44 / 150
strongly agreed that antibiotics are overused in the UK and that
resistance is a problem in the UK, but were neutral with regards to
resistance being a problem in their hospital. Only 9% felt confident
in prescribing antibiotics. Specific areas of weakness included
de-escalation of antibiotics, dosing, and transitioning from IV to oral
antibiotics, as well as appropriate prescribing in the context of known
resistance.
Discussion and/or Conclusion(s):
Our findings suggest that students
perceive resistance as a national/international problem rather than a
local problem, and that future prescribers lack knowledge and
understanding of antimicrobial stewardship required to counter the
spread of resistance. Further studies are required to clarify the
generalisabilty of these findings and guide future medical school
curricula.
ID: 4754
An audit to assess the influence of procalcitonin on patient
management after providing 24/7 cover of procalcitonin testing
Chandanie Mendis Ramasundara, Kordo Saeed, Bruce Wake.
Hampshire Hospitals NHS Foundation Trust
Background:
Bacterial sepsis is a major course of morbidity and
mortality. Procalcitonin (PCT) ia a useful guide for the clinicians to
take correct decisions on antibiotic prescribing to improve patient
outcome by reducing emergence of resistence and health care costs.
Aim(s)/Objective(s):
To assess the indications and how early provision
of PCT results influence patients
’
management and outcome.
Method(s):
Details of 130 PCT episodes were collected from 104
patients admitted to Basingstoke and North Hampshire Hospital
(BNHH). Patients were followed prospectively for 7 days to assess the
outcome.
Results:
The majority of patients were between 40
–
90 years (95%).
62% of them were males.
The main indications for PCT were to support the diagnosis or
exclusion of bacterial infection [n-60, (46%)] and to assess the response
to treatment [n-33, (25%)]. Only 8% of PCT were done for earlier
stopping of antibiotics when a course already started.
In 37% of episodes, the clinicians were continued the same antibiotics.
In 27% of episodes antibiotics were withheld and in 9% were stopped.
De-escalated only in 3 episodes.
Two patients who have not started antibiotics died and 7 were not
improved. Patients died, not at the result of infection. All de-escalated
patients were improved. 75% of PCT episodes had an impact on
patients
’
management according to the BNHH Micro guide PCT results
interpretation criteria.
Discussion and/or Conclusion(s):
Higher percentage of PCT episodes
had an impact on patients
’
management. Majority of patients were
improved within 7 days. The early and regular provision of PCT results
help clinicians to take appropriate decisions regarding antibiotic
prescribing.
ID: 4766
Audit of antimicrobial prophylaxis in adult patients undergoing
neurosurgical and spinal surgeries at Newcastle Upon Tyne
Hospitals NHS Foundation Trust
Harish Reddy
1
, Manjusha Narayanan
2
.
1
Freeman Hospital, Newcastle
Upon Tyne Hospitals NHS Foundation Trust,
2
Newcastle Upon Tyne
Hospitals NHS Foundation Trust
Background:
•
Wound infection of incised skin or soft tissue during operations
is common, but incidence can be reduced by the use of antibiotics
for surgical prophylaxis. But if used inappropriately, it can be
detrimental
•
Carrying out an audit in this area will provide an indication of the
quality of antibiotic prescribing in practice and would highlight
areas for potential improvement
•
This was a new audit following introduction of protocol for
neurosurgical and spinal surgeries
Aim(s)/Objective(s):
•
To study quality of adherence to hospital protocol for antimicrobial
prophylaxis and explore reasons for non-adherence
•
Promote good record keeping and awareness of good prescribing
practice
•
Objective evaluation of antimicrobial prescribing quality, suitable
for on-going prescriber feedback
Method(s):
•
The standard compared in this audit was Newcastle Upon Tyne
neurosurgical and spinal surgery prophylaxis protocol, which have
been developed based on current best evidence
•
Audit was conducted over 2-week period and data was obtained
from theatre list
•
Audit data was obtained from case note review, e-records and
Pathology software system
Results:
•
Choice of antimicrobial prophylaxis was as per the guidelines in
only 60%
•
Only 7% of patients received antibiotics at the right time
•
Small proportion (5%) of patients received inappropriate add-
itional doses of antibiotics
Discussion and/or Conclusion(s):
•
Inappropriate administration of antibiotics increases prevalence of
antibiotic-resistant bacteria, and predisposes patient to infection
with organisms like
C. difficile
. It is hoped that findings of this audit
will emphasize importance of adherence to trust antimicrobial
prophylaxis protocol
•
Feedback and further audits might encourage surgeons to
undertake their own data collection on a rolling programme
basis, which helps evaluate improvement in prophylactic anti-
biotics prescription
•
Emphasise the importance of adherence to timing of antibiotic
instillation.
ID: 4771
Evaluation of the role of the Antimicrobial Management Team
Nurse in achieving improvements in antimicrobial stewardship
Alison Cockburn.
NHS Lothian
Background:
Within the Antimicrobial Management Team (AMT) in
NHS Lothian a nurse was appointed to perform clinical auditing of
antimicrobial use and education of nurses and prescribers. New
antimicrobial prescribing guidelines were implemented within the
Board in April 2015 to reduce broad spectrum antibiotic usage and
reduce Clostridium difficile infection (CDI). During the routine audit
cycle, issues with inaccuracies with gentamicin prescribing procedures
was identified and an audit undertaken by the AMT Nurses to
investigate this situation.
Aim(s)/Objective(s):
The aim of this study was to evaluate the role of
the AMT Nurse in achieving improved antimicrobial stewardship
related to gentamicin administration and prescribing.
Method(s):
Antibiotic prescribing on 18 medical and surgical wards
was audited to assess adherence to the antibiotic prescribing guide-
lines and procedures for gentamicin prescribing. Education was
subsequently provided for nursing staff on gentamicin administration
and prescribing. Additionally, a gentamicin dosing wheel was created
and implemented to assist nurses in calculating blood sample timings.
A staff survey and further audit was then performed.
Results:
The audit showed that 90% of prescriptions contained errors
involving documentation, sampling or administration of gentamicin.
Following implementation of the education programme the error rate
dropped to 13%. Improvements in nurses
’
level of knowledge regarding
gentamicin prescribing and administration were also achieved.
Discussion and/or Conclusion(s):
This study showed that the
AMT nurse has an effective role within the AMT assisting the
implementation of policies and guidelines, monitoring practices,
enabling knowledge sharing and providing education on antimicrobial
stewardship.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S39