5.1 Local implementation

Implementation of national clinical guidelines is the responsibility of each NHS Board and is an essential part of clinical governance. It is acknowledged that every Trust cannot implement every guideline immediately on publication, but mechanisms should be in place to ensure that the care provided is reviewed against the guideline recommendations and the reasons for any differences assessed and, where appropriate, addressed. These discussions should involve both clinical staff and management. Local arrangements may then be made to implement the national guideline in individual hospitals, units and practices, and to monitor compliance. This may be done by a variety of means including patient-specific reminders, continuing education and training, and clinical audit.

5.2 Key points for audit

Management of acute otitis media:

• well defined practice policy about use of antibiotics and yearly review of antibiotic prescription rate for children with AOM are in place
• only proven treatments are used.

Referral criteria:

• criteria for referral for hearing and other assessments are available
• admission rates with reference to referral criteria are monitored
• follow up of children with hearing problems and those who have had operative intervention such as insertion of grommets is taking place.