6768 Introducing point of care testing for group A strep in a children’s emergency department, during an epidemic

Objectives Sore throat is a common presentation to CED. Scoring can be used to stratify those more likely caused by Group A Streptococcus (GAS). A previous audit identified scoring was rarely used, throat swabs regularly sent and neither used to guide antibiotic prescriptions. We used Point of care (POC) testing to develop a structured approach to sore throat assessment, reduce antibiotic prescribing and the use of laboratory swabs. Methods A decision tree was constructed to assess children whom the clinician considered might have bacterial tonsillitis. Those with a McIsaac score of 3 or greater were offered a POC test for GAS with antibiotics prescribed for positive results. Testing was introduced following staff training, publication of the protocol and update of local guideline. Initial use of POC testing was audited for: Scoring guiding those selected for testing Test results guiding prescribing. Compliance was 70%. Following this pilot community circulation of GAS increased significantly. High profile cases of invasive GAS led to overuse of testing and compliance reduced to 20%. A QI project devised to reduce testing which had led to significant costs and an increase in antibiotic prescribing due to poor sensitivity of the test in those with low pre-test probability. PDSA Cycles: Team education – reminder of need to perform clinical score, all swabs to be discussed with senior decision maker Nurse (NIC) to challenge each request questions, 'Have you recorded the score? Discussed with senior decision maker? Will it change management?' Removal of under 3's from testing. Results Outcome measures; compliance with protocol and number of tests per day. Another trust site not part of the QIP was used as control group. Compliance improved from 20% to 80%. The number of daily tests at the intervention site decreased from 3–5 to 0–2 during the test period whilst comparison site remained static. Conclusion It is possible via a programme of continual improvement to successfully implement a POC test for GAS even within a national epidemic. We found several themes when using a standardised protocol: Clinicians tendency to use test out of scope e.g. part of a respiratory or septic screen Disregarding swab result Using prior to completing assessment Using the NIC and ensuring a senior review ensured that swabs were used appropriately. Having demonstrated testing use is feasible within a challenging environment, we aim to examine whether embedded use reduces antibiotic prescribing, lab swab use and therefore unnecessary intervention and cost.