Aims The aim of this audit was to look at how GPs in a surgery were diagnosing and managing paediatric patients with constipation. I hoped to improve history taking, examination and management of constipation based on gold standards set by NICE guidelines.
Methods Over a 3 month period in a GP surgery data was collected from EMIS (GP healthcare record system) on patients who had been diagnosed with constipation. All patients were under the age of 18 and never diagnosed with constipation in the past. With NICE guidelines in mind the history was reviewed looking to see if red and amber flags had been documented. Examination was looked over to check the correct examinations were carried out. Diagnosis and management was reviewed to assess whether the correct treatment was given according to guidelines. Results were presented along with a 20 min teaching session about constipation. The teaching session included; definitions, cost to the NHS and gold standard history taking, examination and treatment. Patient notes were then re-audited 8 months later.
Results In total 39 patient notes were audited. (Graphs 1–4 below shows the percentage of patients who had red/amber flags documented, examinations done and treatment given with comparison made pre and post the teaching session).
Conclusion Constipation is an increasingly large problem and accounts for 35% of gastroenterology appointments. If constipation is better managed by GPs it can reduce referrals and increase clinic time for patients in need of specialist paediatric gastroenterology input. GPs are not documenting whether they have considered red and amber flags in the history. Documenting/carrying out all examinations necessary for diagnosing idiopathic constipation improved since the teaching but it is not perfect. Managing constipation varies broadly between different GPs despite clear guidance and teaching. Movicol was first line but lactulose is becoming more popular amongst GPs. A flow sheet and template are looking to be produced to encourage appropriate documentation and treatment for children with constipation this should prevent referrals to outpatient gastroenterology. Once treatment has been optimised for these children I will look at referrals to secondary care pre and post these interventions.
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