Endocrine Abstracts

Audit standard: All patients should receive written and verbal advice about the risk of neutropenia associated with the use of anti-thyroid drugs. Compliance rate 100%.

Our Endocrinology Department has a detailed patient information sheet that is provided to the patients at the time of initiation of anti-thyroid drugs.

Background: Recently, a patient was admitted with neutropenia secondary to the use of carbimazole. She did not know about the risk of neutropenia associated with the use of anti-thyroid drugs. This raised doubts as to whether we adhere to our standards. To answer this question, we undertook this audit to determine if we were meeting our standards.

Methods: We retrospectively reviewed the clinic letters and notes of all new patients who were seen in our endocrine clinics between January and December 2008 (n=69) and prescribed anti-thyroid drugs.

Results: Anti-thyroid drugs were started by the general practitioners in 50 patients (72%) and by the endocrinologists in 14 patients (21%). It was not possible to identify where anti-thyroid drugs were started in five patients (7%). Neutropenia advice was documented in clinic letters and notes in 30 (43%), and 18 patients (26%) respectively following their first clinic appointment. There was no documentation of neutropenia advice in clinic letters and notes in 21 patients (30%). In 18 patients (19%), there was no documentation of advice either in clinic letters or notes even after their third clinic appointment.

Conclusion: Our audit confirms poor documentation of neutropenia advice in both clinic letters and notes.

Action plan: 1. We have developed a system with the help of IT department that allows our secretaries to automatically add the warning information into the clinic letters whilst typing.

We have prepared a medic-alert card that is given to all patients during their first consultation. This card provides them precise information about the side effects of anti-thyroid drugs and actions to undertake should they experience any side effects.