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Important reminders for clinicians from POAC regional governance

Diabetic foot- use of IV antibiotics in primary care for patients with active foot disease will only be funded where there is clear documentation of discussion with a named endorsing specialist prior to treatment. There have been more than 12 sentinel event cases reported by POAC in last 18 months where IV antibiotics have been given without prior discussion, resulting in hospitalisation and serious outcomes.

Red flags on HealthPathways- red flags exist for a reason and are there as a safety net for patients and clinicians. Kindly familiarise yourself with these for key pathways. An example is Pyelonephritis and age/gender exclusions. POAC will not fund patients when excluded, unless there is clear documentation of a named endorsing specialist for any cases where primary care management has been approved. See here

ECG policy criteria-when an ECG is performed for the purpose of excluding acute coronary syndrome (ACS), a same day Troponin is required and the result must be clearly documented. Normal ECG alone cannot safely exclude ACS, hence POAC will not fund an ECG without troponin-see here

Wells scoring and D-dimers for DVT - Wells criteria should only be applied to patients after a history and physical examination suggest venous thromboembolism as a diagnostic possibility. Without signs and symptoms of a DVT this risk stratification tool should not be applied. If Wells scoring is applied to an appropriate patient and is <2, a D-dimer is then required (or discuss with Haematology if considered likely to be high risk of DVT based on other factors). Do NOT do a d-dimer before the Wells score has been calculated, even if a D-dimer is easily accessible e.g. point of care testing; testing D-dimer in a patient with a Wells score >/= 2 is not good use of scarce resources  -see here

Cellulitis and use of IV Cephazolin in impaired renal function- when calculating the dose of IV cephazolin, use the calculation advice from Auckland regional antimicrobial stewardship group here (point 5) to determine whether probenecid should be withheld and if the dose of cephazolin should be reduced. AKI is a serious adverse event and can increase hospitalisation rates and adversely affect patient outcomes


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