The Trouble with Guidelines (a sort of apology to Anna McD)
It was only earlier this year that I really got to grips with the SDCEP guidelines produced in Scotland which produce some of the extraordinary advice for general dental practitioners to be able to get on with their daily lives.
I was introduced by my friend and colleague John Gibson to this and have become evangelistic about pushing the access to this documentation out widely to as many colleagues as I can in the help of them improving treatment for patients.
This guidance is relevant, up to date, easy to use and most helpful, but of course is only as good as it’s current position and only able to protect me until the next piece of guidance comes along.
It was with this backdrop that we were discussing our antibiotic prophylaxis at the recent aesthetic live skills course with myself, Anna, Andy and Colin Burns. A group of clinicians whose knowledge about what they’re doing is not too shabby and whose commitment to provide decent care for patients seems to be quite strong and firm.
It turned out to be quite a discussion about what we were doing in specific situations for patients with artificial heart valves or patients with previous endocarditis. This was raised as I had seen a patient that week a patient who had an artificial heart valve and had suffered endocarditis leading to replacement of the artificial heart valve with yet another artificial heart valve.
And so it became a ‘journal off’ to see who could access the most current piece of guidance associated with antibiotics prophylaxis.
My resistance (ha ha do you get the joke) to prescribing antibiotics has been well mentioned and is strong; I try wherever possible to not give antibiotics as I think it is a time bomb waiting to happen. I do though completely accept the fact that other people have different views on this. We were able to find several sets of guidance that end up contradicting each other, although they were only months apart.
The SDCEP guidelines for 2016 said no antibiotic prophylaxis but the NICE guideline says ‘not recommended routinely’.
What does all this mean?
In the end it puts the onerous on the practitioners to make the decision.
It’s almost impossible to filter down which guidance is more powerful than others.
Should we accept NICE, the SDCEP, a more recent paper which is produced by the British Heart Valve Society, a British Society for Echo or should we accept any other number of committees that exist to give us advice or instruction.
Anna was able to pull out an article from the British journal of cardiology from 2016, you can read it here, but all it seems to say is that NICE guidelines are now less dogmatic and allows clinicians to use their clinical judgment.
Apparently this allows us to ‘provide the care our patients want’ at least until a problem occurs and they tell us that they didn’t want it anymore.
Not quite sure where to turn these days or just seem to be turning all the time.
Blog post number: 1480