scholarly journals P035 Patient facing pharmacist reduces length of stay for paediatric short stay patients

2019 ◽  
Vol 104 (7) ◽  
pp. e2.40-e2 ◽  
Author(s):  
Joanne Crook ◽  
Ivan Lam
Keyword(s):  
Length Of Stay ◽  
Average Length ◽  
Working Hours ◽  
Ward Round ◽  
Electronic Prescribing ◽  
List Type ◽  
Short Stay ◽  
Patient Journey ◽  
Out Of Hours ◽  
Paediatric Hospital

AimTo reduce the average length of stay (LoS) of paediatric inpatients requiring discharge medication (TTO’s) on the short stay pathway (Comet).MethodsA paediatric multi-disciplinary team (MDT) used the model for improvement to identify stakeholders and key drivers for change. The Comet patient journey was mapped from A&E to discharge. Plan-Do-Study-Act (PDSA) cycles were used to reduce LoS, targeting the addition of a paediatric pharmacist to the morning ward round and use of over- label packs to facilitate nurse-led discharge for simple TTO’s required within 2 hours. Data was collected over a two week period in summer; PDSA 1 baseline data, one week prior to change; PDSA 2, one week after implementation. Baseline measurements included time taken to write, screen and dispense TTO and the average LoS. Data was collected via the electronic prescribing system (Lastword). Patients eligible for the Comet pathway were included for analysis. Results were analysed using Microsoft Excel. Ethics approval was not required for this study.ResultsPDSA one; 15 patients admitted onto the Comet pathway. 67% patients were admitted outside working hours. Six patients needed TTOs, 33% were written out of hours and all dispensed by pharmacy. Average time to writing TTO 14.6 hours (16minutes-44hhours); time to pharmacist clinical screen 19.4 hours (6 minutes – 21 hours); average time for pharmacy to dispense TTO after screening 2 hours (69–203 minutes); average LoS for all Comet patients 17.6 hours (8–44) and 26 hours (14–44) for those needing TTO’s. Post implementation 12 patients were eligible for the Comet pathway. 83% patients were admitted outside of hours. Six patients needed TTO’s, 16% were written out of hours and 33% were dispensed by the nursing team. Average time to writing TTO increased to 20.2 hours (14–26), average time to pharmacist clinical screen was reduced to 10 minutes (1–98) and average time for pharmacy to dispense TTO reduced to 57 minutes (47–74). Average LoS for Comet patients was similar to PDSA 1 at 17.7 hours (3–27) but reduced to 20.8 h0urs (5–27) for those needing TTO’s.ConclusionIncreasing patient-facing time of pharmacists to improve outcomes is recommended by the Carter report.(1)Pressures in emergency-care to free up beds for patients means we need to look for creative solutions. (2) This study found the addition of a paediatric pharmacist to the ward round increased efficiency of writing, screening and dispensing TTO’s - dramatically reducing time to screening TTO’s; and the average LoS by 5 hours. The pharmacist was aware of Comet discharges at the time of decision to discharge and was on hand to resolve medication related issues. New doctors in August could explain the increased time to writing TTO’s in the second week. Promotion of nurse-led discharge via over-label packs reduced the number of TTO’s sent to pharmacy. Limitations include2 weeks of data over summer were analysed and non-paediatric hospital activity would impact pharmacy dispensing time. Future work will test how pharmacist transcribing TTO’s on the ward round affect Los and to review pharmacist clinical interventions to assess impact on outcomes.ReferencesDepartment of Health. Carter report: Unwarranted variation: A review of operational productivity and performance in English NHS acute hospitals. 5thFebruary 2016.Royal College of Paediatrics and Child Health. Standards for Short-Stay Paediatric Assessment Units (SSPAU). March 2017.

scholarly journals Weekend new patient reviews in psychiatry: evaluation of activity over 3 months

2017 ◽  
Vol 41 (6) ◽  
pp. 337-340
Author(s):  
Michael Rutherford ◽  
Mark Potter
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Average Length ◽  
Clinical Implications ◽  
Out Of Hours ◽  
Feasible Method ◽  
Average Length Of Stay ◽  
South West ◽  
Before And After ◽  
The Mean

Aims and methodSouth West London and St George's Mental Health NHS Trust developed a system of weekend new patient reviews by higher trainees to provide senior medical input 7 days a week. To evaluate the effectiveness of these reviews, the notes for all patients admitted over 3 months were examined. The mean length of stay for patients before and after the introduction of the weekend new patient reviews were compared via unpaired t-test.ResultsA total of 88 patients were seen: 84.4% of patients were seen within 24 h of admission. Higher trainees instituted some changes in 78.9% of patients. The most frequent action was to modify medication, in 47.8%. The average length of stay after the introduction of weekend reviews was not significantly different.Clinical implicationsWeekend reviews of newly admitted patients by higher trainees is a feasible method for providing senior input to patients admitted out of hours.

scholarly journals Delirium – are we doing enough prevention and basic management in acute settings?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S112-S112
Author(s):  
Anna Watkins ◽  
Remy Flechais ◽  
Shah Tarfarosh
Keyword(s):  
Length Of Stay ◽  
Hearing Aids ◽  
Average Length ◽  
List Type ◽  
Electronic Patient Records ◽  
Visual Aids ◽  
University Hospitals ◽  
Management Options ◽  
Pharmacological Prevention ◽  
Dementia Patients

AimsTo identify the prevalence of delirium and/or dementia on complex medicine wards.To assess the use non-pharmacological prevention and management options in these patients.BackgroundDelirium, a common hospital syndrome, is often multi-factorial. So, the management needs not only treating a reversible cause but also minimising the factors that could increase the risk of developing delirium, or worsen its course.The Scottish-Intercollegiate-Guidelines-Network (SIGN) and National-Institute-for-Health-and-Care-Excellence (NICE) guidelines outline non-pharmacological factors to reduce the risk of developing delirium, and for its management once established.These factors include orientation, ensuring patients have their glasses and hearing aids, promoting sleep hygiene, maintaining optimal hydration and nutrition, early mobilisation, appropriate lighting and providing cognitively stimulating activities.MethodSIGN, NICE and local guidelines were used to develop a checklist of core non-pharmacological factors that minimise the risk of developing delirium and help in its management. Adherence to recommendations from these guidelines was thus evaluated in 4 Complex Medical Units of The John-Radcliffe Hospital (Oxford University Hospitals NHS Foundation Trust), cross sectionally. The data were collected by interviewing nursing staff on the wards, assessing the ward environment, reviewing nursing charts and electronic patient records.ResultThere were 57 patients aged >65 years across all four wards, with average percentages of delirium and dementia patients being 46% and 34%, respectively. Nurses were unsure about their patients having hearing or visual aids in 41% and 29%, respectively. On all four wards there was no clear signage, no digital clock, no calendar, and earplugs were not offered. Overall, the use of non-pharmacological recommendations was sub-optimal across a number of items. After a month, when the notes were reviewed, it was found that 18 out of those 57 patients had passed away (32%) and the average length of stay for delirium/dementia patients was way more than the other patients during that admission.ConclusionWe found high rates of delirium and dementia and a lack of consistent use of recommended non-pharmacological strategies for their management. Better adherence to these could help shorten length of stay and improve patient outcomes.Recommendations for patients with/at risk of delirium: –Bedside board for each patient with the name of the ward/hospital, picture of the named nurse.–Ensuring visible clock/calendar.–Non-pharmacological delirium management checklist to be added to the daily nursing notes.Emphasis on visual/hearing aids and daily reorientation. –Appropriate lighting in the bays.–Offer earplugs if not sleeping at night.

scholarly journals P19 Direct observational study of infusion errors associated with smart-pump technology in paediatric intensive care

2020 ◽  
Vol 105 (9) ◽  
pp. e15.2-e16
Author(s):  
Moninne Howlett ◽  
Erika Brereton ◽  
Cormac Breatnach ◽  
Brian Cleary
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
The United States ◽  
Error Rates ◽  
Paediatric Intensive Care ◽  
Electronic Prescribing ◽  
List Type ◽  
Paediatric Hospital ◽  
Smart Pumps ◽  
Smart Pump

AimsProcesses for delivery of high-risk infusions in paediatric intensive care units (PICUs) are complex. Standard concentration infusions (SCIs), smart-pumps and electronic prescribing are recommended medication error reduction strategies.1 2 Implementation rates are low in Irish and UK hospitals.2 3 Since 2012, the PICU of an Irish tertiary paediatric hospital has been using a smart-pump SCI library, interfaced with electronic infusion orders (Philips ICCA®). The incidence of infusion errors is unknown. This study aims to determine the frequency, severity and distribution of smart-pump infusion errors and to identify contributory factors to the occurrence of infusion errors.MethodsProgrammed infusions are directly observed at the bedside. Parameters are compared against medication orders and auto-populated infusion data. Identified deviations are categorised as either medication errors or discrepancies. Five opportunities for error (OEs) were identified: programming, administration, documentation, assignment, data transfer. Error rates (%) are calculated as: infusions with errors; and errors per OE. Pre-defined definitions, multi-disciplinary consensus and grading processes are employed.ResultsA total of 1023 infusions for 175 patients were directly observed on 27 days between February and September 2017. 74% of patients were under 1 year, 32% under 1 month. The drug-library accommodated 96.5% of all infusions. Compliance with the drug-library was 98.9%. 55 infusions had ≥ 1 error (5.4%); a further 67 (6.3%) had ≥ 1 discrepancy. From a total of 4997 OEs, 72 errors (1.4%) and 107 discrepancies (2.1%) were observed. Documentation errors were most common; programming errors were rare (0.32% OE). Errors are minor, with just one requiring minimal intervention to prevent harm.ConclusionThis study has highlighted the benefits of smart-pumps and auto-populated infusion data in the PICU setting. Identified error rates are low compared to similar studies.4 The findings will contribute to the limited existing knowledge base on impact of these interventions on paediatric infusion administration errors.ReferencesInstitute for Safe Medication Practices, ISMP. 2018–2019 Targeted medication safety best practices for hospitals2018 [Available from: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitalsv2.pdf [Accessed: June 2019]Oskarsdottir T, Harris D, Sutherland A, et al. A national scoping survey of standard infusions in paediatric and neonatal intensive care units in the United Kingdom. J Pharm Pharmacol 2018;70:1324–1331.Howlett M, Curtin M, Doherty D, Gleeson P, Sheerin M, Breatnach C. Paediatric standardised concentration infusions – A national solution. Arch Dis Child. 2016;101:e2.Blandford A, Dykes PC, Franklin BD, et al. Intravenous Infusion Administration: A comparative study of practices and errors between the United States and England and their Implications for patient safety. Drug Saf. 2019;42:1157–1165

Is a Diagnosis-Based Classification System Appropriate for Funding Psychiatric Care in Alberta?

1995 ◽  
Vol 40 (9) ◽  
pp. 507-513 ◽  
Author(s):  
Chantelle M Wellock
Keyword(s):  
Length Of Stay ◽  
Classification System ◽  
Negative Impact ◽  
Average Length ◽  
The United States ◽  
Classification Systems ◽  
Short Stay ◽  
Average Length Of Stay ◽  
Variation Explained ◽  
Better Than

Objective This study evaluated the appropriateness of the Refined Group Number (RGN) classification system for funding psychiatric discharges in Alberta. Method Multiple regression was used to calculate the amount of variation explained (R2) in length of stay by RGNs for psychiatric discharges. The distribution of short-stay cases (less than 5 days) was also reviewed. Results The R2 value was higher than those from American studies (0.284 versus less than 0.10) for psychiatric discharges. The length of stay distribution by RGN indicated that the mean was not representative of typical cases. Short-stay cases made up the majority of cases from rural hospitals and had a negative impact on the average length of stay. Conclusions The RGN methodology performed better than diagnosis-based classification systems in the United States. However, there were significant weaknesses in the classification system which suggest that a funding system using the RGN grouper would result in inequitable funding for psychiatric discharges.

P32 Pre-go-live simulation testing of new electronic prescribing systems in a specialist paediatric hospital

2018 ◽  
Vol 103 (2) ◽  
pp. e2.36-e2
Author(s):  
Nazurah Liyana Rajudin ◽  
Kirollos Sourour ◽  
Chi Huynh ◽  
Anthony Sinclair ◽  
David Terry
Keyword(s):  
Hospital Setting ◽  
Clinical Decision ◽  
Electronic Prescribing ◽  
List Type ◽  
Cross Sectional ◽  
Support Tool ◽  
Paediatric Hospital ◽  
System A ◽  
Drug Regimens ◽  
Simulation Testing

AimSingle-site cross-sectional evaluation of a specialist paediatric hospital electronic clinical systems designed to support the medication process. This included simulation testing and evaluation of three electronic systems: PICS an electronic prescribing system designed in an adult hospital and being adapted for paediatric use; BDD an in-development electronic drug dictionary database that will serve as a clinical decision support tool; and Ascribe the existing pharmacy dispensing and management system (used to provide target levels). Simulation testing is used to assess the utility of the systems in the local (paediatric hospital) setting and gauge readiness for use in the live environment.MethodsUnique drug regimens from consecutive hand written outpatient pharmacy prescriptions and the hepatology ward paper drug charts were harvested and used as the simulation test. Each regimen was therefore in current use at the study site. The test prescriptions were used to identify each systems’ ability to accommodate that regimen, such that:PICS (electronic prescribing system) – can the regimens be prescribed on PICS?BDD (drug dosing database) – are these regimens held within the database?Ascribe (hospital pharmacy system) – can the regimens be recorded on Ascribe to facilitate medication supply?The system tests were undertaken in early July 2015 following suitable training on how to use each of the three systems. Trained researchers attempted to enter the regimens into PICs and Ascribe; and to identify if the regimens were available within the BDD database.Approval was granted by the study site, and Aston University Ethics Committee.ResultsOutpatients (89 unique regimens)PICS: 74% (66/89) of drug regimens could be completely reproduced electronically, with 34% (30/89) matching default dosing regimens.BDD: 40% (36/89) of drug regimens were found in the database (drug name, indication, route and dose in relation to the age of patient)Ascribe: 77.5% (69/89) of drug regimens were reproducible and had labelling templates that existed on the system, a further 17% (15/89) drug regimens were available but required some amendment to existing templates.Hepatology ward – (126 unique regimens)PICS: 71% (90/126) could be prescribed as written on the drug charts.BDD: 58% (73/126) of drug regimens were found in the database (drug name, route and dose in relation to the age of patient)Ascribe: 94% (118/126) of drug regimens were reproducible and had labelling templates that existed on the ascribe system, a further 18% (23/126) drug regimens were available but required some amendment to existing templates.ConclusionOverall, at the time of testing, the electronic prescribing system (PICS) could accommodate approximately 72% of drug regimens, the BDD database could accommodate approximately 51% – compared to the Ascribe (target figure) of 87%. The findings suggest that further work is required to ensure the systems in development (PICS and BDD) are ready for use.

Extrakorporális és intrakorporális anasztomózis rövid távú eredményeinek összehasonlítása malignus daganat miatt végzett laparoszkópos jobb oldali hemikolektómia esetén

2020 ◽  
Vol 73 (4) ◽  
pp. 148-152
Author(s):  
Kornél Vajda ◽  
László Sikorszki
Keyword(s):  
Length Of Stay ◽  
Gold Standard ◽  
Average Length ◽  
Colon Surgery ◽  
Right Hemicolectomy ◽  
Malignant Tumours ◽  
Short Term ◽  
Significant Difference ◽  
Laparoscopic Assisted ◽  
Laparoscopic Hemicolectomy

Összefoglaló. Bevezetés: A laparoszkópia térhódítása a jobb oldali colon műtéteknél is nyilvánvaló. Ma legtöbb helyen a laparoszkóposan asszisztált jobb oldali hemikolektómia extrakorporális anasztomózissal a gold standard. A morbiditás randomizált vizsgálatok alapján még 30% körüli. A technikai fejlődés lehetővé tette az intrakorporális anasztomózist. Célkitűzés: Retrospektív módon elemezni rosszindulatú jobb oldali vastagbéldaganat miatt végzett laparoszkópos hemikolektómiák rövid távú eredményeit a két módszer összehasonlításával. Eredmények: 2018. 01. 01. – 2019. 12. 31. között 184 jobb oldali hemikolektómiát végeztünk, ezek közül 122 történt malignus betegség miatt. 51 esetben nyitott és 71 esetben laparoszkópos műtét történt. 37 férfi (átlagéletkor: 70,59 év) és 34 nő (átlagéletkor: 72,14 év) volt. 50 esetben extrakorporális (EA) és 21 esetben pedig intrakorporális anasztomózist (IA) végeztünk. Az EA csoportban 18, míg az IA csoportban 3 szövődmény alakult ki 30 napon belül (p = 0,067). Az EA csoportból 3, az IA csoportból 1 beteget veszítettünk el 30 napon belül (p = 0,66). Az átlagos ápolási idő az EA csoportban 9,48 (5–32) nap, míg az IA csoportban 6,52 (4–19) nap volt (p = 0,001) a szövődményes esetekkel együtt. A szövődményes esetek nélkül az EA csoportban 6,35 (5–10) nap, az IA csoportban pedig 5,55 (4–8) napnak bizonyult (p = 0,09). A műtéti idő pedig az EA csoportban 147 (90–240) perc, az IA csoportban pedig 146,47 (90–265) perc volt (p = 0,11). Konklúzió: Az irodalommal összhangban azt találtuk, hogy IA esetén kevesebb a szövődmény, ezzel is összefüggésben rövidebb az átlagos ápolási idő, és a műtéti időt tekintve nincs szignifikáns különbség. Ezeket figyelembe véve az intrakorporális anasztomózis javasolható jobb oldali laparoszkópos hemikolektómia esetén. Summary. Introduction: Laparoscopy became evident for right-sided colon surgery too. Today the laparoscopic-assisted right-hemicolectomy is the gold standard with extracorporeal anastomosis. Morbidity according to randomized trials is still approximately 30%. The development of the surgical technique resulted in the creation of intracorporeal anastomosis. Our aim was to compare the short-term results of the two methods. Aim: To analyse the short-term results of right-sided hemicolectomy that were performed due to malignant tumours with the comparison of the two methods. Results: A cohort of 184 right-sided hemicolectomy were performed from 01.01.2018 to 31.12.2019 from which 122 were operated on because of a malignant disease. 51 open and 71 laparoscopic operations were performed. The average age of 37 men and 34 women were 70.59 and 72.14 years, respectively. 50 patients underwent extracorporeal (EA) anastomosis and 21 intracorporeal (IA) anastomosis. Within 30 days the number of complications were 18 in the EA group and 3 in the IA group (p = 0.067). 3 from the EA group and 1 from IA group died within 30 days (p = 0.66). The average length of stay were 9.48 days in the EA group and 6.52 days in the IA group together with the complicated cases (p = 0.001) while 6.35 days and 5.55 days without the complicated cases (p = 0.09). The average duration of operation was 147 minutes in the EA and 146.47 minutes in the IA group (p = 0.11). Conclusion: We found concordance with the literature that there are fewer complications in case of IA which might be related to shorter length of stay. There is no significant difference between the surgical times. Bearing these facts in mind, IA might be suggested for right- sided laparoscopic hemicolectomy.

scholarly journals P044 Can an electronic prescribing system ensure clear anticoagulation discharge communication?

2019 ◽  
Vol 104 (7) ◽  
pp. e2.49-e2
Author(s):  
Susie Gage
Keyword(s):  
Patient Safety ◽  
Discharge Summary ◽  
Electronic Prescribing ◽  
List Type ◽  
Heparin Infusion ◽  
National Patient Safety Agency ◽  
High Dependency ◽  
National Patient ◽  
Discharge Summaries

AimThe National Patient Safety Agency (NPSA)1 identified heparin as a major cause of adverse events associated with adverse incidents, including some fatalities. By ensuring good communication, this should be associated with risk reduction.1 The aim of this study was to ensure there is clear anticoagulation communication on discharge, from the paediatric intensive care unit (PICU) electronic prescribing system (Philips), to the paediatric cardiac high dependency unit and paediatric cardiac ward. To investigate whether the heparin regimen complies with the hospital’s anticoagulant guidelines and if there is any deviation; that this is clearly documented. To find out if there is an indication documented for the heparin regimen chosen and if there is a clear long term plan documented for the patient, after heparin cessation.MethodsA report was generated for all patients who were prescribed a heparin infusion on PICU, between 1st January 2018 and 30th June 2018, from the Philips system. All discharge summaries from the PICU Philips system were reviewed. Only paediatric cardiac patients were included that had a heparin infusion prescribed on discharge, all other discharge summaries were excluded from the study. Each discharge summary was reviewed in the anticoagulant section; for the heparin regimen chosen, whether it complies with the hospital’s anticoagulant guidelines and if there was any deviation whether this was documented. The indication documented of which heparin regimen was chosen and whether a clear long term plan was documented after heparin cessation; for example if the patient is to be transferred onto aspirin, clopidogrel, warfarin or enoxaparin.Results82 discharge summaries were reviewed over the 6 month period between 1st January 2018 and 30th June 2018; 16 were excluded as were not paediatric cardiac, leaving 66 paediatric cardiac discharge summaries that were reviewed. 45 out of 66 (68%) complied with the hospital’s heparin anticoagulation guidelines. Of the 32% that deviated from the protocol; only 33% (7 out of 21) had a reason documented. Only 50% (33) of the summaries reviewed had an indication for anticoagulation noted on the discharge summary and 91% of discharge summaries had a long term anticoagulant plan documented.ConclusionThe electronic prescribing system can help to ensure a clear anticoagulation communication as shown by 91% of the anticoagulation long term plan being clearly documented; making it a more seamless patient transfer. On the Philips PICU electronic prescribing system there is an anticoagulant section on the discharge summary that has 3 boxes that need to be completed; heparin regimen, indication and anticoagulation long term plan. However, despite these boxes; deviations from the anticoagulant protocol were poorly documented as highlighted by only 33% having the reason highlighted in the discharge summary, only 50% of the indications were documented. Despite having prompts for this information on the discharge summary, the medical staffs needs to be aware to complete this information, in order to reduce potential medication errors and risk.ReferenceThe National Patient Safety Agency (NPSA). Actions that make anticoagulant therapy safer. NPSA; March 2007.

Fighting Childhood Pneumonia in Uganda

2017 ◽  
pp. 1-17
Author(s):  
Tim Calkins ◽  
Kara Palamountain ◽  
Aniruddha Chatterjee ◽  
Robert Frantz ◽  
Elizabeth Hart ◽  
...  
Keyword(s):  
Stakeholder Analysis ◽  
List Type ◽  
Patient Journey ◽  
Childhood Pneumonia ◽  
Pharmaceutical Manufacturers ◽  
The World ◽  
Women And Children ◽  
Potential Impact ◽  
Global Stakeholders ◽  
The U.S

It is January 2014, and the case protagonist, David Milestone (senior advisor at the Center for Accelerating Innovation and Impact at the U.S. Agency for International Development's Global Health Bureau), is preparing for a meeting of global stakeholders and pharmaceutical manufacturers who are interested in reducing mortality caused by childhood pneumonia and are prepared to donate $10 million to support this effort.Milestone's goal is to propose a strategy to address childhood pneumonia in Uganda, toward which the $10 million donation would go. In addition to effectively and sustainably reducing childhood pneumonia deaths, the plan must align the interests of various stakeholders behind the problem. A successful strategy in Uganda could be a model for interventions elsewhere. The United Nations Commission on Lifesaving Commodities for Women and Children recently identified Uganda as a “pathfinder” country, meaning it could serve as the example for other countries wrestling with the same issues. This is a remarkable opportunity to change the lives of children in Uganda—and all around the world.After reading and analyzing the case, students will be able to: Perform a stakeholder analysis Appreciate the challenges involved in improving public health, especially in developing countries Create a patient journey and use it to identify potential impact points

scholarly journals Colonization and Infection With MRSA and CRKP and Its Result in an Increased Mortality Rate Within the Intensive Care and High-Dependency Units in Barbados

2020 ◽  
Vol 41 (S1) ◽  
pp. s173-s174
Author(s):  
Keisha Gustave
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
High Mortality ◽  
Average Length ◽  
Cohort Analysis ◽  
Health Concern ◽  
Queen Elizabeth Hospital ◽  
Surveillance Program ◽  
Average Length Of Stay ◽  
High Dependency

Background: Methicillin-resistant Staphylococcus aureus(MRSA) and carbapenem-resistant Klebsiella pneumoniae (CRKP) are a growing public health concern in Barbados. Intensive care and critically ill patients are at a higher risk for MRSA and CRKP colonization and infection. MRSA and CRKP colonization and infection are associated with a high mortality and morbidly rate in the intensive care units (ICUs) and high-dependency units (HDUs). There is no concrete evidence in the literature regarding MRSA and CRKP colonization and infection in Barbados or the Caribbean. Objectives: We investigated the prevalence of MRSA and CRKP colonization and infection in the patients of the ICU and HDU units at the Queen Elizabeth Hospital from 2013 to 2017. Methods: We conducted a retrospective cohort analysis of patients admitted to the MICU, SICU, and HDU from January 2013 through December 2017. Data were collected as part of the surveillance program instituted by the IPC department. Admissions and weekly swabs for rectal, nasal, groin, and axilla were performed to screen for colonization with MRSA and CRKP. Follow-up was performed for positive cultures from sterile isolates, indicating infection. Positive MRSA and CRKP colonization or infection were identified, and patient notes were collected. Our exclusion criteria included patients with a of stay of <48 hours and patients with MRSA or CRKP before admission. Results: Of 3,641 of persons admitted 2,801 cases fit the study criteria. Overall, 161 (5.3%) were colonized or infected with MRSA alone, 215 (7.67%) were colonized or infected with CRKP alone, and 15 (0.53%) were colonized or infected with both MRSA and CRKP. In addition, 10 (66.6%) of patients colonized or infected with MRSA and CRKP died. Average length of stay of patients who died was 50 days. Conclusions: The results of this study demonstrate that MRSA and CRKP cocolonization and coinfection is associated with high mortality in patients within the ICU and HDU units. Patients admitted to the ICU and HDU with an average length of stay of 50 days are at a higher risk for cocolonization and coinfection with MRSA and CRKP. Stronger IPC measures must be implemented to reduce the spread and occurrence of MRSA and CRKP.Funding: NoneDisclosures: None

scholarly journals Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach

2021 ◽  
Vol 10 (1) ◽  
pp. e001120
Author(s):  
Brendan Joseph McMullan ◽  
Michelle Mahony ◽  
Lolita Java ◽  
Mona Mostaghim ◽  
Michael Plaister ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Audit And Feedback ◽  
Hospital Length Of Stay ◽  
Oral Antibiotic ◽  
Intravenous Therapy ◽  
Paediatric Hospital ◽  
Inpatient Settings ◽  
Surgical Teams

Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.

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