Quality Improvement Project (QIP) C.
Difficile Example
Supervisor
Feedback
Date BE, ME or
*automatically inserted AE
GP Trainee entry Below GP Supervisor comments
expectations,
Meets
expectations,
Above
Expectations
Project Title and why it was Title: Review of antibiotics use associated ME You have contextulised the project
chosen with increased risk of clostridium difficile. in the practice setting highlighting
one personal case in addition to
You should explain what trigger I recently treated a patient with known highlighting this area is a CCG
(case, data or events) led you to bronchiectasis with co-amoxiclav for her identified priority. You have started
look at this area. You should chest infection as recommended by the to consider the impact of the QIP
comment on the likely impact of respiratory team. Between primary and (for example number of admissions,
this on patients, and review the secondary care this patient received several risk of morbidity etc). You could
guidance or evidence that is weeks of co-amoxiclav and subsequently have considered this further. It
relevant to the area (e.g. a contracted C.difficile. She was quite unwell would have been nice to see a
literature review).
and required admission. The recommended review of the evidence or guidance
antibiotic for this patient has since changed. on why antibiotic prescribing is
The local clinical commissioning group have important.
identified reducing prescribing antibiotics
which increase risk of developing c diff as a
priority to attempt to reduce the prevalence
of C. difficile. C.difficile can cause significant
morbidity. It is important to reduce the risk
of infection thereby reducing patient
suffering and admissions by only
prescribing at risk antibiotics for specific
recommended uses. The risk increases with
the use of certain antibiotics e.g.
cephalosporins and co-amoxiclav especially
when combined with protein pumps
inhibitors.
Project Aim Reduce the use of antibiotics associated BE You could try presenting the
with increased risk of clostridium difficile. aim/objectives in a SMART format.
When explaining your project You could be more clear on who is
aim, consider what you are I will know that there has been a change as your target group.
trying to accomplish, how will prescribers will adhere to the antibiotic
you know that a change is an formulary. This in turn will reduce the
improvement and what changes prevalence of c difficile recorded in the
could you make that would practice, improving both quality of patient
result in improvement in patient care and safety.
safety or patient care?
Describe what baseline data BE You have gathered some baseline
or information you gathered I measured the number of patients data over the preceding two months.
prescribed antibiotics known to increase However you have included part of
You should explain how you your ‘act’ within the ‘plan’ part of the
the risk of C.diff (quinolones,
understood the current position PDSA. There is no baseline data to
cephalosporins, macrolides, co-amoxiclav,
in order to decide that compare with as you have used the
and clindamycin). I also recorded if a patient
improvements were needed. same data throughout.
was co prescribed a protein pump inhibitor
Explain which QI tools or You have also not clearly identified
methods you used to fully in the last 2 months.
which QI tools you are using.
understand the ‘problem’ you For each patient I ascertained the reason
were trying to solve. Suitable for prescribing the antibiotic and checked if
methods would include QI tools the prescription was compliant with local
for example; assessing baseline guidelines. If not, I reviewed the notes to
data, process-mapping, ascertain if there was a clear reason for
conducting a survey and using prescribing an alternative antibiotic.
fishbone analysis.
Quality improvement requires
attempting to measure some
change, though the nature of
the measurement will be
different in different projects
and some data could be
available before the start of
your personal involvement.
(See PowerPoint slides 3-4) BE You have gathered data however
Describe what subsequent you have not demonstrated any
data or information you change from any intervention made.
gathered
How did you measure and
evaluate the impact of change?
You should share enough data
to demonstrate outcomes; you
may not need to share all your
data.
How did you plan and test out BE You have broadly identified the
your changes? I decided to use a PDSA approach. I PDSA approach and started to
planned to identify patients being identify the method behind this. The
Effective QI work involves ‘S’ within PDSA should be explored
prescribed certain antibiotics (plan).
testing out changes (small further. The PDSA cycles could be
cycles of change) and then I then reviewed the records of the patients, broken down into smaller repeated
learning from this experience looking at the indications for antibiotic cycles to demonstrate the impact of
and building on it. How did you prescribing to see if it was in line with the proposed changes.
apply this principle to your QI recommended guidelines (do). I produced a
project? paper detailing the results (study) and it was
discussed at a meeting and actions agreed
(act).
How have you engaged the The project was discussed at a practice BE You need to describe clearly how
team, patients and other meeting and I was asked to undertake a the individual team members
stakeholders throughout the review. All present at the meeting were very engaged (and how this happened
project? pleased that I had offered to undertake the throughout the QIP). Did you
project. involve any of the administrative
Describe any challenges of team, nursing team or pharmacists?
getting different team members Did you have any obstacles? Who
engaged with your QIA. could continue this work after you
Describe how you maintained leave the surgery?
momentum e.g. planning for an
early win:win.
BE There is no clarity on the
Summarise the changes as a The results were discussed at a practice sustainability (maintenance) of
result of your work and how Meeting. It was agreed to follow the change or if any change had taken
these will be maintained. guidelines where appropriate. I uploaded a place as there were no repeat
copy of the guidelines onto the surgery’s measurements. Results were
If improvement was not however shared with the practice. It
intranet to help achieve this.
achieved, explain why and what would have been appropriate to
you learnt about this. describe who was at the meeting
If the guidelines were not followed, it was
agreed to document the reason for (for example were pharmacists or
non-compliance with guidelines. nurse prescribers present as well as
Describe how you relayed your doctors). You could have also
results to the team and the
All were now more aware of the risks of reflected on how the feedback on
feedback you received.
prescribing such antibiotics especially if prescription of antibiotics not in line
the patient was on a PPI as well. with local guidance was received.
All present at the meeting agreed with
the actions.
It was agreed that I would repeat the review
in my ST3 year.
BE I am glad you have learnt how to
What have you learnt and This project taught me how to do a perform a computer search. It would
have you got any outstanding search using the practice’s computer have been good to have read your
learning needs? system. reflections on your learning from a
QI Method perspective – and how
Think about what you will you could use this in the future
I also enjoyed presenting the results to
maintain, improve and stop in (specific examples), how your
the practice and the discussion following.
QIA? leadership has developed and
It was really useful to hear everyone’s point consideration to the value and
It is important to consider what of view (including a discussion on which sustainability of the QIA.
changes you might need to antibiotic should be used for patient with
make as you continue to engage
epididymo-orchitis. )
with QIA, for example consider
the size of project, the amount
of evidence collected, how you I would like to do similar projects throughout
worked with others, the effective my career.
use of IT, its value to long term
care and its impact on
sustainability (health outcomes
for patients and populations
from an environmental, social
and financial perspective)
Based on this Observation, please rate the overall competence at which the trainee has shown that they are performing:
Below level expected prior to starting on a GP Training programme ▢
Below the level expected of a GP trainee working in the current clinical post x
At the level expected of a GP trainee working in the current clinical post ▢
Above the level expected of a GP trainee working in the current clinical post ▢
Identified continued learning needs in relation to the QI process [to be You have succeeded in doing some interesting work but
completed after discussing the assessment with trainee] appear to have struggled to structure it clearly and
explain how this fits into a Quality Improvement process.
I would suggest that the learning here is that if you read
the criteria and the way it is going to be assessed in more
detail you will do significantly better.
The other area ( and this is more closely focussed on QI)
that I’d suggest needs to be addressed is sustainability;
quality is dependent on processes… and this needs
members of the continuing team to be involved; your do it
myself approach may have got an assessment done but
will be unable to maintain improvement we need to talk
about how you could have engaged others in this project.
Completion of this project is a mandatory part of GP Speciality Training; failure to complete all parts will affect training progression.
Feedback that the trainee is Below expectation in some sections does not mean that the project needs to be repeated although there may be agreement that
this is the best way to get evidence for the competences which this part of training provides evidence for.
The assessment of overall competence at which the trainee is performing in this assessment will influence the ES’s overall assessment in the ESR for the
year of training in which it is carried out.
Trainees are welcome to share relevant (Caldecott compliant) data related to this project with this entry. Please note that some file formats will take up more
space, using formats like pdf will take up less space. The GP Supervisor is not expected to work through a presentation to find the data which should be
clearly demonstrated on this form or referenced.
