1. R Williams Stourport Health Centre
TSH monitoring audit 2015/16
R Williams
Stourport Health Centre

2. Introduction TSH monitoring no longer in QOF for 2015/16
Reporting mechanism less robust as consequence
System on diary entry for TSH recall implemented but not being fully used by all clinical staff
Significant event June 2015 – reminder not in place for pt on thyroxine – repeat blood test not done and operation cancelled as result

3. Initial audit July 2015
Search of clinic system – patients overdue TSH on thyroxine
30 patients overdue bloods by 12/12 +
10 had no reminder
Reminders added and recalls arranged for those patients

4. Follow up cycle August 2015 More detailed audit of TSH monitoring
391 patients on thyroid hormones (script 4/12)
388 thyroxine
3 liothyronine
40 patients overdue TSH (12/12 +)

5. 40 overdue patients
Only 2 had no reminder – both new patients – notes not yet summarised
Of 38 with reminder
28 done within past 13 months and therefore being called this month
Remainder all called several times – clear trail on system

6. Improvement from previous results
As follow on audit – all 391 records check to ensure reminder on
33 additional patients on thryoxine with no reminder

7. 33 patients with no reminder
8 had wrong reminder code (although should have been called)
6 patients had only recently started thyroxine – although reminder should still have been added

8. Repeat audit cycle Mar 2016
Following introduction of more robust recall system and reporting mechanism a further audit of TSH reminders was carried out
408 patients were taking thyroxine
All patients on thyroxine had a reminder
17 patients were overdue

9. Overdue patients Mar 16 17 patients 2 done in sec care
5 due this month or next – and called
1 palliative
4 new patients – notes not received but reminders still added for all
5 patients overdue – 3 very overdue – all had been called regularly and the 3 very overdue patients had flags on notes

10. Discussion
Removal of monitoring from QOF creates clinical risk as monitoring systems less robust
Creation of new system effective
100% had reminders on system
Small number of patients overdue – all appropriately managed
Continue to monitor system but appears robust