Background: Methadone is a synthetic, narcotic analgesic used in the treatment of drug misuse. Tragedies involving children being poisoned by the accidental ingestion of methadone are no longer a rare occurrence. Following an audit of the effectiveness of the provision and recall of information to patients attending an NHS Methadone Clinic a protocol was introduced to ensure that staff documented the provision of such information and patients gave a written confirmation that they had received the information.
Ann R Coll Surg Engl 2009; 91: 697-699 697Tonsillectomy is one of the most frequent operations performed by general otolaryngologists. In [2005][2006], over 50,000 tonsillectomies were carried out in England and Wales; most are for recurrent tonsillitis.1 Current evidence suggests that tonsillectomy is an effective treatment for recurrent tonsillitis in severe cases; however, in mild-to-moderate cases, a conservative approach may be indicated. 2,3Recently, concerns over the number of tonsillectomies being performed has been raised, in part relating to the variation in rates of tonsillectomy both nationally and internationally. 4 The otolaryngology community generally advocates tonsillectomy as a worthwhile operation in those with severe recurrent tonsillitis. However, in order to demonstrate that appropriate patients are being listed for surgery, good documentation of its indications is essential.In 1999, the Scottish Intercollegiate Guideline Network (SIGN), which produces evidence-based clinical practice guidelines, published guidance on the management of sore throats and indications for tonsillectomy. 2 The indications recommended by the SIGN group are that patients should meet all of the following criteria prior to tonsillectomy: (i) sore throats should be due to tonsillitis; (ii) five or more episodes per year; (iii) symptoms for at least a year; and (iv) the episodes should be disabling and prevent normal function.2 The guideline forms a basis for clinical audit. The aims of this audit were to: (i) determine if the SIGN guidelines were being followed and documented for children undergoing tonsillectomy for recurrent tonsillitis; and (ii) implement change in order to facilitate an improvement in practice. Patients and Methods Data collection and analysisWe performed a prospective audit of 50 children undergoing Interventions including the production of posters and rubber stamps were agreed and implemented between the two audit periods. RESULTS Following the implementation of simple changes, significant improvements were seen in documentation relating to the SIGN guidelines for tonsillectomy. Overall, the number of children meeting all four SIGN criteria for tonsillectomy rose from 12% to 44% (χ 2 = 57.8; P < 0.001). Furthermore, a significant reduction was seen in the number of children below the age of 5 years undergoing tonsillectomy for recurrent tonsillitis (χ 2 = 14.66; P < 0.001).
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