Transcript Antimicrobial Updates

The 3-Day Antibiotic Bundle
Shadi Botros
Principal Clinical Pharmacist
SBAR
SITUATION:

C.Diff outbreak in the Vascular Surgery ward
Health Secretary Nicola Sturgeon
Statement to the Scottish Parliament
Clostridium difficile outbreak: Ward 31 Ninewells Hospital
November 12, 2009
SBAR
BACKGROUND:
Risk of C.Diff directly influenced
by antibiotic prescribing(1)
30% reduction in CDAD
Updated Antibiotic policies
currently in place
1) Bignardi GE. Risk factors for Clostridium difficile infection. J Hosp Infect. 1998 Sep;40(1):1-15.
SBAR
ASSESMENT:
Snap shot audit of in-patient prescription
charts on vascular surgery ward
Poor compliance with updated antibiotic
policies
SBAR
RECOMMENDATION:
Promote prudent antibiotic prescribing
Good compliance with updates antibiotic
guidelines
Ensure shortest duration of IV antibiotics
Design, test and implement a 3 day
antibiotic bundle
Use IHI improvement methodologies
Test of change
Reduce the risk of C.Diff
Constant and sustained reduction in the number of
new C.Diff cases
Promote Prudent Prescribing
•Improved compliance with Antibiotic policies
•Ensuring optimum duration of therapy
Spread through the whole ward and
constant auditing
Engaging all members of the Multidisciplinary team in
the process to ensure that it is NOT person-dependent
Testing the reliability of the new antibiotic bundle (1, 3, 5 test)
Testing the usability of the newly updated Antibiotic bundle
RESULTS
Weeks
24
/0
3/
10
17
/0
3/
10
10
/0
3/
10
03
/0
3/
10
26
/0
2/
10
19
/0
2/
10
08
/0
2/
10
04
/0
2/
10
% Compliance
RESULTS
Compliance With PAPER Bundle
100
90
80
70
60
50
40
30
20
10
0
Compliance
RESULTS
The 3 Day Antibiotic Bundle
INDICATION :
Start Date:
Review Date:
Action Taken on Review
Check Microbiology Results
Review Patient & Initial Diagnosis
Consider IV to Oral Switch
RESULTS
Vascular Surgery (Ward 12)
Ward 12 NW % Patients with Completion of 3-day Bundle
Long Term Pharmacy Vaccancy + Bank Nurses
100
New Test of Change
for Auditing By
Nurses Monthly
(New Drs)
90
70
60
50
Paper Bundle
Introduced
Yellow Sticker
Bundle Introduced
+
New Test of Change
40
30
20
Patient transferred from
another ward
10
New Relief Dr
+
No Stickers
Lack of Pharmacy Staff to
carry out Audit
0
04
/02
/10
08
/02
/10
19
/02
/10
26
/02
/10
03
/03
/10
10
/03
/10
17
/03
/10
24
/03
/10
31
/03
/10
09
/04
/10
16
/04
/10
23
/04
/10
30
/04
/10
07
/05
/10
14
/05
/10
21
/05
/10
28
/05
10
04
/06
/10
11
/06
/10
18
/06
/10
25
/6/
10
02
/07
/20
10
09
/07
/20
10
16
/07
/20
10
23
/07
/20
10
31
/07
/20
10
06
/08
/20
10
13
/08
/20
10
20
/09
/20
10
20
/10
/20
10
20
/11
/20
10
20
/12
/20
10
20
/01
/20
11
% Compliance
80
Date
SPREAD
Locally (NHS Tayside)
Surgical wards (GI + Acute receiving unit)
Medical wards (mHDU + Respiratory)
Nationally (Scotland)
PVC bundle
National Hospital Rx
Internationally
Ireland
USA
SUMMARY
Using the IHI improvement methodologies,
we were able to successfully,
Design and implement a multi-disciplinary
3 day antibiotic bundle
Achieve reliable good compliance with our
antibiotic policies that promote prudent
antibiotic prescribing
Achieve our ultimate goal of reducing the risk
of HAI and eliminating CDAD from our clinical
environment
Remember….
Trying to improve patient safety has its
ups and downs……..
........ but it’s a hell of a ride!
QUESTIONS?