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The 3-Day Antibiotic Bundle

The 3-Day Antibiotic Bundle. Shadi Botros Principal Clinical Pharmacist. S BAR. SITUATION: C.Diff outbreak in the Vascular Surgery ward. Health Secretary Nicola Sturgeon Statement to the Scottish Parliament Clostridium difficile outbreak: Ward 31 Ninewells Hospital November 12, 2009.

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The 3-Day Antibiotic Bundle

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  1. The 3-Day Antibiotic Bundle Shadi Botros Principal Clinical Pharmacist

  2. SBAR SITUATION: • C.Diff outbreak in the Vascular Surgery ward Health Secretary Nicola Sturgeon Statement to the Scottish Parliament Clostridium difficile outbreak: Ward 31 Ninewells Hospital November 12, 2009

  3. SBAR • BACKGROUND: • Risk of C.Diff directly influenced by antibiotic prescribing(1) • 30% reduction in CDAD • Updated Antibiotic policies currently in place 1) Bignardi GE. Risk factors for Clostridium difficile infection. J Hosp Infect. 1998 Sep;40(1):1-15.

  4. SBAR • ASSESMENT: • Snap shot audit of in-patient prescription charts on vascular surgery ward • Poor compliance with updated antibiotic policies

  5. SBAR • RECOMMENDATION: • Promote prudent antibiotic prescribing • Good compliance with updates antibiotic guidelines • Ensure shortest duration of IV antibiotics • Design, test and implement a 3 day antibiotic bundle • Use IHI improvement methodologies

  6. Test of change Reduce the risk of C.Diff Constant and sustained reduction in the number of new C.Diff cases Promote Prudent Prescribing • Improved compliance with Antibiotic policies • Ensuring optimum duration of therapy DATA Spread through the whole ward and constant auditing Engaging all members of the Multidisciplinary team in the process to ensure that it is NOT person-dependent Testing the reliability of the new antibiotic bundle (1, 3, 5 test) Testing the usability of the newly updated Antibiotic bundle

  7. RESULTS

  8. RESULTS

  9. RESULTS The 3 Day Antibiotic Bundle INDICATION : Start Date: Review Date: Action Taken on Review Check Microbiology Results Review Patient & Initial Diagnosis Consider IV to Oral Switch

  10. RESULTS Vascular Surgery (Ward 12)

  11. SPREAD • Locally(NHS Tayside) • Surgical wards (GI + Acute receiving unit) • Medical wards (mHDU + Respiratory) • Nationally(Scotland) • PVC bundle • National Hospital Rx • Internationally • Ireland • USA

  12. SUMMARY • Using the IHI improvement methodologies, we were able to successfully, • Design and implement a multi-disciplinary 3 day antibiotic bundle • Achieve reliable good compliance with our antibiotic policies that promote prudent antibiotic prescribing • Achieve our ultimate goal of reducing the risk of HAI and eliminating CDAD from our clinical environment

  13. Remember…. • Trying to improve patient safety has its ups and downs…….. • ........ but it’s a hell of a ride!

  14. QUESTIONS?

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