CLINICAL AUDIT REPORT

Implementation of NICE guidelines (PH3) on one to one interventions to reduce the transmission of STI’s including HIV, and to reduce the rates of under 18 conceptions, especially among vulnerable and at risk groups

Department of Infectious Diseases and Sexual Health

Speciality Medicine

Audit lead: Justine Mellor
Report by: Justine Mellor
Date report produced (October 2009)

Executive summary

This audit was completed by the staff at the Trinity centre to determine whether the service is implementing, and is in compliance with, the NICE public health intervention guidance “One to one interventions to reduce the transmission of sexually transmitted infections (STI’s) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups”.

The NICE audit template and criteria have been applied and findings reveal that the recommendations are partially been adhered to and are further explained in the results section of this report. Where standards are below those set by the NICE audit criteria, recommendations have been outlined to implement into future practice.

Background

The National Strategy for Sexual Health and HIV ( DoH 2001) set national targets for reducing newly acquired HIV infections, gonorrhoea infections and unwanted pregnancies.

However, diagnosis of sexually transmitted infections continue to increase, most alarmingly among young people, some black and minority ethnic groups, and gay men (DoH 2008). Little is known about changes in behaviour since the publication of the strategy, although indicators of sexual ill-health and recent surveys among different population groups suggest risk behaviour is continuing. One third of young people report inconsistent condom use (ONS 2007) and almost half of gay men report an episode of unprotected anal intercourse in the preceding year (Weatherburn et al 2008). Frequent use of alcohol and other drugs is associated with higher numbers of sexual partners and decreased likelihood of using protection. (Bellis 2007)

In 2001 the National Strategy stated that the evidence base for HIV and STI prevention was still dispersed and unsystematic and effective interventions hadn’t been agreed. Since then the National Institute for Health and Clinical Excellence completed a review of the literature and in 2007 the public health intervention guidance 3 was published. The guidance presents the recommendations on “One to one interventions to reduce the transmission of sexually transmitted infections (STI’s) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups. One to one interventions are an important element of modern sexual health services and should be integral to the routine care provided by both primary care, contraceptive and sexual health services.

Aim of the audit

The aim of the audit is to determine if the Trinity Centre is implementing, and in compliance with the NICE public health intervention guidance “One to one interventions to reduce the transmission of sexually transmitted infections (STI’s) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups.

Recommendations

As this was the initial audit at the Trinity Centre it has provided a baseline assessment of current practice from which future audits can now be measured.
To assist with this and improve standards the following recommendations are made:

• Introduce a local Motivational Interviewing code for KC60/GUMCAD
• Improve documentation in patient records by Health Advisors by implementing a MI record sheet to record one to one intervention.
• Provide information packs for vulnerable young people with local details around emergency contraception and CASH services and safer sex literature.
• Practitioners using MI skills should have monthly supervision with psychology to ensure good practice and comply with clinical governance.
• Consider further practitioners to complete training in MI skills to improve patient flow in department by reducing onward referral.
• Re-audit in 12 months to be completed.

Download full version

• Clinical Audit Report (PDF, 180KB)