Endocarditis Prevention Advice Audit Arend A, Yeong M September 2017

*nice.org.uk/guidance/cg64 Background Patients at risk of developing endocarditis* Acquired valvular heart disease with stenosis or regurgitation Hypertrophic cardiomyopathy Previous infective endocarditis Structural congenital heart disease, including surgically corrected or palliated structural conditions, but excluding isolated atrial septal defects, fully repaired ventricular septal defects or fully repaired patent ductus arteriosus, and closure devices that are judged to be endothelialised Valve replacement Vital to provide clear and consistent advice regarding endocarditis prevention to these patients. *nice.org.uk/guidance/cg64

Audit Aim To assess the compliance with providing clear and consistent information regarding endocarditis prevention in the cardiology clinic letters to patients at risk of developing endocarditis .

Objectives Review the clinic letters in peripheral cardiology clinics in North Devon District Hospital from June to August 2017. Identify the patients at risk of developing endocarditis Assess advice given to the patient regarding endocarditis prevention.

Standards/Criteria No. Standard/criteria All patients at risk of endocarditis are given advice to: Target Any exceptions 1 Maintain good oral health 100% nil 2 Have at least 6 monthly dental reviews. 3 Discourage from having tattoos and piercings

Results Total of 30 clinic patients identified from 2 peripheral clinic sessions. 28 clinic letters available for review. 2 patient DNA 18 patients identified to be at risk of developing endocarditis based on reference criteria.

Results Close to 2/3 of clinic patient are at risk of developing endocarditis

Results

Results No. Standard/criteria, for those at risk of endocarditis are given advice to: Target Result 1 Maintain good oral health 100% 66.7% 2 Minimum of dental reviews at every 6 months. 3 Discouraged from having tattoos and piercings 44.4%

Conclusions There is suboptimal provision of endocarditis prevention advice. There may be verbal provision of this advice but not documented in the clinical notes or clinic letters. There is lack of a standard statement in the clinic letters regarding this advice.

Thank you Action plan No. Agreed action Implementation date Who is going to do it ? 1 Clinic letter foot note with endocarditis prevention advice. September 2017 Dr Andy Arend, Dr Michael Yeong 2 Repeat audit to assess compliance with providing advice. October 2017 Thank you

Action plan No. Agreed action Implementation date Who is going to do it ? 1 Statement in clinic letter regarding endocarditis prevention advice on all letters to patients at risk of developing endocarditis September 2017 Reminder of bacterial endocarditis: ......patient Christian name......has a very small risk of a potentially severe infective complication of structural heart disease. This infection risk can be substantially minimised by maintaining good dental health with 6 monthly dental assessments and avoiding if possible non-medical invasive procedures such as tattoos and piercing. Recommended information is available at [http://guidance.nice.uk/cg64

Background Endocarditis – inflammation of endocardial surface of heart and may involve heart valves and endocardium that covers implanted material Endocarditis is uncommon but associated with significant morbidity and mortality