Implementation of NICE guidance on urinary tract infections in children in primary and secondary care.

ABSTRACT

AIM: To audit compliance with the 2007 National Institute of Clinical Excellence guidelines on the management of urinary tract infection in children under the age of 16 years across primary and secondary care services in England. METHODS: A retrospective multisite audit of 10 general practice, 3 paediatric, 2 paediatric emergency and 2 emergency general units. Four distinct geographical areas were represented. Data were collected between 1 January 2010 and 31 December 2010. Six criteria were audited, which focused on the following improving the rate of diagnosis, management of the very young child with UTI and selection of children for imaging. RESULTS: A total of 1149 children were audited (682 from primary care and 467 from secondary care). Overall compliance was as follows criterion 1 28%; criterion 2 68%; criterion 3 89%; criterion 4 43%; criterion 5 (comprising 12 subcriteria) 13% and for criterion 6 45%. CONCLUSION: The results indicate significant shortcomings in the implementation of NICE guidance on childhood UTI in England. The guidance is complex and this makes its implementation challenging. It was difficult to identify children presenting with nonspecific fever from clinical data systems. Adequate IT systems throughout the NHS are a key step to improving implementation of this and other NICE guidance.