Antibiotic Prophylaxis Against Infective Endocarditis Implementation Advice Consultation Feedback Form

Transcription

1 Antibiotic Prophylaxis Against Infective Endocarditis Implementation Advice Consultation Feedback Form Consultation is the opportunity for anyone with an interest in this implementation advice to provide feedback and influence its development. We welcome your views on this draft document as part of the formal consultation process. Please return your form before 31 January 2018* to: Tel: *Please note that feedback received after this date may not be considered. Freepost Licence RSSH-ETXY-ZKBL SDPBRN (Antibiotic Prophylaxis Consultation) Dundee Dental Education Centre, Frankland Building Small s Wynd, Dundee, DD1 4HN A collation of all feedback received, with our responses, will be available on request. This may identify the source of comments received from an organisation or in an official capacity but not those received from individuals. About you Providing this information allows us to understand respondents interests in the topic and to clarify comments, if required. Individuals' personal details will only be used for this purpose and will not be included in collated feedback or otherwise shared. Please note that we are unable to consider anonymous responses. Name: Arianne Matlin Professional role: Policy Adviser Sector, e.g. GDS, PDS/CDS, hospital: GDS/PDS/hospital Responding: As an individual address: Arianne.Matlin@bda.org On behalf of an organization X If an organisation, please give full name: British Dental Association Address: 64 Wimpole Street. London, WW1G 8YS Specific interest/role in topic: 1. Implementation Advice Please indicate the extent to which you with the following statements on the five-point scale and provide comments or explanation, as appropriate. Please note that adequately covers/describes means that sufficient information is provided and the information is relevant and helpful. Section 1 adequately covers the background to the implementation advice 1

2 The BDA welcomes the highlighting of the 2013 Cochrane review that found insufficient evidence to determine whether antibiotic prophylaxis is effective. Although the potential for adverse reactions to antibiotics is noted, the BDA is concerned that there is no discussion of the connection between inappropriate prescribing and the development of antimicrobial resistance (AMR). It should be stated that NICE Guidance CG64 applies to all health professionals carrying out invasive procedures in England and Wales BUT has been endorsed/adopted by NHS Health Scotland. NICE has clearly defined non-routine as clinical judgement and patient preference following discussion with the patient of the NICE CG64 recommendations and all relevant risks and benefits. We welcome the provision of advice on prophylactic regimens in the event of a decision that antibiotics should be provided. Section 2 adequately covers the available evidence and other relevant sources of information The BDA welcomes the involvement of a wide range of medical and dental experts in developing the recommendations. We would urge SDCEP to highlight the guidance to cardiologists and GPs in addition to dentists. 2.1: We note that the NICE guidance is very clear about which patients are at increased risk. No distinction is made between degrees of risk within this patient group. 2.2: As noted in the draft, the classification of patients at highest risk within the increased risk category is based on expert opinion rather than on evidence. We would urge SDCEP not to accept such a distinction, so that the guidance remains evidence-based and consistent with NICE CG64, and to avoid confusion. Within section 3.2 and summary flowchart 2, there is duplication of conditions for patients at increased risk and highest risk. Again, this is confusing and we would urge SDCEP to remove the additional highest risk classification to avoid confusion. 2.3: NICE CG64 contains recommendations for further research. We would suggest that it is not within the remit of an implementation guide to comment on this. Section 3 provides sufficient information to enable dentists to manage patients who are at risk of infective endocarditis 3.4: In order to provide informed consent, patients must also be provided with information on the risks of antibiotic prophylaxis, including both AMR (patient- and population-level) and possible adverse reactions. Sections 3.1 and 3.2 adequately describe the distinction between increased risk patients and highest risk patients 2

3 3.2: See comments on Section 2 above. We believe that such a distinction should not be made. Section 3.3 adequately describes the classification of invasive dental procedures 3.3: The table provides a helpful summary. 3

4 2. Supplementary Information Please indicate how you think each of the following is. Where possible, please provide explanations to support your answers (e.g. comment on the level of detail, whether the information is adequate, if not, why not?). Appendix 1 Methodology Appendix 2 Summary Flowchart Appendix 3 Points to Cover During Antibiotic Prophylaxis Discussion with Patient Appendix 4 Patient Information Appendix 5 Template Letter Extremely Extremely Extremely Extremely Extremely Comments (please indicate which of the above appendices these relate to): Appendix 3: As above, the information on increased risk from dental treatment compared to routine oral hygiene procedures should be amended; the highest risk category should be removed; and the risks of antibiotics should be discussed. Appendix 4: As above, discussion of the risks associated with antibiotics should be included. Also, it should be emphasised that the default decision not to provide prophylactic antibiotics for dental procedures has been in place since 2008 with no reliable evidence of harm to patients. Appendix 5: This is a helpful template. 3. Presentation Please indicate the extent to which you with the following statements and provide comments or explanation as appropriate. The information is clearly presented (i.e. the language and format used is helpful) The implementation advice is clear and unambiguous 4

5 4. Methodology How confident are you in the manner in which this implementation advice has been developed? (see Appendix 1) confident Extremely confident 5. Training Please answer these questions assuming the consultation draft of this implementation advice is published. Are there any specific training needs associated with this implementation advice? Yes No Unsure Training on cardiac conditions and risk might be helpful to GDPs. 6. Equality This question refers to potential discrimination, including by age, disability, ethnicity, gender, gender identity/transgender status, religion or belief, sexual orientation, geographical location or whether a person is a carer. Do you think that any particular groups or individuals (clinicians or patients) are likely to be disadvantaged or discriminated against by this implementation advice? Please provide more details: Yes No Unsure Difficulties might arise for a patient whose medical history is incomplete (for example, due to frequent change of address). 7. Any Other Comments Please comment on any other aspects of this implementation advice here. Thank you for taking the time to contribute to this consultation. 5