Aim: Audit was carried out in accordance with trust policy to review all adult patients initiated on Growth Hormone during the period April 2009 to April 2011 and primarly to evaluate efficacy and to ascertain if care is consistent with NICE guidelines.
Method: Medical notes of all patients initiated on Growth Hormone during the stated period were retrieved. The cases we're audited against criteria 1, 2, 4, 5 and 6 as specified in NICE guideline TA 64, Appendix C.
Results: 16 patients were initiated on Growth Hormone during this period. One had previously received Growth Hormone as a child. The remainder were first noted to have deficiency after the age of 25. Criteria from NICE Guideline TA64' Appendix C: 1a. The individual has severe growth hormone deficiency <9 mU/L on an Insulin Tolerance Test or equivalent cross validation test. Expected standard 100% Audit compliance 75% b. The individual has impaired quality of life, >11 score on QoL-AGHDA Expected standard 100% Audit compliance 100% c. The individual is receiving medication for other pituitary hormone deficiencies Expected standard 100% Audit compliance 100% 2.a,b. Individual is reassessed at 9 months of treatment. AGHDA must improve by at least 7 points. If not pt discontinues Growth Hormone replacement Expected standard 100% Audit compliance 100%. mean score improvement 16.7 points. 4. N/A 5.The following are carried out by a qualified specialist a. Initiation of Growth Hormone treatment b. Dose titration c. Assessment of response during the trial period Expected standard 100% Audit compliance 100% Endocrinologist referred individuals to Growth Hormone Specialist Nurse, then all clinical care delivered/assessed by nurse who is also a non-medical prescriber. 6. Shared care protocol is implemented between secondary and primary care. Expected standard 100% Audit compliance 100%
Conclusions: 100% concordance with expected standards for 2,5 and 6 of NICE guideline TA64 during the period stated. 75% concordance for criteria 1a. Endocrinologist made clinical decision Growth Hormone deficiency was unequivocal. Recommendation is that Audit will be repeated in 2 years time for period April 20112012, to ensure excellence in care is maintained Growth Hormone Clinical Nurse Specialist delivers exceptional standards of care and demonstrates advanced practice.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.