0.6 (CR6).

Conclusions Current BASHH targets were missed in all six criterion. In criterion 1, first line treatment was not prescribed with explanatory documentation in two cases. However in both these two cases the culture proved to be sensitive to the antibiotics used. In criterion 2, one case resulted in the target being missed. This patient had refused all tests, but presumptive treatment was not prescribed. Poor written documentation accounts for the failings in criteria 3 and 4. This may have been due to the recent introduction of electronic patient records. It is hoped that recent improvements to the system may improve these figures. Future audits should show an improvement in TOC as the new guidelines are adopted. Finally although criterion 6 has not met the BASHH target this year, it is a significant improvement on previous years results.

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