ABSTRACT
Introduction Recent surveillance reports a 22% increase in syphilis diagnoses in Wales. This audit evaluates the standard of care given to patients with new diagnoses of syphilis during the COVID-19 pandemic. Methods The electronic patient record database was used to retrospectively identify those who had a positive diagnosis of primary, secondary or early latent syphilis between 01/03/2020 to 30/09/2021 and case notes were audited against the 2015 BASHH Syphilis guidelines. Results 78 records were identified with 9 incorrectly coded as syphilis. 69 patients received care for early syphilis during the period. 91% were men who have sex with men (MSM). 28% co-infected with HIV. 62% were white-British, 7% were of another ethnic background. 51% presented with symptoms, 46% were asymptomatic and 2% diagnosed elsewhere. 74% were diagnosed at face-toface clinical services and 17% through online testing. All patients had pre-treatment RPRs 72% had them on day of treatment. 100% had partner notification discussed. 100% were offered pre-exposure prophylaxis for HIV (PrEP). 99% received recommended treatments (BASHH standard 97%). Interestingly, despite coding and documentation stating early syphilis, 26% of patients had late syphilis treatment regimes. At the time of audit, 48 patients were 6 months post-treatment - 40% had RPR documented (BASHH standard 60%), 29% not documented, 19% lost to follow-up and 8% care transferred care. Conclusion The service saw more new early syphilis diagnoses during the pandemic than the 18 months prior (previously 56 cases). BASHH standards were almost met despite virtually all nurses being re- deployed to COVID wards.
ABSTRACT
Introduction During COVID-19, the sexual health service introduced telephone triage to reduce face-to-face consultations but maintain BASHH standards of clinical care. The service does not have TV PCR testing and relies on laboratory diagnosis of TV alone. This audit examines the impact of COVID- 19 changes on presentation and treatment of TV. Method Electronic patient records were searched for patient coded with TV and compared for the periods 01/01/2019 - 01/01/2020 and 01/01/2021-01/01/2022. The year 2020-2021 was not included due to the reduced capacity of services and concerns of data quality during this period. Results 43 cases were identified in 2019 compared to 47 in 2021. All patients were treated with antibiotics as recommended by BASHH guidelines. The most common symptom for females both years was discharge, however males were identified through contact tracing. More patients waited with symptoms and were incorrectly treated for other conditions following service changes due to COVID-19. Cure rates also lower in the 2021 data compared with the 2019 data. The results are summarised in the table attached. Discussion The frequency of Trichomonas diagnosis did not decrease during COVID despite reduced testing overall. The delay in diagnosing and treating TV had increased however with patients having symptoms longer and being treated for other infections first. This could be improved by incorporating PCR testing into local triage algorithms.
ABSTRACT
Introduction During the COVID19 pandemic, TEC Cymru purchased Attend Anywhere video consulting software and made implementation and training available for all Welsh clinical services. Many services used video consulting software to reduce face-to-face contact and maintain services whilst staff were otherwise redeployed. Methods Data were collated from questionnaires from clinician and patients after their video consultation and collated by the research team at TEC Cymru. Results 654 questionnaires were collected between March 2020 and January 2022 with 42% from Cardiff & Vale. Video consultations were reported as excellent by 302 (47%). 439 (75%) of respondents reported a face-to-face visit was prevented. Most patients were white British (90.8%) and most were in the 25-44 age range (71.1%). More patients reported excellent ratings than clinicians suggesting a discrepancy between expectation. 69.7% of patients reported benefits of not taking time off work for consultations and 83.0% reported that video consultations would reduce rates of sexually transmitted infections. Further data can be presented comparing patient and clinician ratings. The responses to each patient enablement statement are presented in the attached table. Discussion Those that used video consulting during the pandemic had high satisfaction ratings and felt empowered by this mode of delivery of care. Clinician data focused on technical challenges and concern remains of those without technological capability. (Table Presented).
ABSTRACT
Background: During the COVID-19 pandemic our clinic offered telephone triage and booked appointments if required to all patients. The dedicated young person's walk-in clinic was temporarily suspended. These changes raised concerns regarding access for vulnerable patients especially under 18s. To assess the impact of these changes in access and the impact of the pandemic on young and vulnerable patients, we reviewed the number of cases discussed at monthly local safeguarding (SG) meetings between March 2020 -February 2021 and compared with pre-pandemic data (March 2019 -February 2020). Method: EPR was used to access departmental SG meetings data between March 2019 and February 2021. Results: 226 SG cases were discussed from March 2020 to February 2021 compared with 196 the previous year. This includes some patients who required multiple discussions. 99 (44%) patients between March 2020 -February 2021 were over 18 years compared with 73 (37%) patients from the previous year. 25 (11%) patients from March 2020 -February 2021 were male compared with 28 (14%) from the previous year. Table 1 shows the breakdown of patient age ranges. When excluding repeated discussions, the total number of patients is shown in Table 2. Conclusion: Safeguarding discussions increased despite fewer patients attending clinic. There were an increased number of patients requiring multiple SG discussions during the pandemic. This indicates that more complex cases were seen in 2020 (examples will be presented) this maybe as a result of unintended consequences of lockdown and pandemic management. This data demonstrates that our current clinic model allows us to identify and engage with vulnerable patients although it is clear that not all vulnerable and young patients have presented to services during the pandemic. (Table Presented).
ABSTRACT
It has been known, for decades, that the use of injectable medicines in European hospitals has been associated with frequent medication errors, some of which cause preventable severe harms and deaths. There have been national and European inquiries and reports concerning improving patient safety by recommending greater use of pharmacy aseptic preparation services and provision of ready-to administer injectables, which have not been widely implemented.In England experience of treating patients with COVID-19 infections has brought into focus other benefits of significantly extending pharmacy aseptic preparation services. These benefits include saving nursing time, having systems in place which have resilience and capacity, reducing variation in practice, improving clinical staff and patient experience, and enabling more injectable medicines to be administered to patients at home. It has also been recognised that more action is required to standardise policies and procedures for injectable medicines and mplement the use of smart infusion devices with dose error reduction software, to help minimise drug administration errors.Hospital pharmacists have a key role in developing these services to bring European hospitals more in line with those provided by hospital pharmacies in North America. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved. Desde hace décadas se conoce que el uso de los medicamentos nyectables en los hospitales europeos se encuentra asociado a numerosos errores de medicación, algunos de los cuales provocan daños graves y muertes prevenibles. Se han publicado investigaciones e informes nacionales y europeos sobre la mejora de la seguridad del paciente que recomiendan una mayor utilización de las unidades de preparación aséptica de los servicios de farmacia y la provisión de los medicamentos inyectables listos para su administración, recomendaciones que apenas se han implementado.En Inglaterra, la experiencia de tratar a los pacientes con infección por COVID-19 ha puesto de manifiesto otros beneficios que conlleva la ampliación de las unidades de preparación aséptica de los servicios de farmacia. Estos beneficios incluyen ahorrar tiempo de enfermería, disponer de sistemas con mayor resiliencia y capacidad, reducir la variabilidad en la práctica, mejorar la satisfacción del personal clínico y del paciente, y facilitar la administración de más medicamentos inyectables a los pacientes en sus domicilios. También se ha reconocido que se precisan actuaciones dirigidas a estandarizar las directrices y procedimientos de utilización de los medicamentos inyectables e implementar el uso de dispositivos de infusión inteligentes con software de reducción de errores de dosis, con el fin de minimizar los errores en la administración de estos medicamentos. Los farmacéuticos de hospital tienen un papel clave en el desarrollo de stas actividades para que los servicios que prestan las farmacias hospitalarias europeas estén más en consonancia con los que se proporcionan en Norteamérica.
ABSTRACT
It has been known, for decades, that the use of injectable medicines in European hospitals has been associated with frequent medication errors, some of which cause preventable severe harms and deaths. There have been national and European inquiries and reports concerning improving patient safety by recommending greater use of pharmacy aseptic preparation services and provision of ready-to administer injectables, which have not been widely implemented.In England experience of treating patients with COVID-19 infections has brought into focus other benefits of significantly extending pharmacy aseptic preparation services. These benefits include saving nursing time, having systems in place which have resilience and capacity, reducing variation in practice, improving clinical staff and patient experience, and enabling more injectable medicines to be administered to patients at home. It has also been recognised that more action is required to standardise policies and procedures for injectable medicines and mplement the use of smart infusion devices with dose error reduction software, to help minimise drug administration errors.Hospital pharmacists have a key role in developing these services to bring European hospitals more in line with those provided by hospital pharmacies in North America.
ABSTRACT
Introduction: COVID19 has led to closure of traditional walk in sexual health services. Clinicians using telephone consultations may miss non-verbal cues such as changes in body language. NHS Wales procured video consultation (VC) software which was implemented in our clinic. We present service evaluation and patient feedback from this. Methods: We searched electronic patient records for VC attendance codes. Patients undergoing VC were invited by SMS after consultation to complete an electronic patient satisfaction survey. They rated different elements of the experience using Likert scales and could leave additional feedback. Results: Between 04/04/2020-17/07/2020, 227 patients had VCs;105 were new and 115 were follow ups. The median age was 33 ranging from 15-78 years and 102, (45%) were male. Consultations were mostly for GUM 123 (54%) but also SRH (16%), HIV (16%), PREP (6%) and counselling sessions (9%). 62 patients (27%) completed the survey. 44% were aged 25-34. 35% of the survey responders had accessed clinic for SRH purposes only. 85% were 'very satisfied' when asked about the overall VC. 89% were 'very happy' with the length of time spent with the practitioner and 89% felt 'very happy' that their privacy had been respected. 98% said that they would use it again and 98% would recommend it to a friend. In the freehand section, the overall individual feedback was positive including from vulnerable groups in our local population. Discussion: VC has been used extensively in our integrated service and has allowed the service to manage demand and maintain quality during the COVID19 pandemic. The participating service users match our local patient demographics. The VC experience was highly satisfactory to those who responded to the survey. Although the use of VC will not be possible for all, this service enables us to prioritise those groups who need face to face contact whilst maintaining social distancing.
ABSTRACT
Introduction: In Wales, PrEP has been freely available for at risk groups such as MSM and trans people since 2016. Despite lockdown measures, casual sex continued for some causing concern about HIV acquisition. Due to a need to reduce face to face visits and provide a service following clinical staff redeployment to COVID wards, the service developed a new model for PrEP provision. Postal kit testing for HIV became available in Wales regardless of age or risk and this provided an opportunity to integrate these services and provide remote PrEP services. Methods: We examined clinical information, attendance and prescribing data collected from EPR during the COVID19 outbreak and compared with 2019. Results: Between 01/02/2020-01/04/2020, 186 attended the PrEP service in anticipation of lockdown compared with 111 in 2019. During this period six monthly PrEP was issued with advice to switch to event based dosing where possible. Between 01/04/2020-17/07/2020 93 patients went through the virtual clinic where care was provided by video and telephone consultations and postal kit tests for HIV and renal function compared with 283 in the same period in 2019. 1 used the pharmacy home delivery service whilst all others preferred to pick up PrEP at the clinic pharmacy. 1 patient known to the PrEP service did not access the clinic for further prescriptions during lockdown and seroconverted as lockdown eased. Discussion: Many people changed sexual behaviours early in the COVID pandemic, yet acute HIV infection was diagnosed in our cohort despite advice to avoid sex with casual partners during the lockdown, highlighting the importance of maintaining provision of HIV biomedical prevention services. PrEP services can be safely delivered outside of the traditional face to face setting via remote or online clinics. These models could also be applied outside of the pandemic to improve access in a format that some patients prefer.