guide to clinical audit antibiotic use in urinary tract infection

7/29/2019 Guide to Clinical Audit Antibiotic Use in Urinary Tract Infection

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Guid

e

to

clinicalaudit

1. Select patientsProspectively as patients present for consultation,or retrospectively from a search of electronic/papermedical records, identify 20 patients who have adiagnosis or have a provisional diagnosis of:

asymptomatic bacteriuria,

acute cystitis (lower urinary tract infection), or

acute pyelonephritis.

2. Obtain patient consentPatients must be informed that data from theirmedical records may be used for the purposesof clinical audits, and written consent must be

obtained (see attached poster and patientconsent form).

3. Record patient data(first data collection)Use the Patient record form to record the patientsyou have included. DO NOT send to NPS keepthis record to assist in identifying patients forsecond data collection (see No. 6).

Complete a clinical audit form for each patient.See notes on pages 23.

Please note:

patient information must only be collected andrecorded by the participating doctor

both full-time and part-time GPs are requiredto submit 20 completed clinical audit forms.

4. Submit the clinical audit formsReturn the 20 clinical audit formsand Registration form to:

NPS Clinical Audit: Antibiotic 2005Locked Bag 4888STRAWBERRY HILLS NSW 2012

To be received at NPS not later than

9 September 2005Please note: Unfortunately, late submissionscannot be accepted.

5. When you receive your resultsYou will receive:

your original clinical audit forms

feedback on your individual results

the aggregate results of all participantsmanagement practices

commentary on the aggregate results

a Review Phase packto complete and return(see below).

6. Completing the clinical audit cycle(including second data collection)

You are required to:review your individual and the aggregate resultsin the Feedback report

identify which of your original 20 patientsrequire follow-up

record additional patient data

reflect on changes in management

submit the Review Phase pack.

Professional development and PIP

NPS has applied for clinical audit points in the20052007 triennium of the Royal AustralianCollege of General Practitioners (RACGP) Quality

Assurance & Continuing Professional Development(QA&CPD) Program (Category 1 activity) and theAustralian College of Rural and Remote Medicine(ACRRM) Professional Development Program(practice improvement category).

The Review Phase packmust be completed andreturned to NPS for RACGP and/or ACRRM clinicalaudit points to be allocated and for the clinicalaudit to qualify for the Quality Prescribing Initiative(QPI) of the Practice Incentives Program (PIP).You will then be sent a certificate of completion.

Aims of the clinical audit

To review your prescribing of antibiotics forurinary tract infection

To compare your practice with therecommendations of Therapeutic Guidelines:Antibiotic, Version 12, 2003 and with thepractice of other participating doctors

How to participate

Please tear off eachsection carefully.Registration form andclinical audit formsshould be returned to NPSby 9 September 2005.

Antibiotic use in urinary tract infection


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Notes for clinical audit formAdditional information to assist you to review management

2

Patient details

Urinary tract infection (UTI) is a common bacterialinfection. It is the fifteenth most commonly managedproblem and the fourth most frequently managed newproblem in general practice.1 It can occur in males andfemales of all ages, however it is more common in sexuallyactive women. The most common causative organismsof urinary tract infection are Escherichia coliandStaphylococcus saprophyticus.2

Your patient code

(Q1) Choose your own unique identifying code for thepatient, e.g. a sequential number or the patients initials(please do not use the patients name).

Provisional/confirmed diagnosis

(Q4) Please indicate one only for each patient:

asymptomatic bacteriuria

acute cystitis (lower urinary tract infection), or


Signs and symptoms of urinary tract infection

Signs and symptoms include abdominal pain, behaviouraldisturbance, chills, cloudy/foul smelling urine, confusion,dysuria, failure to thrive, fever, frequency, haematuria,incontinence, nocturia, secondary incontinence, suprapubicdiscomfort, suprapubic tenderness and vomiting.35

A temperature of > 38.5C is more characteristicof pyelonephritis.3

Urinary tract infection in elderly people may present withfeatures such as secondary incontinence, confusion,anorexia, high temperature or shock.

History of presentation

(Q5) Please indicate if the current presentation for urinarytract infection for each patient is:

only episode within a 12 month period

within 2 weeks of previous infection(i.e. relapse/treatment failure)3

second presentation within a 12 month period

(i.e. > 2 weeks after previous infection)

3 presentations within a 12 month period(i.e. recurrent).3

Investigations for this presentation(Q7) Dipstick tests are useful in guiding initialmanagement. They cannot be relied on to definitelyexclude or confirm a diagnosis of a UTI. Culture the urineif it is important to make an accurate diagnosis or to selectan effective antimicrobial agent.3

Urine culture2,3:

should be obtained from a clean-catch midstreamurine (MSU) sample for culture and sensitivity

IS NOT indicated when cystitis is suspected inotherwise healthy women

IS indicated for

pregnant womenelderly people with clinical signs of UTI

recurrent cystitis

treatment failure (relapse)

males of any age

females under 5 years of age

premenarcheal females with recurrent UTI

should, where possible, be collected before antibiotictreatment is commenced4,5

is recommended after the completion of antibiotictherapy in:

pregnant women, men, children and patients

with acute pyelonephritis.

When cystitis is confirmed by a positive urine culture,males of all ages, females under 5 years of age andpremenarcheal females with recurrent UTI should beinvestigated further to exclude any underlying abnormality2

(e.g. vesico-ureteric reflux, reflux nephropathy, prostateenlargement, urinary obstruction).

Results of urine culture

(Q9) Review of the patient depends on the clinicalsituation.

In all patients where an MSU has been sent for culture andsensitivity, check results of the culture to ensure that

antibiotic treatment is appropriate.


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3

Management

Symptomatic and other management(Q10)

Paracetamol or ibuprofen can be used to relieve painand high temperatures.3

Cranberry juice has not been shown to be of benefit inthe treatment of acute urinary tract infection.3,6

There is some evidence to suggest that cranberry juicemay be effective in prevention by reducing the numberof symptomatic UTIs in women. Its effectiveness inchildren, elderly women and elderly men remainsunclear.6

Urine-alkalinising agents (Atravescent, Citralite,Citravescent, sodium bicarbonate, Uracol, Ural,

Uricalm, Uricosal, Urocite-K) are popular agents used inthe symptomatic management of urinary symptomswhich may relieve discomfort of UTIs.7 Urine-alkalinising agents change the pH of the urine makingsome antibiotics and antibacterials less effective (e.g.hexamine hippurate [avoid concomitant use],nitrofurantoin [avoid excessive alkalinisation of urinepH > 8.0]) and increasing the risk of crystalluria whenused in combination (quinolones).7,8

Increased fluid intake is often recommended assymptomatic management for urinary tract infectionbut its effectiveness is unproven.3

Antibiotic/antibacterial

(Q11)Clearly mark the antibiotic or antibacterial prescribed,the dose, route of administration, frequency, andlength of treatment used to manage this presentation.

Where there is a combination product prescribed (e.g.amoxycillin+clavulanate ortrimethoprim+sulfamethoxazole) only indicate the doseof the first named compound in the combination (i.e.amoxycillin or trimethoprim).

If the antibiotic prescribed is not listed please specifyand indicate the reason for your choice.

Prophylactic antibiotic therapy(Q12)

In children with a positive urine culture and after theinitial infective episode, antibiotic prophylaxis (withnitrofurantoin or trimethoprim) should be startedimmediately after the treatment course and continueduntil urinary tract imaging has been done.2

Women with frequent recurrences (e.g. 3symptomatic episodes/year)3 may be considered forintermittent self-treatment, at the onset ofcharacteristic symptoms, or prophylaxis with either:

continuous low dose antibiotic prophylaxis

within 2 hours after sexual intercourse.

Prophylaxis instituted after successful treatment can reduceor prevent subsequent attacks and may be continued for36 months, or in some cases longer.2

Prophylactic antibiotic treatment2

1. nitrofurantoin (child: 12.5 mg/kg up to) 50 mg orally,at night (50 mg and 100 mg capsules only; avoid use inmoderate to severe renal impairment; caution in elderly)

2. cephalexin (child: 12.5 mg/kg up to) 250 mg orally,at night

3. trimethoprim (child: 2 mg/kg up to) 150 mg orally,at night (300 mg scored tablets only)

Prophylactic antibiotic treatment of urinary tract infection

should be considered following successful treatment ofrecurrent infection or where indicated in children.

Guidelines

Consistency with Therapeutic Guidelines: Antibiotic(Q16) Use the summary chart of antibiotic treatment in urinary tract infection to compare your responses to TherapeuticGuidelines: Antibiotic, 2003 recommendations. Indicate if current management was consistent with Therapeutic Guidelines:Antibioticby marking the box.


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Summary of recommended antibiotic treatment in urinary tract infections2

Asymptomatic bacteriuria In school-aged children, non-pregnant women and those over 60 years of age, asymptomaticbacteriuria probably does not require treatment if the urinary tract is normal (see TherapeuticGuidelines: Antibiotic, Version 12, 2003 for further information).

Acute cystitis (lower urinary tract infection)

AntibioticLength oftreatment

Non-pregnant women

Any of the regimens is expected to curethe majority of acute non-complicatedlower UTI in non-pregnant women.

Single dose therapy is not as reliableas multiple dose therapy in preventingrelapse.

If relapse occurs after appropriate andadequate antibiotic treatment, considerpyelonephritis and treat for 1015 days.

1. trimethoprim 300 mg orally, daily

OR2. cephalexin 500 mg orally, 12-hourly

OR3. amoxycillin+clavulanate 500+125 mg orally, 12-hourly

OR4. nitrofurantoin 50 mg orally, 6-hourly

(avoid use in moderate to severe renal impairment; caution in elderly)7

Amoxycillin without clavulanate is only recommended if susceptibility of the organismis proven.

If the culture is positive for Pseudomonas aeruginosa or resistance to all the above drugshas been proven consider norfloxacin 400 mg orally, 12-hourly for 3 days.

3 days

5 days

5 days

5 days

Pregnant women

It is important to consider the category

of risk posed by the use of the particularantibiotic during pregnancy.

Urine culture should be repeated aftertreatment.

1. cephalexin 500 mg orally, 12-hourly (category A)*OR

2. nitrofurantoin 50 mg orally, 6-hourly (category A)*(avoid use in moderate to severe renal impairment; do not use at or near term)7

OR3. amoxycillin+clavulanate 500+125 mg orally, 12-hourly (category B1)**

Amoxycillin without clavulanate (category A)* is only recommended if susceptibility of theorganism is proven.

10 days

10 days

10 days

Men

(if there is no underlying abnormality)

All males with a UTI should beinvestigated to exclude underlyingabnormality which determines theduration of antibiotic therapy.

1. trimethoprim 300 mg orally, dailyOR

2. cephalexin 500 mg orally, 12-hourlyOR

3. amoxycillin+clavulanate 500+125 mg orally, 12-hourlyOR

4. nitrofurantoin 50 mg orally, 6-hourly(avoid use in moderate to severe renal impairment; caution in elderly)7

14 days

14 days

14 days

14 days

Children#

For children with a positive urine cultureconsider pyelonephritis and/or anunderlying abnormality in males of anyage, females under 5 years of age andpremenarcheal females with recurrent UTI.

1. cephalexin 12.5 mg/kg up to 500 mg orally, 12-hourlyOR2. trimethoprim 6 mg/kg up to 300 mg orally, daily (300 mg scored tablets only)

OR3. amoxycillin+clavulanate 12.5+3.1 mg/kg up to 500+125 mg orally, 12-hourly

OR4. trimethoprim+sulfamethoxazole 4+20 mg/kg up to 160+800 mg orally, 12-hourly

5 days

5 days

5 days

5 days

Acute pyelonephritis

Mild to moderate infection 1. cephalexin (child: 12.5 mg/kg up to) 500 mg orally, 6-hourlyOR

2. amoxycillin+clavulanate (child: 22.5+3.2 mg/kg up to) 875+125 mg orally, 12-hourlyOR

3. trimethoprim (child: 6 mg/kg up to) 300 mg orally, daily

If the culture is positive for Pseudomonas aeruginosa or resistance to all the above drugshas been proven consider ciprofloxacin 500 mg orally, 12-hourly.

10 days

10 days

10 days

Severe infection parenteral treatmentshould be given initially, substituting oraltherapy as soon as possible for a total of1014 days.

Treatment should be guided by antibioticsensitivity results.

amoxycillin/ampicillin (child: 25 mg/kg up to) 1 g IV, 6-hourlyPLUSgentamicin (child: < 10 years: 7.5 mg/kg; 10 years: 6 mg/kg) 46 mg/kg IV, daily(adjust dose for renal function)

In patients with hypersensitivity to penicillin, gentamicin alone will usually be adequate.Where gentamicin is undesirable (e.g. the elderly, presence of significant renal failure orfollowing a previous adverse reaction), as a single drug use:

cefotaxime (child: 50 mg/kg up to) 1 g IV, 8-hourlyORceftriaxone (child: 50 mg/kg up to) 1 g IV, daily

1014 days

1014 days

Please note:

In patients with moderate to severe renal impairment a reduced antibiotic dose may be required (see also Australian Medicines Handbook, 2005).7

* Category A: drugs which have been taken by a large number of pregnant women andwomen of child bearing age without any proven increase in the frequency ofmalformations or other direct or indirect harmful effects on the foetus have been observed.

**Category B1: drugs which have been taken by only a limited number of pregnant womenand women of child bearing age without any proven increase in the frequency ofmalformations or other direct or indirect harmful effects on the foetus have been observed.

Quinolones should be avoided in children unless deemed necessary onmicrobiological grounds.

Please note there are two strengths of amoxycillin+clavulanate oral liquid available(i.e. amoxycillin 25 mg/mL + clavulanate 6.25 mg/mL in 75 mL [Augmentin, Clamohexal,Clamoxyl, Clavulin] or amoxycillin 80 mg/mL + clavulanate 11.4 mg/mL in 60 mL[Augmentin Duo, Clamohexal Duo, Clamoxyl Duo, Clavulin Duo]).

# After the initial infective episode, antibiotic prophylaxis (with nitrofurantoin ortrimethoprim) should be commenced immediately after the cessation of thetreatment course until urinary tract imaging has been done.


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5

Class Generic Brand name

Aminoglycosides gentamicin

Cephalosporins

cephalexin Cilex, Ialex, Ibilex, Keflex, Sporahexal

ceftriaxone Rocephin

cefotaxime

Penicillins

amoxycillinAlphamox, Amohexal, Amoxil, Amoxil Duo, Bgramin, Cilamox,Ibiamox, Fisamox, Maxamox, Moxacin

amoxycillin+clavulanate

Augmentin, Augmentin Duo, Augmentin Duo Forte,

Augmentin Duo 400, Ausclav, Ausclav Duo, Ausclav DuoForte, Ausclav Duo 400, Clamoxyl, Clamoxyl Duo, ClamoxylDuo Forte, Clamoxyl Duo 400, Clavulin, Clavulin Duo,Clavulin Duo 400, Clavulin Duo Forte, Curam, Muric

ampicillin Alphacin, Ampicyn, Aspen, Austrapen, Ibimicyn

Quinolones

ciprofloxacin C-Flox, Ciprol, Ciproxin, Profloxin, Proquin

norfloxacin Insensye, Norflohexal, Noroxin, Nufloxib, Roxin

Other antibacterials

hexamine hippurate Hiprex

nitrofurantion Macrodantin, Ralodantin

trimethoprim Alprim, Triprim

trimethoprim+sulfamethoxazoleBactrim DS, Cosig Forte, Resprim, Resprim Forte, Septrin,Septrin Forte

Generic and brand names for selected antibiotics


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Level 7 / 418A Elizabeth Street Surry Hills NSW 2010

Phone: 02 8217 8700 l Fax: 02 9211 7578 l email: [email protected] l web: www.nps.org.au

National Prescribing Service Limited ACN 082 034 393An independent, Australian organisation for Quality Use of Medicines,

funded by the Australian Government Department of Health and Ageing

1. Britt H, et al. General practice activity in Australia 200304. Canberra: Australian

Institute of Health and Welfare (General Practice Series No 16); 2004. Report No.:

AIHW Cat. No. GEP 16.

2. Therapeutic Guidelines:Antibiotic, 12th ed. Melbourne: Therapeutic Guidelines

Limited; 2003.

3. PRODIGY Guidance-Urinary tract infection (lower)-women (last revised January

2004); accessed 12 January

.

4. PRODIGY Guidance-Urinary tract infection (lower)-men (last revised September

2004); accessed 31 March

.

5. PRODIGY Guidance-Urinary tract infection children (last revised April 2002);

accessed 14 January .

6. Jepson RG, et al. Cranberries for preventing urinary tract infections. Cochrane

Database Syst Rev 2004;(2):CD001321.

7. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd;

2005.

8. Stockley's Drug Interactions, 6th ed. London: Royal Pharmaceutical Society of Great

Britain; 2002.

The information contained in this material is derived from a critical analysis of a wide range of authoritative evidence.

Any treatment decisions based on this information should be made in the context of the clinical cir cumstances of each patient.

References

Patient consent

Please:

display the enclosed poster (Quality assurance andyour privacy) in your practice

ask patients who present to the practice to read

and sign a copy of the enclosed Patient informationand consent form, or

send the enclosed Patient information and consentform to patients whose records you wish to useretrospectively, asking them to sign and return itto the practice

DO NOT send the Patient information and consentform to NPS.

Privacy

By participating you agree to aggregation of yourde-identified patient data and use of your personaldata. Individual results of your clinical audit are kept

confidential by NPS.

What will happen to

Your patient data:

your de-identified patient data forms are returnedto you

your individual results are provided to you only

your data are aggregated with that of otherparticipants and the de-identified aggregate results:

are provided to all participants

may be used in NPS evaluation and reports

are provided to the RACGP and ACRRM.

The RACGP has advised that program informationmay be shared with researchers and interested generalpractitioners for the purpose of continuing educationcoordination at the discretion of the QA&CPD Program.

Your personal details:

are provided to the RACGP QA&CPD Programand/or ACRRM Professional Development Programfor point allocation (if applicable)

are recorded for the purpose of the PIP andNPS evaluation

can be obtained from NPS by request in writing.

Individual clinical audit results will not be availableafter potentially identifying data are removed fromNPS records at the close of the clinical audit cycle.

Please note: you are responsible for advising NPSof any changes of address during the audit cycle.

Further information

Therapeutic enquiries

Kim Barry at NPS: phone (02) 8217 8700

Audit and QPI enquiries

Cris Abbu at NPS: phone (02) 8217 8700

NPSA0299


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10. Symptomatic and other management recommended for

this presentation

(mark all that apply)

cranberry juice or cranberry tablets

ibuprofen

increased fluid intake

intra-vaginal oestrogen

paracetamol

urine-alkalinising agents (e.g. Citralite, Citravescent, Sodibic, Ural)

noneother ________________________________________________________________________________________________________________________________________

not known

11. Antibiotics/antibacterials prescribed for this presentation

Please turn over to complete Q11

12. Will/have you prescribed prophylactic antibiotic/antibacterial

treatment subsequent to this presentation?

(See Guide page 3)

yes no not known

13. Was the patient educated about potential adverse effects and

drug interactions with antibiotic/antibacterial treatment?

yes no

14. Were instructions given to the patient on dose, frequency and

duration of treatment?

yes no

15. Was the patient provided with or recommended to obtain a

Consumer Medicine Information leaflet?

yes no

16. Use the summary chart of recommended antibiotic treatment in

urinary tract infection (see Guide page 4) to compare your

responses to Therapeutic Guidelines: Antibiotic, Version 12, 2003

(Please indicate which statement applies for this patient).

Prescribing of antibiotic treatment for this patient IS consistent with

Therapeutic Guidelines: Antibiotic, Version 12, 2003 recommendations

Prescribing of antibiotic treatment for this patient IS NOT consistent with

Therapeutic Guidelines: Antibiotic, Version 12, 2003 recommendations

Clinical audit: Antibioticuse in urinary tract infection

Patient details Management

NPS office use only

Use a black biro to mark a cross (X) in the appropriate boxbeside your response.

If you make a mistake, use white correction fluid.

Please see the Guide to clinical auditbooklet for supporting information to assist you to complete this form.

kg

Only indicateweight for patientsaged 014 years

1. Your patient code:

2. Age range: 05 years 614 years 1565 years > 65 years

3. Sex: male

female premenarcheal pregnant postmenopausal

4. Provisional/confirmed diagnosis (mark one only)


acute cystitis/lower UTI

acute pyelonephritis

5. History of presentation (See Guide page 2)

only episode within a 12 month period

within 2 weeks of previous infection (relapse)

2nd presentation within a 12 month period

3 presentations within a 12 month period

6. History of anatomical or functional abnormalityyes no not known

7. Investigations for this presentation (mark all that apply)

urine dipstick (nitrate, leucocyte esterase and blood)

catheter specimen of urine Obtained (mark all that apply)

midstream urine (MSU) before starting antibiotic treatment

suprapubic aspiration of urine after antibiotic course completed

other (please specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

none

8. Were investigation(s) ordered (other than urine culture)?yes (please specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

no not known

9. Were results of urine culture available to guide

antibiotic selection?

yes no not known

Patient counselling

Guidelines

Please turn over to

complete form


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None OR Clearly mark name, dose (mg), route, frequency and duration for the antibiotic prescribed at this visit.

If the patient is a child, indicate the dose in mg for each kg of weight.

Antibiotic/antibacterial prescribed and dose (brand names) Route Frequency Duration

amoxycillin(Alphamox,Amohexal,Amoxil, Bgramin, Cilamox, Ibiamox, Fisamox,Maxamox, Moxacin)

DOSE mg or mg/kg

oral

IV/IM

single dose 8-hourly

once daily 12-hourly

6-hourly

other _____________________

not applicable 7 days

3 days 10 days

5 days 14 days

other _____________________

amoxycillin+clavulanate(Augmentin, Ausclav, Clamoxy, Clavulin, Curam, Muric)[Indicate dose of amoxycillin only]

DOSE mg or mg/kg

oral single dose 8-hourly


6-hourly

other _____________________


3 days 10 days

5 days 14 days

other _____________________

ampicillin(Alphacin,Ampicyn,Aspen, Austrapen, Ibimicyn)

DOSE mg or mg/kg

oral

IV/IM



6-hourly

other _____________________


3 days 10 days

5 days 14 days

other _____________________

cefotaxime

DOSE mg or mg/kg

IV/IM single dose 8-hourly


6-hourly

other _____________________


3 days 10 days

5 days 14 days

other _____________________

ceftriaxone

(Rocephin)

DOSE mg or mg/kg


once daily 12-hourly6-hourly

other _____________________


3 days 10 days5 days 14 days

other _____________________

cephalexin(Cilex, Ialex, Ibilex, Keflex, Sporahexal)

DOSE mg or mg/kg



6-hourly

other _____________________


3 days 10 days

5 days 14 days

other _____________________

ciprofloxacin(C-Flox, Ciprol, Ciproxin, Profloxin, Proquin)

DOSE mg or mg/kg

oral

IV/IM



6-hourly

other _____________________


3 days 10 days

5 days 14 days

other _____________________

gentamicin

DOSE mg or mg/kg



other _____________________



other _____________________

hexamine hippurate(Hiprex)

DOSE mg or mg/kg



6-hourly

other _____________________


3 days 10 days

5 days 14 days

other _____________________

nitrofurantoin(Macrodantin, Ralodantin)

DOSE mg or mg/kg



6-hourly

other _____________________


3 days 10 days

5 days 14 days

other _____________________

norfloxacin(Insensye, Norflohexal, Noroxin, Nufloxib, Roxin)

DOSE mg or mg/kg



other _____________________



other _____________________

trimethoprim(Alprim, Triprim)

DOSE mg or mg/kg



6-hourly

other _____________________


3 days 10 days

5 days 14 days

other _____________________

trimethoprim+sulfamethoxazole(Bactrim, Cosig Forte, Resprim, Septrin)[Indicate dose of trimethoprim only]

DOSE mg or mg/kg

oral

IV/IM



6-hourly

other _____________________


3 days 10 days

5 days 14 days

other _____________________

other antibiotic prescribed

(please specify) __________________________________________________

DOSE mg or mg/kg

Reason for selection

drug allergy pregnancy or lactation

adverse reaction to first-line drug(s) other

treatment failure using first-line drug(s)

oral

IV/IM



other _____________________



other _____________________

11. Antibiotics/antibacterials prescribed at this presentation

Please turn over and

continue with Q12.


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Clinical auditenrolment form

Clinical audit

Aims of this clinical audit

Completing this clinical audit cycle offersyou the opportunity to:

review your prescribing of antibiotics foruncomplicated urinary tract infection

compare your practice with the recommendations

provided in Therapeutic Guidelines: Antibiotic,Version 12, 2003 and with the practice of otherparticipating doctors.

Continuing professionaldevelopment points and PIP

NPS has applied for professional development pointsin the 20052007 triennium of the RACGP QualityAssurance and Continuing Professional DevelopmentProgram (QA&CPD) and the ACRRM ProfessionalDevelopment Program.

This is the second clinical audit offered by NPS which

qualifies for the Quality Prescribing Initiative (QPI)of the Practice Incentives Program (PIP) for May2005 to April 2006.

What this audit involves

As patients present for consultation or from a searchof your medical records, identify 20 patients who havebeen diagnosed with either:


acute cystitis (lower urinary tract infection)


Complete a clinical audit form for each patient.

Participation in this clinical audit requires agreementto aggregation of de-identified patient data.

Completing the clinical audit cycle

Review individual and aggregate resultsand commentary.

Record patients progress.

Identify where improvement in patientmanagement has occurred.


IMPORTANT To enrolFill out the form on the reverse then return to NPSto recieve your free audit pack.

This Clinical Audit activity has been approved by the RACGP QA&CPD Program.

TOTAL POINTS for Steps 15: 30 (Category 1)


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Your details:

Please use BLOCK LETTERS

Doctors first name

Family name

Phone number ( )

Fax number ( )

Postal address

Suburb/town

State Postcode

Fax this completed form to (02) 9211 7579 Post to: NPS, PO Box 1147,

STRAWBERRY HILLS NSW 2012


After you have enrolled, your free audit pack will be posted to you. To see a sample audit form before enrolling,visit our website at www.nps.org.au/healthpro. Enrolments must be received at NPS by Friday 12 August, 2005.

NPSF0298

To enrol

Fill out the form below then return to NPS.

Enrolments must be received at NPS byFriday 12 August 2005.

Submission date for your auditCompleted clinical audit forms must be submittedto NPS by Friday 9 September, 2005. Unfortunately,late submissions cannot be accepted.

For more information:

Kim Barry Phone: 02 8217 8700Chris Abbu Fax: 02 9211 7579

Email: [email protected]}

Clinical auditenrolment form

OR

guide to clinical audit antibiotic use in urinary tract infection

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