GDC charges related to antibiotic prescribing
When a dental professional is being investigated by the UK General Dental Council, perhaps after a complaint has been made, they will routinely search the practitioner's other records - ones that have no relation to the complaint - to find extra charges to bring against them.
This may seem unfair - particularly when one's livelihood is at stake - but the GDC view this as in keeping with their role as a regulator.
To avoid GDC scrutiny, the important points when you prescribe antibiotics are:
- Record the justification for antibiotics
- Record the drug chosen, dose, quantity, advised duration.
- Record your offer of a review visit.
- If not using amoxicillin, penicillin or metronidazole, record the reason for your choice (e.g. allergy, interactions).
- Record the evidence of regional spread (nodes, trismus, severe swelling, cellulitis) or systemic spread (fever, malaise).
- Also record negative findings of these signs/symptoms, to prove you checked.
- If there is suspicion of systemic spread, do a sepsis check and record the result.
... and ... 8. regularly audit your prescriptions!
Example
Pt c/o pain lower left quadrant 4 days. Feels generally unwell.
MH - allergy to penicillin, can't tolerate metronidazole (alcohol).
E/O exam: Swollen tender L submandibular lymph nodes. Mild trismus.
I/O exam: large fluctuant buccal swelling LL6. LL6 has carious exposure.
Ear temp 38.5°C.
Diagnosis: acute periapical infection, with abscess, LL6. Regional and probable systemic spread present.
UK Sepsis Trust sepsis check done (see sheet). Low risk - pt given advice.
Emergency tx today: Abscess incised and drained++. Rx Azithromycin 500mg orally twice a day. 5 days supply. Told to stop if symptoms resolve sooner. For ab review in 3 days.
Etc...
Pt c/o pain lower left quadrant 4 days. Feels generally unwell.
MH - allergy to penicillin, can't tolerate metronidazole (alcohol).
E/O exam: Swollen tender L submandibular lymph nodes. Mild trismus.
I/O exam: large fluctuant buccal swelling LL6. LL6 has carious exposure.
Ear temp 38.5°C.
Diagnosis: acute periapical infection, with abscess, LL6. Regional and probable systemic spread present.
UK Sepsis Trust sepsis check done (see sheet). Low risk - pt given advice.
Emergency tx today: Abscess incised and drained++. Rx Azithromycin 500mg orally twice a day. 5 days supply. Told to stop if symptoms resolve sooner. For ab review in 3 days.
Etc...
Below are just a few of the many charges the GDC's Investigating Committee have regularly brought against registrants regarding antibiotic prescriptions while investigating unrelated complaints.
When such charges are brought, the Professional Misconduct Committee then considers the charges: The PMC is the body that can impose practicing restrictions and conditions, or suspend / erase the dental professional from the register.
| "By reason of the facts alleged, your fitness to practice is impaired by reason of your misconduct." |
| You inappropriately prescribed antibiotics without sufficient clinical investigation |
| You failed to provide an adequate standard of care by prescribing antibiotics which were not clinically justified and/or necessary |
| You prescribed antibiotics to the patient and did not offer a follow up appointment |
| You prescribed antibiotics to Patient A without any, or any adequate, justification |
| You prescribed a course of antibiotics when no such treatment was indicated namely; a) when the patient presented absent any signs of systemic illness or severe or spreading infection |
| Repeatedly prescribing antibiotics without dealing with the underlying cause of infection |
| ... we were not assured xxx had knowledge of the recognition, diagnosis and early management of sepsis |
| You prescribed antibiotics when it was not clinically indicated |
| Several concerns were identified in relation to your ... antibiotics prescribing ... |
| There was no record of any systemic involvement which could justify the prescription of antibiotics. The Committee considers that XXXX issued the prescription without clinical justification. |
| In relation to antibiotic prescription, you failed to record dosages, durations of the course and/or justifications for prescriptions. |
| You prescribed antibiotics without clinical justification |
| You inappropriately prescribed antibiotics |
| There is no record in respect of the teeth for which the antibiotics were being prescribed |
| You did not record that: i. you issued a prescription for antibiotics; ii. the reason for prescribing antibiotics |
| You issued a prescription for antibiotics without adequate clinical justification; |
| You prescribed antibiotics when it was not indicated to do so |
| You prescribed antibiotics in excess of the recommended dose and duration |
| The Committee accepts the evidence of the expert that there is no record of systemic involvement and therefore the rationale for prescribing antibiotics is inadequate |
| There was no documentation of facial swelling or sepsis that would have indicated an antibiotic to be prescribed |
| You should not have prescribed antibiotics when nothing in the records that indicated that the patient had signs of systemic illness or that there was a severe and spreading infection |
| you failed to justify appropriately your prescribing of antibiotics |
| Antibiotics may be prescribed if, aside from systemic infection, there is evidence of the engagement of lymph nodes or malaise, and the Committee infers from the absence of any such recorded features that those features were not present. The Committee therefore finds the facts alleged at head of charge 3 (g) (i) proved. |