Swine Flu Medical Management Audit Fareed Bhatti

GPST3( Sunnybank Med Ctr)

Background. Biggest global medical challenge since the

world wars with far reaching implications, where

the different healthcare systems all over the

world might potentially come to be tested to their

breaking point.

. There will be considerable cost (as well as political)

implications in a global economy slowly

recovering from a ‘Financial Pandemic’.

. The situation is evolving, so is the clinical demands and the management strategy.

It means GPs and other clinical staff have to keep on their toes to make sure they

are aware of the latest information available.

Are we well informed ?

How the Swine Flu started

Duration/ Location of Audit

15th to 17th July 2009

Sunnybank Medical Centre, Bradford.

Aims:

• The whole picture is evolving with information scattered at times. An assessment of our familiarity with the procedures and the medicines being used for treatment and prophylaxis in Swine Flu in different clinical scenarios.

• To disseminate the collated information and audit its impact.

Specific audit points

• Some aspects of the illness.• PPE( Personal Protection Equipment).• RCGP assessment and treatment Algorithm.• Drugs, their indications and doses in

treatment and prophylaxis.• Some aspects of prescription of the

medication.

Methodology

Distribution: It was carried out during the Practice teaching session as well as distributed to GPs on their on call days. Distributed to PNs during their clinical sessions with ample time to assimilate the given information.

Benchmarking: A pre-enlightenment self assessment questionnaire was given to all members. It was randomised to prevent embarrassment.

Intervention: A standard information package was provided which the Audit participants were encouraged to go through.

Re-audit: The same self assessment questionnaire was given at the end.Some people did score worse having been ‘informed’.

The Self Assessment Questionnaire

Question 1

Q- Tamiflu can be used in pregnant women as well

in a lower dose.

True / False

Answer- False

Relenza(Inhaled Zanamivir) is the preferred drug,

but if contraindicated then Tamiflu can be used

considering risks.

Question 2

Q :The dose for prophylaxis in adults is 75mg OD for 7 days.

True / False

Answer- False

Prophylaxis dose in adults is 75mg OD for 10 days.

Question 3

Q- Adult dose of Tamiflu for treatment is 150mg OD for

5 days.

True / False

Answer- False

Adult treatment dose of Tamiflu is 75mg BD for 5 days.

Question 4

Q- According to the latest RCGP guidance otherwise

healthy adults patients who have had Flu like symptoms for

more than 7 days can have Tamiflu.

True / False

Answer- False

See latest treatment algorithm.(Next Slide)

RCGP Assessment and Treatment Algorithm (Version 3)

Question 5

Q- Patients who have recovered from the ‘Swine Flu’ will be immune to Influenza for the rest of the

season. True / False

Answer- False

The virus might mutate further and cause

re-infection.

Question 6

Q- A shorter course of Tamiflu is indicated if the flu like

symptoms recur in14 days after the initial attack.

True / False

Answer- False

See latest RCGP treatment Algorithm

( Although the advice is less than certain about cases where the patients decide to get angry and demand another course of Tamiflu.)

Question 7Q- The routine personal protective equipment (PPE)

consists of disposable gloves, apron and mask.

True / False

Answer- True Eye protection only in procedures expected to produce

respiratory aerosols e.g. a spitting contest in a school

playground.

Question 8

Q- Given the predicted shortage of personal safety equipment only the FFP3 grade masks may be

reused after autoclaving at 173 degree C.

True / False

Answer- False Currently all guidance suggests single use only but should try to

wear it for longer periods to conserve stocks of masks. Other

things like gloves and aprons etc are single use.

Question 9

Q- Tamiflu can be prescribed on an FP10 form.

True / False

Answer- True

But need to write ‘Convenient Stationery’ at the bottom part of the

script and cross out the FP10 number.

Question 10

Q- What additional words should be written on the Px

for Tamiflu/Relenza ? ________________

Answer-

‘Convenient Stationery’

Question 11

Q- No dose adjustment is needed for renal impairment for

Tamiflu use.

True / False

Answer- False For renal failure Zanamivir (inhaled) preferred because no dose

adjustment required. But for Tamiflu see below

Question 12

Q- Relenza is the drug of choice for treatment of

breast feeding women.

True / False

Answer- False

For breastfeeding ladies the preferred drug is Oseltamivir,

but if they are taking Zanamivir and during the course of

treatment deliver and commence breastfeeding, they can

continue to take it and there is no need to switch to

Oseltamivir.

Question 13

Q- Prophylaxis should not ordinarily be given to

contacts.

True/ False

Answer- True Prophylaxis given only to Special groups/ At Risk groups. But

clinical judgement should be exercised. See RCGP Algorithm

for at risk groups.

Question 14

Q- Tamiflu may be used for prophylaxis in children under 1yr of age.

True/ False

Answer- True

Although no clear answer yet. Depends on clinical picture

and discussion with parents +/-paediatrician if needed.

Definitely seek advice for children under 2 months of age.

Question 15

Q- There is a direct correlation between contracting Swine flu and developing a sudden liking for truffles.

True / False

Answer- Not enough evidence. Further studies are needed to clarify the link between Swine Flu and penchant for Truffles. There is also conflicting evidence for link between Swine flu and developing hairy pointy ears as well as

ability to understand porcine vocalisations.

Intervention- The Information package

Information …Continued

The Audit resultTotal participants 5GPs+1GPST+4 PNs= 10

Pre-Intervention results Mean= 10.8/15 Mode= 11 High score= 14 /15 Low score = 7/15

Post Intervention results Mean= 13/15 Mode= 14 High score= 15/15 Low score= 11/15

Results..Continued

• Objectively

- Improvement in the knowledge base

• Subjectively - Ease of access to information.

- Smoother consultations.

- Safer? (Less scattered information)

Recommendations

• A practice based policy should be adopted, and according to the RCGP guideline (a 60 odd page document!) a Clinical Lead should be nominated.

• Information in any leaflet etc should be kept up to date as clinical guidelines and Logistics change fairly quickly.

• Discussion of Pros and Cons of treatment/ prophylaxis should be explained to patients and documented.

And when all else fails…..And when all else fails…..

P.S. The audit and the documents will be posted on the Pennine VTS website

Thank you