An audit of nurses using standing order directives to administer medications to children at risk of contracting rheumatic fever.

AIM: The following article reports an audit, conducted between July 2014 and July 2017, of adherence to best practice in medication administration and documentation by nurses. METHOD: A sample of 47 registered nurses' (RNs') documentation relating to the administration of 939 medications using standing order directives were examined and scored by seven senior nurses and a medical practitioner against an audit tool. The scores were divided into four quartiles with the top two quartiles demonstrating best practice in adherence to safety standards for the administration of medication. RESULTS: Forty-three RNs (91.5%) scored in the top two quartiles. The remaining four RNs (8.5%), following supervision by a senior nurse, subsequently demonstrated improvement in their documentation to the quartile one range of the audit tool. This audit demonstrates that, following education in diagnosis and treatment of common childhood conditions, the majority of nurses who were audited could diagnose simple conditions of childhood and safely administer medications to them. Moreover, two years after the programme was introduced, the serious sequelae of acute rheumatic fever (ARF) reduced in children aged 5-12 years. CONCLUSION: RNs who took part in the audit used standing order directives to safely administer medications to children. RN prescribing throughout New Zealand should be explored as an effective means to provide timely treatment and improve patient outcomes.

Nurse-led school-based clinics for rheumatic fever prevention and skin infection management: evaluation of Mana Kidz programme in Counties Manukau.

AIM: To evaluate registered nurse-led school clinics in 61 primary and intermediate schools in Counties Manukau. METHODS: The evaluation (conducted August­December, 2014) collated evidence concerning service delivery, outcomes, value for money and effectiveness. RESULTS: 97% (23,756/24,497) of eligible children were consented, 11% (20,696/191,423) of throat swabs taken (February 2013­September 2014) were culture positive for Group A Streptococcus (GAS); 20,176 were treated. Mana Kidz teams treated (includes cleaning and covering alone) 17,593 skin infections and actioned 4,178 school health referrals. A pre-programme cross sectional GAS pharyngeal prevalence demonstrated a relative risk 1.8 (1.3­2.3) (95%CI) of being pharyngeal GAS positive in 2013 compared to 2014. Hospitalisations for acute rheumatic fever (ARF) and skin infections for children aged 5­12 years living in Counties Manukau are declining and this appears to be temporally related to the introduction of the Mana Kidz programme. Effective engagement with children, parents/ whanau and improved health literacy was demonstrated, especially knowledge about sore throats, ARF, medication adherence and skin infection. The programme was delivered at $280 per participating child in the 2013/14 financial year. CONCLUSION: Mana Kidz is an effective programme with a substantial contribution to health care for children, aged 5­12 years, identified at increased risk of poor health outcomes.

Antimicrobial stewardship using pharmacy data for the nurse-led school-based clinics in Counties Manukau District Health Board for management of group A streptococcal pharyngitis and skin infection.

AIM: To evaluate antimicrobial usage in the school-based clinics against operating guidelines. METHOD: Antimicrobial prescribing data (2014) from 10/18 participating pharmacies serving 14,153/23,588 primary school children of the programme were accessible. Prescriptions from 5/10 pharmacies were available for identifying type, amount, and indication of the medicine. One pharmacy serving a defined population (n=3,513) with single healthcare provider delivering the school programme was selected for detailed evaluation and identifying individuals receiving multiple treatments. RESULTS: Data from 10 pharmacies (n=7,889 prescriptions) showed 91.2% of prescriptions were for group A streptococcal-positive throat swab, 8.8% for skin infections. More detail from 5/10 pharmacies showed only 2% of group A streptococcal pharyngitis treatments (107/4,672) were not first-line (56 cephalexin and 51 rifampin prescriptions). Fusidic acid (159/452, 35.18%) or cephalexin (169/452, 37.39%) were most commonly used for skin infection. Analysis in the defined population showed <4% (151/4,325) of assessed skin conditions received antimicrobials, and only 6 individuals received more than one course of oral antimicrobial over the year. CONCLUSION: Antimicrobial administration demonstrates high compliance with the protocol. There was very limited use of second-line antimicrobials for recurrent pharyngitis. Most skin infections did not require antimicrobial treatment. Repeated antimicrobials for individuals were rare.