Reflective Template:  Quality Improvement Activity (QIA)

This reflective template has been designed to use with the SOAR Database (Scottish Online Appraisal Resource).  When you have completed this reflection, please upload it to SOAR / Form 3 and submit it to your interview to share with your Appraiser.	3-step guide to completing this form:

1)	Save this form (using “Save As”) to your computer (e.g. My Documents, Desk top), and customise the file name (e.g. QIA Reflection 2012)
2)	Proceed to filling out the form - when finished, Save and Close the document.
3)	Login to SOAR and Upload this file from where you had saved it (from step 1), either to the Documents Library, or directly to Form 3.	

This reflection template form should be used for Domain 2: Safety and Quality.

The boxes will expand automatically as you type into them.
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What supporting information have you provided for your QIA?
This reflection is on my antibiotic audit which was presented as QIA.
This is an 8 point audit where the criterion was that my prescribing of antibiotics should be concordant with the Highland Formulary.	

What strengths or achievements does it demonstrate?
I reflect that the strength of audit is not just the content but the process.
The content is of course important and I have in this audit demonstrated an improvement in my prescribing from 70.2 to 88.3 percent, This is a substantial improvement but would not stand statistical scrutiny. However the audit demonstrates that I have read and considered the NHS Highland Guidelines and this is a strength.	

Did you encounter any difficulties in this process?
This audit was a fair bit of work. As a locum it did require that I note each patient when I saw them, as going back to the practice or the OOHs service would have been too time consuming.	

Have you been able to make any changes as a result of undertaking this activity?
There are several changes which I made in my antibiotic prescribing to be concordant with the NHS Highland Formulary. These are the areas where I fell short and changed my prescribing:
1 Epididymitis  treated with Cephelexin and not Doxycycline
2 COPD treated with Ciprofloxacin and not Co-amoxiclav
3 Sore throat treated with amoxicillin and not pheoxymethylpenicillin
I am particularly embarrassed about treating sore throat with amoxicillin as I should know better. 	

What have you learned from undertaking this activity?
The advice on the range of infection which I encountered was not adequately covered by the NHS Highland Formulary, which is a pity because overall it does give good advice. In the area of URTI, Bronchitis and LRTI the advice was not clear. However the process of this audit was very helpful in stimulating me to understand my antibiotic prescribing.	

Is there anything else that you would like to/ need to do to follow it up?
I have done an audit on all prescribing with the criteria that my prescribing should be consistent with prescribing advice, BNF, NICE, the Pink One, The Highland Formulary and this was very educational. It is hard work and it is especially difficult as a locum. What it has shown me is that I can fulfil the QIA required for revalidation, and as an advisor for RCGP on Revalidation for locums and OOHs GPs, I know audit is possible as a locum and OOHs GP.
I would be interested in a Centor Score audit.