scholarly journals EP.TU.682Antibiotic Stewardship Within A General Surgery Department – A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Toks Fadipe
Keyword(s):  
Data Collection ◽  
Antimicrobial Stewardship ◽  
Low Frequency ◽  
Electronic Prescribing ◽  
Junior Doctors ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Improvement Project ◽  
Surgical Department ◽  
Chi Squared

Abstract Background Antimicrobial stewardship involves a coherent set of actions geared towards responsible use of antimicrobials. NICE antimicrobial stewardship guidance forms the basis for trust wide standards; the surgical department inconsistently complies to these standards. Aims Use of PDSA framework to improve departmental antibiotic prescribing practices. Methods Data collection via Meditech™ prescribing records and documentation. ‘Snapshots’ of antibiotic prescriptions for surgical inpatients taken collecting the following data: Cycle 1 data collection in August/September 2020, followed by a presentation distributed to junior doctors detailing importance of accurate prescribing. Cycle 2 data collection in October/November 2020 was followed by a summary of documentation/prescribing guidelines being circulated to surgical juniors. The final data collection period took place in November 2020. Analysis via Chi-Squared test. Results Interventions improved prescribing of correct antibiotics (75 to 89.3%), and documentation of IV antibiotic prescriptions with courses longer than 72 hours (p < 0.05). Similar insigificant improvements observed with reviewing prescriptions within 72 hours and samples sent to microbiology. Discussion Low frequency of samples sent to microbiology as antibiotics often used for surgical prophylaxis and continued post-operatively without prior cultures. Brief documentation on the ward round, accentuated by constraints enforced by Covid-19 pandemic. Conclusion Positive changes can be achieved from simple interventions. Sustainable changes in prescribing practices require engagement of entire clinical team and amendments to electronic prescribing.

261 Using Technology to Improve Inpatient Surgical Lists

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Gowda ◽  
Z Chia ◽  
T Fonseka ◽  
K Smith ◽  
S Williams
Keyword(s):  
Quality Improvement ◽  
Patient Care ◽  
Junior Doctors ◽  
Research Projects ◽  
Point Scale ◽  
Improvement Project ◽  
Surgical Department ◽  
Team Meetings ◽  
And Training ◽  
Multi Disciplinary Team

Abstract Introduction Every day in our surgical department; prior to our quality improvement project, Junior Doctors spent on average 3.26 clinical hours maintaining 5 surgical inpatient lists of different specialities with accessibility of lists rated as “neutral” based on a 5-point scale from difficult to easy. Our hospital previously had lists stored locally on designated computers causing recurrent difficulties in accessing and editing these lists. Method We used surveys sent to clinicians to collect data. Cycle 1: Surgical Assessment Units list on Microsoft Teams Cycle 2: Addition of surgical specialities and wards lists onto Microsoft Teams. Cycle 3 (current): expand the use of Microsoft Teams to other specialities. Results Utilising technology led to a 25% reduction in time spent on maintaining inpatient lists, to 2.46 hours a day, and an improvement in the accessibility of lists to “easy”. Across a year, this saves over 220 hours clinician hours which can be used towards patient care and training. Furthermore, use of Microsoft Teams has improved communication and patient care, in the form of virtual regional Multi-Disciplinary Team meetings and research projects. Conclusions Microsoft Teams is currently free to all NHS organisations in England so there is potential for these efficiency savings to be replicated nationwide.

Antimicrobial stewardship: Australia

2016 ◽  
Vol 21 (3) ◽  
pp. 139-149 ◽  
Author(s):  
Allan D. Spigelman ◽  
Shane Rendalls ◽  
Mary-Louise McLaws ◽  
Ashleigh Gray
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
World Health ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Content Type ◽  
Research Education ◽  
Australian Health ◽  
Organization Policy ◽  
Health Organization

Purpose – The purpose of this paper is to provide an overview of the context for strategies to overcome antimicrobial resistance in Australia, which may provide valuable learnings for other jurisdictions. Design/methodology/approach – Non-systematic review of literature from websites of national, state and territory health departments and interviews with key stakeholders for Australian strategies to reduce antimicrobial resistance. Findings – In July 2015 all states and territories in Australia adopted the National Antimicrobial Resistance Strategy 2015-2019, which is built on the World Health Organization policy package to combat antimicrobial resistance. This strategy represents “the collective, expert views of stakeholders on how best to combat antimicrobial resistance in Australia. It will also support global and regional efforts, recognising that no single country can manage the threat of antimicrobial resistance alone”. It combines quantitative and qualitative monitoring strategies with frameworks and guidelines to improve management of the use of antimicrobial resistant drugs. Prior to this, health services and states developed and implemented initiatives aimed at monitoring and improving prescribing practices. Development of the national strategy has encouraged and fostered debate within the Australian health system and a raft of new policy initiatives. Research limitations/implications – Surveillance strategies are in place to monitor impact and trends at jurisdictional and sector levels. However, actual impact on antimicrobial resistance and prescribing practices remains to be seen as existing initiatives are expanded and new initiatives implemented. Practical implications – This overview of key Australian initiatives balancing quantitative and qualitative surveillance, accreditation, research, education, community awareness and price signals on antibiotic prescribing practices may be valuable to health systems in developing local strategies. Originality/value – The authors provide an up to date overview of the context, strategies and aims of antimicrobial stewardship in Australia.

scholarly journals Antibiotic Prescribing Practices in Endodontic Infections: A Survey of Dentists in Serbia

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 67
Author(s):  
Milan Drobac ◽  
Katarina Otasevic ◽  
Bojana Ramic ◽  
Milica Cvjeticanin ◽  
Igor Stojanac ◽  
...  
Keyword(s):  
Bacterial Resistance ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Online Questionnaire ◽  
Systemic Involvement ◽  
First Choice ◽  
Chi Squared ◽  
Endodontic Infections ◽  
Measure Of Association

The study goal was to provide an overview of antibiotic prescribing practices of Serbian dentists when treating endodontic infections and to disseminate the current ESE (European Society of Endodontology) recommendations to the study participants. A link to an online questionnaire was sent to 628 Serbian dentists whose email addresses were publicly available on the Internet, 158 of whom responded to the survey, resulting in a 25.16% response rate. The significance of possible associations was assessed via the Chi-squared test and Cramer’s V measure of association, with p < 0.05 considered as statistically significant. According to the study findings, 55.7% of respondents prescribed a 5-day antibiotic course. Moreover, Amoxicillin 500 mg was the first-choice antibiotic for 55.1% of the respondents, followed by Clindamycin 600 mg (18.4%). For patients allergic to penicillin, 61.4% of respondents prescribed Clindamycin. Statistically significant differences emerged only in relation to acute apical abscess with systemic involvement, whereby dentists aged 46–55 were least likely to prescribe antibiotics in these clinical situations (p = 0.04). Analyses further revealed that recommendations for safe antibiotic prescribing practices were not always followed, as in certain cases, patients were given antibiotics even when this was not indicated. These findings highlight the need for additional education on responsible antibiotic use to prevent bacterial resistance.

scholarly journals Antimicrobial Stewardship – Implementation and Improvements in Antibiotic-Prescribing Practices in a Dental School

2021 ◽  
Vol 9 (1) ◽  
pp. 80
Author(s):  
LahariAjay Telang ◽  
JayashriTamanna Nerali ◽  
PishipatiVinayak Kalyan Chakravarthy ◽  
FawazShamim Siddiqui ◽  
Ajay Telang
Keyword(s):  
Antimicrobial Stewardship ◽  
Dental School ◽  
Antibiotic Prescribing ◽  
Prescribing Practices

scholarly journals Perception of junior doctors about local induction in Birmingham and Solihull Mental Health Foundation Trust - A quality improvement project

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S198-S198
Author(s):  
Saima Jehanzeb ◽  
Kozara Nader ◽  
Ruth Scally
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
General Medical Council ◽  
Quality Improvement Project ◽  
Electronic Prescribing ◽  
Junior Doctors ◽  
Medical Council ◽  
Record System ◽  
Improvement Project ◽  
Mental Health Foundation

AimsA quality improvement project was undertaken to understand the perception of trainees about the quality of the local induction delivered by Birmingham and Solihull Mental Health Foundation Trust (BSMHFT). The primary aim was to evaluate the current local induction programme, following concerns raised by previous trainees in National Training Survey (General Medical Council) and local inspection. Our secondary aim was to devise a revised induction programme based on the trainees’ identified needs.MethodTwo anonymised questionnaire surveys were emailed to all Foundation Year Trainees, Core Psychiatry Trainees and General Practice Speciality Trainees working in BSMHFT, in December 2019 and March 2020, using trust survey monkey.ResultThe overall response to survey was 60 percent. 44.44 percent of the responses came from Core Psychiatry Trainees, with 27.78 percent responses each from Foundation Year Trainees and GP Speciality Trainees. Local induction was defined as induction specific to place of work (47.06%), trust based induction (41.18%) or all of the above options (11.76%) by trainees. 83.33% of all trainees had received local induction, whereas 16.67% did not have any local induction at the start of their post. 11.12% trainees were very satisfied and 44.44% were satisfied with local induction. 72.22 percent of the trainees were informed about of the local induction, prior to starting the post.33.3% trainees had a paper version, 22.22% had an electronic version of local induction pack, whereas 44.44% had no induction pack. 55.55% of those trainees who had an induction pack, 43.75% found it very helpful and 56.25% did not find it helpful.88.89% thought having a local induction would be helpful, whereas 11.11 percent did not feel it would help. 94.44% of the trainees completed a local orientation checklist with their consultants. Some of the trainees experienced difficulty in gaining access to electronic prescribing, electronic patient record system (RIO), and identity badges (ID) at the beginning of their post.Conclusion11.12% trainees were very satisfied, 44.44% were satisfied, 22.22 % were neither satisfied nor dissatisfied and 22 % were dissatisfied, with local induction. 88.89% of the trainees thought having a local induction pack would be helpful. Based on the trainees identified needs we developed a template for local induction pack for each post. Clinical supervisors have agreed to take the lead in preparing the local induction pack specific to their post with trainees.We aim to repeat the survey after implementing the changes identified by trainees based on their training needs.

Stewardship in the primary care and long-term care settings

2016 ◽  
Author(s):  
Naomi Fleming
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Diagnostic Tools ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Term Care ◽  
Care Facilities ◽  
Tract Infections

This chapter focuses on stewardship in the primary care and long-term care settings. Antibiotic prescribing in the community accounts for 80% total antibiotic prescribing and approximately 75% of this is for acute respiratory tract infections, many of which are viral. There is also significant variation in prescribing practices that is not explained by differences in presenting patients. These factors suggest that antimicrobial stewardship programmes are necessary. This chapter identifies the components of stewardship that have been successful in influencing antibiotic prescribing in primary care and shares local experiences with practical examples. The lack of UK evidence about antimicrobial stewardship in long-term care facilities is discussed, along with successful interventions from overseas. Challenges within these settings are highlighted, including patient demand, lack of access to microbiological and diagnostic tools, competing targets, time pressures, and clinical uncertainty.

AN AUDIT OF THE PAEDIATRIC EMPIRIC ANTI-INFECTIVE GUIDELINES AND ANTI-INFECTIVE DRUG DOSE TABLE FOR CHILDREN

2016 ◽  
Vol 101 (9) ◽  
pp. e2.7-e2
Author(s):  
Sanna Zaffar ◽  
Penny Fletcher
Keyword(s):  
Data Collection ◽  
Antibiotic Stewardship ◽  
Compulsory Education ◽  
Marrow Transplant ◽  
Drug Dose ◽  
Empirical Treatment ◽  
Electronic Prescribing ◽  
Junior Doctors ◽  
Duration Of Treatment ◽  
Treatment Review

AimTo assess compliance with paediatric empiric anti-infective guidelines and anti-infective drug dose table for children.MethodData collection was carried out on the paediatric wards.Exclusions▸ Bone marrow transplant patients (BMT).▸ Patients not on empirical anti-infective treatmentData were collected prospectively between January and 30 February 2015. A data collection form was completed and data analysed using Excel.Standards(1) 90% adherence to the paediatric guidelines for empirical anti-infectives treatment(2) 90% prescriptions have the indication recorded in either the drug charts or notes(3) 90% prescriptions have duration recorded of treatment/review date on drug chart or medical notes(4) 95% initial doses should adhere to the anti-infective drug dose table for childrenResultsData were collected from 50 patients; eight were subsequently excluded as they were not on empirical treatment or were prescribed antibiotics started prior to admission giving a final sample for analysis of 42.40/41 prescriptions (98%) adhered to the paediatric guidelines for the empirical treatment prescribed. 1 of 41 prescriptions (2.4%) did not. Exclusion criteria: One indication was not within guidelines (‘abscess’).40/42 prescriptions (95%) stated the indication for the anti-infective. 2 (5%) required prompting from the pharmacist. 14 out of 42 (33%) had the indication documented in the notes and 28 (67%) on the drug chart.26/42 prescriptions (62%) had a record of the duration of treatment/review date on the drug chart/notes. Of the 26 prescriptions with a recorded duration of treatment, 2 (8%) were found in the notes and 24 (92%) were found in the drug chart.67/69 (97%) of the initial doses adhered to the anti-infective drug dose table for children. 2 out of 69 (3%) did not.ConclusionsStandard 1 passed, this shows an improvement from the last audit of the guidelines in 2013 (of 72% adherence). In one case the indication of the antibiotic was not within the guidelines, which should be amended.Standard 2 passed—However, most of the indications were found in the notes, with clear documentation space on the drug chart it would be useful to have the indication in the drug chart. There has been a significant improvement from the previous audit carried out (from 16%).Standard 3 did not meet the adherence requirement expected. However, there has been an improvement from 14% from last year.Standard 4 (not been previously audited) suggests that the drug dosing table is also clear in providing guidance. Two data were excluded from the overall data as cefuroxime and rifampicin are not in the guidelines.Overall, the main need for improvement is having the duration of treatment documented. To achieve improvement in all standards would require:▸ Presenting the results to the antibiotic stewardship and pharmacy team.▸ Implementing an electronic prescribing system which prompts for completion of essential fields.▸ Updating and renewing the antibiotic Smart-phone App.▸ Compulsory education sessions for the junior doctors by the antibiotic stewardship team.

HOW WELL DO OUTPATIENT PRESCRIPTIONS ADHERE TO GOOD ANTIMICROBIAL STEWARDSHIP?

2016 ◽  
Vol 101 (9) ◽  
pp. e2.39-e2 ◽  
Author(s):  
Hirminder Ubhi ◽  
Mitul Patel ◽  
Lisa Ludwig
Keyword(s):  
Antimicrobial Stewardship ◽  
Oral Route ◽  
Outpatient Setting ◽  
Route Of Administration ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Duration Of Treatment ◽  
Microsoft Excel ◽  
Duration Of Therapy ◽  
Prescribing Practice

AimAims of the study included evaluation of outpatient antibiotic prescribing practices relating to good Antimicrobial Stewardship1 focusing on documentation of indication and duration.MethodPrescriptions dispensed at the Outpatient Pharmacy over a 6 week were evaluated. Data collected include patient's hospital identification in full, the antibiotic prescribed, duration of treatment, indication (in a specifically allocated area on the prescription) and route of administration, prescriber speciality and grade. Data were entered onto Microsoft Excel and reviewed by a committee that included a medical microbiologist and antimicrobial pharmacist.ResultsFive hundred and six antimicrobial prescriptions were reviewed. Therapeutic antibiotics accounted for 484/506 (95.6%) and the remaining 22/506 (4.4%) were prophylactic therapy. Indications were documented in 186/506 (36.8%) cases and 465/506 (91.9%) documented duration of therapy. By speciality, adherence with indication and duration, respectively, for oral medication, were as follows: Haematology 2/55 (3.6%) and 12/55 (21.8%), General paediatrics 26/42 (61.9%) and 41/42 (97.6%), Oncology 4/37 (10.8%) and 34/37 (91.9%), Dermatology 12/35 (34.3%) and 35/35 (100%), Nephrology 24/30 (80%) and 30/30 (100%), Ear Nose and Throat (ENT) 9/31 (29%) and 31/31 (100%). Oral route of administration was the most frequently prescribed 391/506 (77.3%), with topical and eye/ear drops prescribed in 63/506 (12.4%) and 50/506 (9.9%) respectively. Nebulised therapy accounted for only 2/506 (0.4%) prescriptions. Most commonly prescribed antibiotics were Co-amoxiclav 83/391 (21.2%), Flucloxacillin 50/391 (12.8%), Penicillin 35/391 (9.0%), Azithromycin 27/391 (6.9%) and Trimethoprim 26/391 (6.6%). Adherence to antibiotic guidelines was seen to be appropriate with 496/506 (98%).From the ten prescriptions that did not adhere, Azithromycin accounted for 8/10 (80%) with 50% of these used for prophylaxis, with lack of clear documentation.ConclusionA designated area on the Outpatient Pharmacy prescription for indication and duration can aid better Antimicrobial Stewardship. Duration of therapy was better documented than indication, however it is postulated that this was to ensure adequate supply on outpatient dispensing and not always through following good antimicrobial prescribing practice. On the whole, the most commonly prescribed antibiotics were predominantly prescribed by the specialities within the antibiotic guidelines. Azithromycin, which is restricted to respiratory team, was prescribed outside of the policy by other specialties. This study helped prioritise which specialities require further input to improve adherence with Antimicrobial Stewardship in the outpatient setting. As dermatology and ENT had 100% compliance with specifying duration, we are now reviewing their prescribing education which can be used to enhance the practice of the other specialities.

scholarly journals Increasing the documentation of 48-hour antimicrobial reviews

2020 ◽  
Vol 9 (1) ◽  
pp. e000805
Author(s):  
Ramandeep Singh Sahota ◽  
Kiran Kasper Rajan ◽  
Jonathan Mark Sabine Comont ◽  
Hyungeun Hans Lee ◽  
Nikolina Johnston ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Medical Students ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Quality Improvement Project ◽  
Junior Doctors ◽  
Healthcare Team ◽  
Negative Consequences ◽  
Improvement Project

Antimicrobial resistance is a growing problem worldwide. Encouraging antimicrobial stewardship can help to reduce the negative consequences of inappropriate antibiotic use. This quality improvement project targets to do this by aiming to improve the proportion of 48-hour antimicrobial reviews completed and documented on two surgical wards at Darent Valley Hospital with a goal of 100% compliance.This project used four PDSA (plan, do, study, act) cycles to achieve our aim: a trust-wide email; education sessions with junior doctors; sticker reminders in patient notes; presenting our study to surgical consultants and displaying posters on the wards.The proportion of antimicrobial reviews completed at 48 hours in the patient notes increased from 18% to 77% over 19 weeks from 10 October 2018 to 20 February 2019. The most successful intervention was providing a presentation for consultants at an audit meeting in conjunction with displaying posters on the wards.The most successful interventions (education sessions with junior doctors and presentation to surgical consultants alongside displaying posters on the wards) were found to be those that required minimal further input after their initial rollout. This project was carried out by medical students and is highly transferrable to other hospitals, and highlighted that a successful quality improvement project can be undertaken by any member of the healthcare team.

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