| Popis: |
Aims Medically stable patients, who received 1 dose of IV antibiotic, are currently being discharged from our institution and ‘ambulated’ with an IV cannulato return for daily antibiotics until culture results become available. Our aims were trying to create a leaner ambulating system using current evidence-based recommendations on timing of antibiotic switch from IV to PO and to achieve time and cost savings for staff and patients. Methods Ambulating patient lists from September 2017 to August 2018 were retrospectively looked at. Our inclusion criteria were: chase blood culture, if negative then change to oral chase blood culture, if negative then stop Data was analysed and assessed using crew resource management techniques, a safety tool developed by NASA. Results 1847 ambulating events were looked at. 24.7% fulfilled our inclusion criteria. Average stay for an intravenous ‘push’ was 50 min, excluding time from the car park or bus station. Patients returned to the ward on average twice. Due to no community nursing and daycare unit cover during weekends, this is when the majority of patients presented. Nursing staff on weekends tends to be reduced, increasing the relative workload. Almost 90% of patients, who were switched to PO once cultures were negative, could have been switched to PO on discharge. 100% of newborns fell into the ‘if negative then stop’ category and were unable to switch. Most common presentations, which could have been switched on discharge were cellulitis, community-acquired pneumonia and ‘? septic’ children, who were well enough not to require admission. It was difficult to quantify how many patients required re-cannulation or experienced cannulation complications using the handover lists as the only source of clinical information. 1 patient, who fulfilled criteria for switching required re-admission due to inability to tolerate PO antibiotics. No ambulating patient required re-admission due to clinical deterioration. Conclusion Using current evidence-based recommendations on switching antibiotics from IV to PO in combination with bioavailability data for the most common antibiotics in our patients would easily achieve significant time and financial savings for parents and the NHS. Freeing up nursing and medical staff to look after inpatients can only be beneficial for better patient care. NASA’s crew resource management techniques are a useful alternative to the commonly used SMART goal approach for QIPs. |
