- Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
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Date lodged: Friday, 24 April 2009
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Current Status:
Answered by Nicola Sturgeon on 5 May 2009
To ask the Scottish Executive, further to the answer to question S3W-22508 by Nicola Sturgeon on 23 April 2009, whether it will publish the outcome of the review by NHS Quality Improvement Scotland of the clinical governance arrangements in place across NHS Orkney.
Answer
NHS Quality Improvement Scotland (QIS) has confirmed the report will be published on its website by end June 2009.
- Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
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Date lodged: Friday, 24 April 2009
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Current Status:
Answered by Nicola Sturgeon on 5 May 2009
To ask the Scottish Executive, further to the answer to question S3W-22508 by Nicola Sturgeon on 23 April 2009, what would trigger an investigation into the incidence of Clostridium difficile at NHS Orkney and whether this was applied in the recent outbreak.
Answer
National guidance requires the setting of local trigger thresholds for each clinical area. Following the recent outbreak these are now in place across NHS Orkney and have been set at two cases for each ward within any 30 day period.
- Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
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Date lodged: Thursday, 16 April 2009
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Current Status:
Answered by Nicola Sturgeon on 5 May 2009
To ask the Scottish Executive, in light of the commitment made by the Cabinet Secretary for Health and Wellbeing at a meeting with the C. diff Justice Group in December 2008 to consider a public inquiry into the deaths from Clostridium difficile at the Vale of Leven hospital if there was a delay in receiving a final report from the Crown Counsel, whether it will now grant a public inquiry.
Answer
I refer the member to the answer to question S3W-23027 on 5 May 2009. All answers to written parliamentary questions are available on the Parliament''s website, the search facility for which can be found at
http://www.scottish.parliament.uk/Apps2/Business/PQA/Default.aspx.
- Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
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Date lodged: Tuesday, 31 March 2009
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Current Status:
Answered by Nicola Sturgeon on 23 April 2009
To ask the Scottish Executive whether there has been a recent increase in the number of healthcare associated infections in Orkney and, if so, what the nature of the problem is and what action has been taken.
Answer
On 3 February, the Scottish Government was notified of an outbreak of Clostridium difficile in NHS Orkney (NHSO). Seventeen patients, including one member of staff, had been confirmed as Clostridium difficile positive since the start of January 2009. This compared to a total of 26 cases for the whole of 2008. Seven cases were identified in the community, 10 in hospital. Of the 17, three have died, with Clostridium difficile recorded on two of the death certificates, in both cases as a contributory cause of death.
Immediately the situation became known, the Chief Nursing Officer (CNO) asked Health Protection Scotland (HPS) to visit to fully explore the circumstances and to provide support, which they did on 6 February. The CNO, supported by members of the Scottish Government HAI team and HPS also visited the board on 10 February, and an action plan was produced. Through weekly monitoring, I am being kept informed of progress.
The detail of the Clostridium difficile outbreak was reported publicly through local media and the NHS Orkney, HAI Reporting template (HAIRT), and the HAIRT was discussed at the NHSO board meeting on 19 February 2009. A copy can be accessed through the NHSO website using the following link http://www.ohb.scot.nhs.uk/images/pdf/OHB114%20Orkney%20HAI.doc.
I spoke to the Chair of NHS Orkney on 5 February and met him on 4 March. He reassured me that the outbreak was contained and the action plan was in place, and I have asked that NHS Quality Improvement Scotland (QIS) review the clinical governance arrangements in place across NHS Orkney, which is consistent with their remit to provide advice and guidance on effective clinical practice.
A further review of infection control arrangements will also be undertaken by HPS by the end of September 2009.
- Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
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Date lodged: Thursday, 12 March 2009
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Current Status:
Answered by Nicola Sturgeon on 24 March 2009
To ask the Scottish Executive, further to the answer to S3W-20799 by Nicola Sturgeon on 6 March 2009, whether it intends to distinguish between samples taken from patients in acute hospitals, non-acute hospitals and community settings in determining the presence of Clostridium difficile.
Answer
Health Protection Scotland (HPS) advise there is no intention to distinguish between samples taken in hospitals, community settings or nursing homes for the national surveillance of Clostridium difficile Associated Disease (CDAD).
HPS will carry out validation studies with individual NHS boards to establish where CDAD cases are arising to best focus efforts to reduce the risk of developing the infection.
Antimicrobial prescribing is the biggest single risk factor for CDAD and in that context it is assumed that all cases are healthcare associated.
- Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
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Date lodged: Thursday, 12 March 2009
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Current Status:
Answered by Nicola Sturgeon on 23 March 2009
To ask the Scottish Executive, further to the answer to question S3W-20800 by Nicola Sturgeon on 4 March 2009, whether each NHS board issues guidance to GPs about prescribing antibiotics.
Answer
Each NHS board has an evidence-based primary care antimicrobial prescribing policy which provides guidance on when to prescribe antibiotics and which antibiotic should be used to treat each common infection. This policy is issued to GPs either electronically or in hard copy.
- Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
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Date lodged: Thursday, 12 March 2009
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Current Status:
Answered by Nicola Sturgeon on 23 March 2009
To ask the Scottish Executive, further to the answer to question S3W-20798 by Nicola Sturgeon on 4 March 2009, how learning and information on prescribing antibiotics is shared with GPs.
Answer
Learning and information about prescribing antibiotics is shared with GPs at a local level through education and feedback sessions organised by the NHS boards prescribing advisers. As part of the Scottish Antimicrobial Prescribing Group''s education work stream, NHS Education for Scotland is currently developing a learning resource for primary care on managing common infections, which will include appropriate use of antimicrobials. The NHS board''s antimicrobial management team is tasked with ensuring the implementation of such educational programmes.
- Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
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Date lodged: Thursday, 12 March 2009
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Current Status:
Answered by Nicola Sturgeon on 23 March 2009
To ask the Scottish Executive, further to the answer to question S3W-20798 by Nicola Sturgeon on 4 March 2009, whether NHS boards receive assurances that prescribing practices are appropriate in addition to monitoring antibiotic use.
Answer
The appropriate use of antimicrobials is an important clinical governance issue. The NHS board''s Antimicrobial Management Team (AMT), which is a sub-group of the board''s Area Drug and Therapeutics Committee, covers both primary and secondary care sectors. Their key role is the development, implementation and compliance monitoring of the board''s antimicrobial policy. The AMT feeds back to the board''s clinical governance and risk management teams.
- Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
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Date lodged: Thursday, 12 March 2009
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Current Status:
Answered by Nicola Sturgeon on 23 March 2009
To ask the Scottish Executive, further to the answer to question S3W-20798 by Nicola Sturgeon on 4 March 2009, whether trend data on the prescribing of antibiotics is publicly available.
Answer
Not all the data used by NHS Board Prescribing Advisers are available publicly. For example, Prescribing Advisers have access to data through the PRescribing Information SysteM for Scotland (PRISMS), a web-based prescribing information database. Prescribing information, including antibiotics, available publicly can be found at
www.isdscotland.org/prescribing.
- Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
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Date lodged: Thursday, 12 March 2009
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Current Status:
Answered by Nicola Sturgeon on 23 March 2009
To ask the Scottish Executive what information is given to patients in relation to the need to complete courses of antibiotics and the potential risk of Clostridium difficile in the over-65s who are vulnerable and may be admitted to hospital in the following two months.
Answer
All labels on antibiotic prescriptions should have standard labelling “ Complete the Course. Pharmacists in hospital and primary care settings also counsel patients on how to take their medicine including taking at regular intervals, requirements to take before and after food and completing the course.
Good prescribing practice for any treatment should also involve discussion with the patient of potential risks and benefits as appropriate on an individual basis.
The benefit of using an antibiotic to treat an infection in a patient over 65 years must be balanced against the potential for predisposing them to Clostridium difficile. Prescribers must weigh up these risks and decide on an individual basis what is clinically appropriate.
