Endocrine Abstracts

GH stimulates the growth of skeletal muscle and connective tissue and increases the rate of protein synthesis. Somatotropin (artificial GH) has been commercially available since 1985 and is most commonly used for the treatment of Isolated GH Deficiency, idiopathic short stature, Turner syndrome, Prader–Willi syndrome, chronic renal insufficiency, and ‘small for gestational age’. GH deficiency has a growing prevalence, affecting 20/million children in the UK. Our aim was to benchmark our performance against NICE guidelines (TA188) and identify areas for improvement. All paediatric patients prescribed GH at our centre since 2011 were included. Available notes were reviewed for evidence of correct initiation, maintenance and discontinuation of GH treatment, as well as the provision of written information and informed consent. Results showed that of 76 patients, GH was mainly started for Isolated GH deficiency (61%), Turner Syndrome (17%) and Prader–Willi syndrome (9%). 93% had documented evidence of GH initiation in line with NICE guidance. In 13 cases there was a documented reason to stop GH and this was done in 62% (8/13) of cases. In 80% there was no documentation of discussion regarding the risks and benefits of GH or provision of written information. Given the significant cost and growing number of patients receiving GH, best practice is an important issue. This audit confirmed that GH was generally initiated in concordance with NICE guidance. The main areas identified for improvement were the documentation of provision of information and discontinuation of treatment. To improve our practice, we suggest the introduction of a pro forma, which will act as an aide-memoire to best practice and assist future auditing. Our earlier work demonstrated pro formas are effective in increasing conformance to best practice. To complete the audit cycle, we plan to re-audit following the introduction of this innovative clinical tool.