RCGP-2014-poster-abstracts

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Discussion: Knowledge of practice level factors will guide further joint primary/secondary working. Very early use of this pathway already suggests significant change in clinical management, streamlining working for GPs and hepatologists. P008 Development of a new surveillance colonoscopy pathway – An innovative quality improvement project by GP Registrars Lee Aye; Mark Lumb Health Education Thames Valley We set out to take a leadership role in developing a new clinical pathway for surveillance colonoscopy, including the creation of a nurse led clinic. This was in response to local resource challenges and issues raised between the LMC and Hospital Trust about the current process. We planned to achieve this by working in conjunction with our local clinical commissioning group and hospital endoscopy unit. The aim was to complete this process within a three-‐month time frame. We implemented a new independent, efficient surveillance colonoscopy pathway based on local best practice and national guidelines. This improved both patient and practitioner experience. Evidence has shown that a 50% reduction in surveillance colonoscopies can be achieved by such methods, thereby reducing strain on resources and ensuring appropriateness of procedures for patients. We demonstrated key skills of GP Registrars as leaders of the future -‐the ability to negotiate between and work amongst different professional groups, advising in clinical and non-‐clinical areas including fitness for bowel preparation,patient safety and logistical analysis,whilst championing patient choice. We developed new personal skills, such as designing standard operating procedures,decision trees and process mapping. From here, we prepared a prospective audit to be set up as to numbers of surveillance colonoscopies performed/saved after nurse led clinical validation. We also built links between local clinical commissioning groups and hospital units -‐ as GP Registrars we acted as the facilitators and implementers of change. P009 Time bomb of atrial fibrillation John Havard; Timothy Reed Saxmundham Health; Orchard Medical Practice This poster brings the urgency of anticoagulation in atrial fibrillation (AF) into focus by using a graphic of a time-bomb strapped to a brain, It uses the East Suffolk data to point out that we have 44 preventable AF strokes expected locally and that we should think of untreated AF patients as ticking time-‐bombs! Nationally we are in a situation where the NICE CG 180 on AF has removed anti platelet agents completely from the management of stroke reduction in AF. The latest GRASP data is showing that 35% of AF patients still only have aspirin as their stroke prevention and also if you look deeper in to the data you find about 95% of the AF population are CHADSVASc 1 or greater so there is a considerable amount of work to do! GPs and patients alike need prompting about failure to anticoagulate and I hope that the ticking timebomb is a memorable illustration. The final line of the poster tries to consolidate the theme. Stroke is a devastating bomb connected to AF by a fuse -‐ warfarin can put out that fuse and protect patients from stroke. Suffolk needs a determined bomb disposal squad throughout the County. Furthermore GRASP AF data can be used to amend the poster to include the figures from any CCG to make it locally relevant and impactful. P010 Venous Thromboembolism Quality Improvement (CQUIN) William Nabulyato; Madyan Qureshi; Sheena Seewoonarain; Satish Kutty; Yvonne Barlow Princess Alexandra Hospital Aims/objectives: To assess current rate of VTE assessment in our district General Hospital (DGH) and whether this was in keeping with the NICE 100% gold standard and our 98% local CCG/CQUIN target standard. Content: 2 long term audit loops one to assess percentage of pre-‐operative VTE assessment across all surgical disciplines and another to assess the trust wide VTE assessment levels. 20
Relevance: Each year over 25,000 people in England die from Venous Thrombo-‐Embolic (VTE) contracted in hospital. The total cost (direct and indirect) to the UK of managing VTE is estimated at £640 million (House of Commons Health Select Committee, 2005) with GPs accounting for the majority of diagnosis. Outcomes: Over the past 4 years VTE assessment in our DGH has increased dramatically from 49% to 98.1% but the snap shot data suggests that 87.7% overall assessment which is woefully short of the 100% gold standard and disappointingly below the 98% CQUIN target. 980 pre-‐operative patients assessed over 6 month period of these 86.2% had VTE assessment. Discussion: VTE Assessment proforma on drug chart re-‐vamped to improve assessment concordance and be in keeping with current NICE guidance. New protocol in place, no admission into anaesthetic room without pre-operative VTE Assessment with view to incorporating this into WHO checklist. Assigned VTE champions as this improved assessment concordance as did trust wide laminated posters. Continued staff and patient education. P011 The repeat prescription ordering system: is yours 'abuse-‐proof' Daniel Kristiansen; Rachel Lindley University of Manchester Aims/objectives: To assess for evidence of over accumulation of prescriptions for pregabalin via the repeat ordering system at an inner city GP practice. Content: Pregabalin is known to have a recreational street value of up to £2.50 per capsule. The prescription history of 64 patients having pregabalin on repeat prescription was investigated. Significant over accumulation of capsules was identified via the repeat system in 5 patients. In one case, 610 excess capsules were accumulated over 12 months by a patient who was coded as having substance misuse problems. The over accumulation identified was chiefly due to patients ordering repeat prescriptions too frequently which was not picked up by the systems currently in place at the practice. A variety of weaknesses were identified in the repeat ordering system, leaving it open to abuse for pregabalin and other drugs. Relevance/impact: After liaison with the area medicines management team, the repeat ordering system at the practice was deemed to be typical to others in the UK. This makes the weaknesses we identified relevant to conference attendees – the same may be occurring at their practice. The poster will share these weaknesses and the steps GP practices can take to make their own repeat ordering system 'abuse-‐proof'. Discussion: Practices may unwittingly participate in the illicit prescription drug market and systems are required to prevent this. This is of particular concern with ‘emerging’ drugs of abuse, such as pregabalin, which GP’s may not be aware of. P012 Rationalisation of opioid prescribing in the primary care setting; a quality improvement intervention Jamie Watson; Sasha Robinson; Melody Rhydderch; Adrian Edwards Wales Deanery; Cochrane Institute Primary Care and Public Health, Cardiff University Background: Concern is growing locally and nationally surrounding opioid prescribing, tramadol being a particular concern in South Wales. It is recognised that patients are coming to harm from opioid prescribing and so a quality improvement intervention was undertaken to rationalise and improve opioid prescribing in one general practice. Design and setting: A review of opioid prescribing to the 8,800 registered patients over six months was undertaken to assess the scale of the problem. Workshops were held exploring doctors’ views on pain management; consequently it was decided to stop new prescriptions of fentanyl and tramadol. Method: Patients receiving strong opioids or large quantities of tramadol were offered dedicated review appointments. The aim was to improve pain control whilst keeping in line with prescribing guidance. Opioid prescribing was reviewed again after six months. Results: 50 patients were reviewed in 16 clinics. There was improved prescribing in 70% of patients receiving strong opioids, as well as 82% of patients receiving large quantities of tramadol. There was a sustained reduction in fentanyl prescribing ranging from 13% to 100% depending on patch strength, with sustained reductions of tramadol scripts of 34%. 21
Page 2 and 3: Clinical P001 The role of Cent
Page 4 and 5: P061 Sharing treatment informati
Page 6 and 7: P117 Bisphosphonate holiday -
Page 8 and 9: P171 Audit of the initial mana
Page 10 and 11: P221 Professional interventions
Page 12 and 13: P270 The academic fellows progr
Page 14 and 15: P329 Sociolinguistic factors aff
Page 16 and 17: P388 GP referral letters-‐ar
Page 18 and 19: standard is that 100% of these
Page 22 and 23: Conclusion: There was success i
Page 24 and 25: Aims: To help understand the r
Page 26 and 27: P022 General practitioners’ vi
Page 28 and 29: Quality assured content and nav
Page 30 and 31: There is an imperative for GPs
Page 32 and 33: P035 Re-‐prescribing regular
Page 34 and 35: • No patient had tried to ob
Page 36 and 37: Community identified needs inclu
Page 38 and 39: • The index of suspicion amon
Page 40 and 41: Conclusion: In Lambeth, removing
Page 42 and 43: Extraskeletal primary myxoid cho
Page 44 and 45: P060 Referrals to children’s
Page 46 and 47: Discussion around barriers to v
Page 48 and 49: Conclusion: A significant propor
Page 50 and 51: IHA's were carried out with su
Page 52 and 53: their Caucasian counterparts. NI
Page 54 and 55: Background: PCOS is an endocrin
Page 56 and 57: shown to have better coping me
Page 58 and 59: age, as indicated by higher up
Page 60 and 61: Relevance/impact: By conducting
Page 62 and 63: University of Birmingham Backgro
Page 64 and 65: Analysis and discussion: Listed
Page 66 and 67: • Prior sputum MC&S suggested
Page 68 and 69: Conclusion: Recommendations for
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anticoagulation and the assessme
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Content: The presentation will
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Aims & objectives: To assess h
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[2] Wood DA, Wray R, Poulter
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made to update schizophrenia po
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150 patients were included with
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evidence of Centor symptoms, an
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Pulmonary rehabilitation is a n
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I found there were 26 paediatr
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Aims/objectives: To analyse pati
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• The DMS should maintain a
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A literature review and audit
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The commonest sites for lesions
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• GPs' confidence in their ab
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severe hypoglycaemic events were
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Discussion: Reception staff’s
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Outcomes: GPs lacked confidence
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identified as major challenges
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Aims: To investigate challenges,
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percentage change (p
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improved glycaemia, blood pressu
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Division, Mount Sinai Medical C
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egarding circulation. Prior to
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P224 ‘One size doesn’t fit
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Results: Year 13 students have
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Aim: To systematically review t
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eathers in sleeping time (MBS)
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Discussion: ‘Evidence flowers
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Aims and objectives: This surve
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Relevance: Medical education sup
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• Patient, Doctor, and Consult
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onset of cardiovascular disease
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this is kept as a reward and
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P270 The academic fellows progr
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in the system especially in pa
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diagnosis can represent a 'teac
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Results: The study found that
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The findings showed that averag
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with other doctors can be very
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• Map existing quality and sa
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• A reduction in non-‐elec
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It is imprtant to learn lesson
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• Deliver teaching on; literat
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Toby Holland; Colette Davey; Lo
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Aims/objectives: i) Gain insight
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model or negative peer percepti
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Anecdotal feedback suggests that
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Background: There is much debat
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Summary of work: A short surve
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Content: The planning, delivery
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practice in a primary care uni
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P358 “When should I worry" G
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tool; initial cohort was patien
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educational network to provide
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P372 Clinical induction workshop
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to 5 (fully achieved). Marks f
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P382 Primary care ethics: a Li
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length for this learning experi
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Method: The aim of the study
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Summary of work: Participants a
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Lesley Morrison; John Gillies S
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Aim: To increase the involvemen
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RCGP-2014-poster-abstracts

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