Domain 2:

Safety and Quality

Example 3 - Prescribing for pain (5 or 8 criterion audit)

As a sessional doctor you will often see a high proportion of patients presenting for unscheduled care with painful conditions. Your prescribing will reflect this.

For ten surgeries, note your use of analgesic prescribing against your chosen set of criteria and standards. You need to consider setting criteria such as:

  1. Patients prescribed analgesics should have a condition or reason clearly recorded in their records
  2. Analgesics should be used which are in line with local formulary recommendations for first line use, unless clinically contraindicated
  3. If a non steroidal anti-inflammatory is used, gastric protection should be considered where appropriate (for example elderly, debilitated patients)
  4. Non steroidal anti-inflammatory drugs should generally be avoided in patients with a past history of GORD, ulcer disease or upper G-I haemorrhage
  5. Strong analgesics should be prescribed in relatively small quantities on first presentation (a week?)
  6. Patients with chronic pain should have a clear record of any adjustment to their regime
  7. Patients who are prescribed opiates often experience constipation: for elderly patients a laxative should be prescribed or a warning of the risk given to the patient and recorded
  8. All analgesic prescribing should be accompanied by a check for known past history of hypersensitivity
  9. All analgesic prescribing should be accompanied by a check for potential drug interactions
  10. If a second line analgesic is used, the reason for its use should be documented

As an alternative you could audit your personal handling of controlled drugs:

  1. Your controlled drug register should contain details of all controlled drugs that you hold (Class A)
  2. Your injectable Class A drugs must be in a locked case or bag
  3. You have details of how to contact the appointed officer responsible for disposal of expired or redundant Class A drugs
  4. Your prescriptions for controlled drugs all meet the regulations (you will need to log these prescriptions or take copies prospectively for this criterion)
  5. No prescriptions for controlled drugs should exceed one month's supply

These are only examples of criteria which you might choose from. You are recommended to use criteria which you can justify, and you will then need to justify the standards that you set for your performance.

You might want to consider repeating the exercise for another 10 surgeries at a later date, to complete the "audit cycle".

If you are unable to undertake these preferred options, you could use the tools below for reflective learning with your appraiser.

Clinical Case Report Proforma | File Size: 42.5 KB | Date Updated: 10/02/2014

Lifted from Sessional GP Toolkit

Management Plan Proforma | File Size: 29.5 KB | Date Updated: 10/02/2014

Lifted from Sessional GP Toolkit

This page was last updated on: 18/08/2016