Pharmacist intervention improves the early administration ... · Pharmacist intervention improves...
Transcript of Pharmacist intervention improves the early administration ... · Pharmacist intervention improves...
Messina. A, Van den Bergh. D, Gokool. V, Vieira. L, Jenkinson. I, Singh. N, Jacobs. T
7 November 2015
Pharmacist intervention improves the
early administration of antimicrobials
across 33 private hospitals.
RESULTS
32,985 patients assessed for ‘hang time’ compliance of first doses of new antibiotic orders over 60 weeks
21,069 patients compliant.
Change in compliance improved from 41.2% pre-intervention week 1 (164/398) to 78.4% post
intervention week 60 (480/612) p<0.0001.
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CARE • DIGNITY • TRUTH • PARTICIPATION • PASSION
Understanding systems
Paul B. Batalden, MD, Professor of Pediatrics, of Community and Family Medicine
The Dartmouth Institute for Health Policy and Clinical Practice at The Dartmouth Medical School
“Every system is perfectly designed
to achieve exactly the results it gets”
Paul Batalden
“All improvement
needs a change
Not all change is
an improvement”
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CARE • DIGNITY • TRUTH • PARTICIPATION • PASSION
Quality defects
Time
40
20
0
Quality
improvement
Original zone of
quality control/ practice
New zone of
quality
control/practice
LESSONS LEARNED
Ddo
Sstudy
Pplan
Aact
Juran Trilogy:
RATIONALE FOR THE INTERVENTION
• Ensuring the timely administration of antimicrobials is critical in the management of patients with
infections.
• Mortality increases by 7.6% for every hour of delay in the administration of antimicrobial therapy in
patients with sepsis1.
• The time elapsed from the written antibiotic order to actual intravenous administration or ‘hang-time’
can often be several hours due to logistics within the hospital.
• Our purpose is to evaluate the change in compliance of administering antimicrobials within an hour of
prescription after implementation of a national antibiotic stewardship pharmacist-driven ‘hang-time’
process improvement protocol.
Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical
determinant of survival in human septic shock. Crit Care Med. 2006; 34:1589-96.
COMMON BARRIERS
• The following barriers are common reasons for the delay of antibiotic administration in South African
hospital settings:
o use of paper charts,
o delays in delivery of the prescription order to the pharmacy,
o delays in prescription chart assessment,
o processing time in pharmacy,
o delivery delays in the transportation of medication from the pharmacy to the wards and,
o routine fixed medicine dosing schedules
o reconstitution of IV antibiotics by nursing staff at the patient bed side.
• ‘Hang time’, referred to as the “golden hour” of antibiotic administration, is a fundamental process which
relies extensively on the involvement, collaboration and participation of all healthcare team members
including: doctors, pharmacists, nursing staff and hospital management.
• As a result, it provides a multi-disciplinary platform to augment the awareness required when initiating
and driving an antibiotic stewardship program in a hospital.
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HOSPITAL 1HANGTIME % COMPLIANCE (< 1 hour)
Start Date 2 April 2012
% compliance Median % Compliance
Early Adopters
Ddo
Sstudy
Pplan
Aact
Learning
session 2
Learning
session 1
PDSA
cycles
PDSA
cycles
Learning
session 3
intensive support
Breakthrough Series : QI methods – accelerating spread and impact
• Learn from each other so we can make a bigger impact faster
• Input of skills, tools and reflective learning
• Identify common challenges and opportunities that we can work on
together
• Motivate and support each other to succeed.
• Stretch the boundaries of what is possible
Accelerating change “together”:
Creating a learning network of hospitals
Best available
clinical evidence
and experience
plus local
relevance
Antibiotic ‘hang-time’ implementation tool kit for 33 hospitals
Building the
collaborative
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4 Week Baseline
for each hospital
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Implementing
and driving the
change
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Continued data
collection
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Collation of data
of all 33 hospitals
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• Nursing and
pharmacy
management
• Evidence and
rationale
• Standardised
measurement tool
• Launch date
• Allocated time to
collect hang-time
baseline
• Captured into
template
• Reviewed at each
hospital
• Submitted to
project leader
• Continued data
collection on
template
• Collated weekly at
hospitals and
feedback provided
to unit managers
• Submitted monthly
to project leader
• Project leader
collated all the
data from 33
hospitals
• Excluded some
data
• Small group
educational
sessions by
pharmacists
• Doctor
engagement
• Poster as reminder
• Time of prescribing
• Sharing solutions
Antimicrobial Stewardship with Pharmacist Intervention
Improves Timeliness of Antimicrobials
Across Thirty-three Hospitals in South Africa
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Netcare Group Weekly Run Chart: Percentage of patients compliant to Hang Time <1 Hr (n=33)
% Compliance to Hang Time <1 Hr Median: % Compliance to Hang Time <1Hr
CONCLUSION
• Timely administration of antimicrobials should be
considered a low-hanging fruit component of AMS.
• Pharmacy led inter-disciplinary engagement between
doctors and nurses to strengthen the importance of
early administration of antimicrobials to improve patient
care.
• Structure and rigor of data allows real time feedback of
data to front line staff is a key strategy to get sustained
buy-in.
• Sharing knowledge and value of collective learning.
Dispel myth of low resource
• Making a greater impact together
• Extending our work to record and publish for others to
adapt or adopt