scholarly journals Paediatric Common Infections Pathways: improving antimicrobial stewardship and promoting ambulation for children presenting with common infections to hospitals in the UK and Ireland

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Carolyne Horner ◽  
Robert Cunney ◽  
Alicia Demirjian ◽  
Conor Doherty ◽  
Helen Green ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Good Practice ◽  
Severe Infection ◽  
Pleural Empyema ◽  
Peritonsillar Abscess ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Infection Pathways ◽  
Diagnostic Approaches ◽  
The Uk ◽  
Common Infections

AbstractPaediatric common infection pathways have been developed in collaboration between the BSAC and national paediatric groups, addressing the management of cellulitis, lymphadenitis/lymph node abscess, pneumonia/pleural empyema, pyelonephritis, tonsillitis/peritonsillar abscess, otitis media/mastoiditis, pre-septal/post-septal (orbital) cellulitis, and meningitis. Guidance for the management of a child presenting with a petechial/purpuric rash and the infant under 3 months of age with fever is also provided. The aim of these pathways is to support the delivery of high-quality infection management in children presenting to a hospital. The pathways focus on diagnostic approaches, including the recognition of red flags suggesting complex or severe infection requiring urgent intervention, approaches to antimicrobial stewardship (AMS) principles and guidance on safe and timely ambulation aligned with good practice of outpatient parenteral antimicrobial therapy (OPAT).

scholarly journals Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Ann L N Chapman ◽  
Sanjay Patel ◽  
Carolyne Horner ◽  
Helen Green ◽  
Achyut Guleri ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Therapy ◽  
Good Practice ◽  
Service Evaluation ◽  
Consultation Process ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Practice Recommendations ◽  
Extensive Consultation ◽  
Adults And Children ◽  
The Uk

AbstractUK good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) were published in 2012 and 2015 for adult and paediatric patients, respectively. Here we update the initial good practice recommendations in a combined document based on a further review of the OPAT literature and an extensive consultation process. As with the previous good practice recommendations, these updated recommendations are intended to provide pragmatic guidance for new and established OPAT services across a range of settings and to act as a set of quality indicators for service evaluation and quality improvement.

scholarly journals Outpatient parenteral antimicrobial therapy: updated recommendations from the UK

2019 ◽  
Vol 74 (11) ◽  
pp. 3125-3127 ◽  
Author(s):  
Ann L N Chapman ◽  
Sanjay Patel ◽  
Carolyne Horner ◽  
Mark Gilchrist ◽  
R Andrew Seaton
Keyword(s):  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Good Practice ◽  
Intravenous Therapy ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Stakeholder Consultation ◽  
Practice Recommendations ◽  
Recent Developments ◽  
Adults And Children ◽  
The Uk

Abstract Outpatient parenteral antimicrobial therapy (OPAT) offers safe, effective and patient-centred care for adults and children. The OPAT UK good practice recommendations for adults and children have recently been updated through a process of literature review, expert consensus and extensive stakeholder consultation. Here we discuss the key changes in the updated recommendations in the context of recent developments, including novel antimicrobial agents and delivery devices, the place of oral antimicrobials as an alternative to intravenous therapy, new OPAT service models and the broader antimicrobial stewardship agenda.

scholarly journals Improving paediatric antimicrobial stewardship in hospital-based settings: why, where and how?

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
E Tanner ◽  
A P S Munro ◽  
J Gray ◽  
H Green ◽  
M Rutter ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Significant Proportion ◽  
Cost Savings ◽  
Healthcare Organizations ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Antibiotic Management ◽  
Short Courses ◽  
The Impact ◽  
Common Infections

Abstract Background Antimicrobial resistance (AMR) is being recognized as a priority by healthcare organizations across the world. However, many children are managed on IV antimicrobials in hospital with very little consideration of antimicrobial stewardship issues. Objectives A nurse-led paediatric ambulatory outpatient parenteral antimicrobial therapy (OPAT) service, managing children with common infections being ambulated on short courses of IV antimicrobials, was introduced within Southampton Children’s Hospital in January 2018. We evaluated the impact of this service in terms of the quality of antimicrobial prescribing and timing of ambulation in children presenting with common infections. Methods All cases managed within the service were reviewed in two separate 2 month time periods: prior to introduction of the service (September–October 2016) and then prospectively after its introduction (September–October 2018). Results A total of 96% of IV antibiotic management decisions at 48 h were deemed appropriate in 2018, compared with 75% in 2016. A total of 64% of patients were ambulated on IV antibiotics at some point during their treatment course in 2018, compared with 19% in 2016. However, a significant proportion of antimicrobial decisions made at the point of presentation to hospital remained suboptimal in 2018. Conclusions Children are commonly managed with IV antibiotics in hospital. We demonstrate marked improvements in appropriate antimicrobial use through the introduction of a nurse-led ambulatory OPAT service. In addition, such a service can promote a greater proportion of children being ambulated from hospital, freeing up valuable inpatient beds and potentially delivering cost savings that can be used to fund such services.

scholarly journals A Delphi Study Investigating Clinicians’ Views on Access to, Delivery of, and Adaptations of MBCT in the UK Clinical Settings

Mindfulness ◽  
2021 ◽  
Author(s):  
Kate Williams ◽  
Samantha Hartley ◽  
Peter Taylor
Keyword(s):  
Delphi Study ◽  
Good Practice ◽  
Evidence Base ◽  
Clinical Settings ◽  
Training Support ◽  
Decision Making Processes ◽  
Complex Decision Making ◽  
Complex Decision ◽  
The Uk ◽  
Clinical Populations

Abstract Objectives Mindfulness-based cognitive therapy (MBCT) is a well-evidenced relapse-prevention intervention for depression with a growing evidence-base for use in other clinical populations. The UK initiatives have outlined plans for increasing access to MBCT in clinical settings, although evidence suggests that access remains limited. Given the increased popularity and access to MBCT, there may be deviations from the evidence-base and potential risks of harm. We aimed to understand what clinicians believe should be best clinical practice regarding access to, delivery of, and adaptations to MBCT. Methods We employed a two-stage Delphi methodology. First, to develop statements around best practices, we consulted five mindfulness-based experts and reviewed the literature. Second, a total of 59 statements were taken forward into three survey rating rounds. Results Twenty-nine clinicians completed round one, with 25 subsequently completing both rounds two and three. Forty-four statements reached consensus; 15 statements did not. Clinicians agreed with statements regarding sufficient preparation for accessing MBCT, adherence to the evidence-base and good practice guidelines, consideration of risks, sufficient access to training, support, and resources within services, and carefully considered adaptations. The consensus was not reached on statements which reflected a lack of evidence-base for specific clinical populations or the complex decision-making processes involved in delivering and making adaptations to MBCT. Conclusions Our findings highlight the delicate balance of maintaining a client-centred and transparent approach whilst adhering to the evidence-base in clinical decisions around access to, delivery of, and adaptations in MBCT and have important wide-reaching implications.

scholarly journals Antimicrobial Stewardship: Development and Pilot of an Organisational Peer-to-Peer Review Tool to Improve Service Provision in Line with National Guidance

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 44
Author(s):  
Olaolu Oloyede ◽  
Emma Cramp ◽  
Diane Ashiru-Oredope
Keyword(s):  
Public Health ◽  
Peer Review ◽  
Antimicrobial Stewardship ◽  
Service Provision ◽  
Good Practice ◽  
Survey Method ◽  
Global Public Health ◽  
Inappropriate Use ◽  
National Guidance ◽  
New Antibiotics

Antimicrobial resistance continues to be a considerable threat to global public health due to the persistent inappropriate use of antibiotics. Antimicrobial stewardship (AMS) programs are essential in reducing the growth and spread of antibiotic resistance, in an environment which lacks incentives for the development of new antibiotics. Over the years, a variety of resources have been developed to strengthen antimicrobial stewardship. However, the differences in resources available present a challenge for organisations/teams to establish the best resources to utilise for service provision. A peer review tool was formulated using four national documents on AMS and tested through three phases with feedback. A survey method was used to collect feedback on the validity, feasibility, and impact of the AMS peer review tool. Feedback received was positive from the earlier pilots. The tool was found to be useful at identifying areas of good practice and gaps in antimicrobial stewardship across various pilot sites. Feedback suggests the tool is useful for promoting improvements to AMS programs and highlights that the content and features of the tool are appropriate for evaluating stewardship.

scholarly journals Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 94
Author(s):  
Carolyn Tarrant ◽  
Andrew M. Colman ◽  
David R. Jenkins ◽  
Edmund Chattoe-Brown ◽  
Nelun Perera ◽  
...  
Keyword(s):  
South Africa ◽  
Sri Lanka ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Low Income ◽  
System Level ◽  
Comparative Approach ◽  
Structured Interviews ◽  
Public And Private ◽  
The Uk

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

scholarly journals Perceptions of Peer Support for Victim-Survivors of Sexual Violence and Abuse: An Exploratory Study With Key Stakeholders

2021 ◽  
pp. 088626052110079
Author(s):  
Alison Gregory ◽  
Emma Johnson ◽  
Gene Feder ◽  
John Campbell ◽  
Judit Konya ◽  
...  
Keyword(s):  
Sexual Violence ◽  
Peer Support ◽  
Service Provision ◽  
Exploratory Study ◽  
Good Practice ◽  
Medical Model ◽  
Service Improvement ◽  
Physical And Mental Health ◽  
Safety Considerations ◽  
The Uk

Experiences of sexual violence, childhood sexual abuse, and sexual assault are common across all societies. These experiences damage physical and mental health, coping ability, and relationships with others. Given the breadth and magnitude of impacts, it is imperative that there are effective, accessible services to support victim-survivors, ease suffering, and empower people to cope, recover and thrive. Service provision for this population in the United Kingdom is complex and has been hit substantially by austerity. Since positive social support can buffer against negative impacts, peer support may be an effective approach. The aim of this exploratory study was to capture the views and perspectives of professional stakeholders concerning service provision for victim-survivors, particularly perceptions of peer support. In-depth semistructured interviews were conducted in the UK during 2018 with six professional stakeholders, highly experienced in the field of service provision for victim-survivors of sexual violence and abuse. An abductive approach to analysis was used, applying principles from thematic analysis. Our sample comprised four females and two males, and their roles included psychiatrist, general practitioner, service improvement facilitator, and senior positions within victim-survivor organizations. Interviews highlighted models of peer support for this population, good practice and safety considerations, and a lack of uniformity regarding quality and governance standards across the sector. Findings indicated that current funding models impact negatively on victim-survivor services, and that provision is fragmented and insufficient across statutory and not-for-profit sectors. The influence of the medical model upon service provision was evident, which resulted in apprehension around support delivered in less-usual forms—including peer support. Further research is needed to explore the potential of peer support for victim-survivors of sexual violence and abuse.

scholarly journals An audit of UK audiological practice in specialist paediatric oncology centres regarding hearing assessment of children at risk of ototoxicity due to chemotherapy

2021 ◽  
Vol 135 (1) ◽  
pp. 14-20
Author(s):  
E C M Brown ◽  
C Caimino ◽  
C L Benton ◽  
D M Baguley
Keyword(s):  
High Frequency ◽  
Good Practice ◽  
Paediatric Oncology ◽  
Chemotherapy Drugs ◽  
Team Working ◽  
Platinum Based Chemotherapy ◽  
Hearing Assessment ◽  
Self Test ◽  
The Uk ◽  
Monitoring Service

AbstractObjectivePlatinum-based chemotherapy drugs are associated with substantial ototoxicity. The hearing of children treated with these drugs should be closely monitored.MethodA questionnaire was sent out to the 19 audiology departments associated with national paediatric cancer specialist centres in the UK looking at current practice in ototoxicity monitoring.ResultsResponses were received from 17 of 19 centres (89 per cent). All offered some form of audiometric monitoring service. Extended high-frequency testing (9–20 kHz) was only utilised by 7 services (29 per cent). A majority of respondents were reluctant to consider self-test devices in paediatric ototoxicity monitoring (n = 9; 53 per cent). Provision of long-term audiological follow up is sporadic with only 4 (23 per cent) respondents keeping all children with normal hearing under review once treatment is completed.ConclusionWhile some good practice in paediatric ototoxicity was identified, opportunities exist to improve clinical practice and protocols, promote multidisciplinary team working and to utilise technologies such as extended high frequency and self-test audiometry.

Peritonsillar abscess drainage: using oropharyngeal endoscopy as a therapeutic adjunct and training tool

2021 ◽  
Vol 135 (2) ◽  
pp. 176-178 ◽  
Author(s):  
A Sawhney ◽  
R Bidaye ◽  
A Khanna
Keyword(s):  
Peritonsillar Abscess ◽  
Therapeutic Procedure ◽  
Deep Tissue ◽  
Abscess Drainage ◽  
Incision And Drainage ◽  
Training Tool ◽  
Poor Access ◽  
The Uk ◽  
And Training ◽  
Poor Lighting

AbstractBackgroundPeritonsillar abscess, or quinsy, is one of the most common emergency presentations to ENT departments, and is the most common deep tissue infection of the head and neck. In the UK, junior members of the ENT team are regularly required to independently assess, diagnose and treat patients with peritonsillar aspiration or incision and drainage.IssueInexperienced practitioners can stumble at several obstacles: poor access due to trismus; poor lighting; difficulty in learning the therapeutic procedure; and difficulty in accurately documenting findings and treatment.SolutionTo counter these and other difficulties, the authors describe the routine use of video endoscopy as a training tool and therapeutic adjunct in the management of quinsy.

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