Antimicrobial Care Bundle The journey so far Julie
Antimicrobial Care Bundle The journey so far. . . . Julie Harris, Antimicrobial Pharmacist
Acknowledgements to UHW Antimicrobial Stickers (Feb 2011)
Clear indication for antimicrobial(s) on medication chart Documentation of stop or review date on medication chart Consistency with Health Board guidelines Documentation of allergy status on medication chart Use of antimicrobial sticker(s) Antimicrobial Care Bundle – July 2011
Conducted by ward pharmacists Check compliance to each element of the care bundle All acute wards within ABMU audited Data analysed, monthly report produced and circulated Monthly ‘spot check’ audits – July 2011
The first month’s results
Extra paperwork Problems locating stickers on ward A lot of detail required Takes up two sections on medication Difficult to attach to correct place on medication chart Reluctance of prescribers Feedback chart
New Sticker- July 2012
Chaired Director Meets by the Chief Executive / Nurse Monthly Directorates report quarterly ◦ HCAI infection rates ◦ Care bundle compliance ◦ Training compliance to the board Infection Prevention Board- April 2012
Sustained pressure on the directorates to improve compliance with the antimicrobial bundle Chief Executive tasking Clinical Directors within each directorate to improve results Raised profile of antimicrobial prescribing within the organisation The Result. . .
Sep-14 Jul-14 May-14 Mar-14 Jan-14 Nov-13 Sep-13 Jul-13 May-13 Mar-13 Jan-13 Nov-12 Sep-12 Jul-12 May-12 Mar-12 Jan-12 Nov-11 Sep-11 Jul-11 Perecentage of antimicrobial prescriptions Allergy status documented on medication chart 100 90 80 70 60 50 Allergy status documented 40 Target 30 20 10 0
Sep-14 Jul-14 May-14 Mar-14 Jan-14 Nov-13 Sep-13 Jul-13 May-13 Mar-13 Jan-13 Nov-12 Sep-12 Jul-12 May-12 Mar-12 Jan-12 Nov-11 Sep-11 Jul-11 Percentage of antimicrobial prescriptions Appropriate antimicrobial prescription 100 90 80 70 60 50 Appropriate antimicrobial prescription 40 Target 30 20 10 0
Outcome Measures?
Other problems. . .
Rx > 7 days
Capture additional ◦ Antibiotic ◦ Indication ◦ Route ◦ Day of therapy clinical information Automate the input of the data ◦ Form readers ◦ Link to fundamentals of care database Proposed changes
Focus on clinical aspects of ◦ High risk antibiotics ◦ Extended durations ◦ Surgical prophylaxis regimens prescribing Highlight areas to directorates that require detailed audit ◦ Each directorate is required to conduct a minimum of 2 antimicrobial-related audits a year New format report
Any Questions / Comments
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