46 / 150
Method(s):
Patients who underwent an orthopaedic surgical proced-
ure, with prophylaxis recommended, from 01/06/2008 to 31/05/2012
were selected. Cases were linked to local creatinine data and to
national patient level hospital activity, community prescribing and
Scottish Renal Registry data. Segmented regression analyses of
interrupted time series were used to evaluate changes in level and
trend of AKI rates associated with the intervention and estimate effect
sizes.
Results:
There was a significant increase in AKI rate trend following
policy change (
β
= 0.28; 95%CI, 0.03 to 0.53; p = 0.028) in trauma
patients, equating to an increase of 0.28 cases of AKI/100 procedures/
month and a relative intervention effect at 24 months of 150% (95% CI
25% to 250%). There was no significant change in AKI rate among
elective patients.
Discussion and/or Conclusion(s):
We found that a change in ortho-
paedic antibiotic prophylaxis policy in NHS Grampian was associa-
ted with an increase in post-operative AKI. This is consistent with
observations in other boards and supports the new recommendation
away from this policy made by SAPG in 2012.
ID: 4832
Use of iVents as a metric of Antimicrobial Stewardship (AMS) at
Cambridge University Hospitals (CUH) Trust
Harriet Cook, Christianne Micallef, David Enoch, Reem Santos,
Sani Aliyu.
Cambridge University Hospitals Trust
Background:
CUH introduced Epic EMR system in October 2014.
A key feature of Epic is the intervention reporting module (
‘
iVent
’
)
which allows pharmacists to communicate any interventions and
recommendations they have made. We investigated the use of iVents
specifically to document AMS interventions.
Aim(s)/Objective(s):
1.
To investigate the types of AMS interventions and classify types
and clinical impact of intervention
2.
To assess whether there are differences in AMS interventions
made between clinical areas and pharmacist grades.
Method(s):
A report was generated collating all AMS iVents recorded
by pharmacists over a one year period. A peer-review group com-
prising antimicrobial pharmacists and consultant microbiologists was
consulted to decide on suitable categories for data analysis. iVents
were then sorted according to these categories and assigned values
for their potential clinical impact. This group also reviewed a
random sample of 50 interventions to assess agreement for categories
and severity and whether the intervention made was clinically
appropriate.
Categories of intervention included administration advice, dose opti-
misation, course length optimisation, patient counselling, thera-
peutic drug monitoring (TDM), choice of agent advice, vaccination
referrals, IV to Oral Switch, Supply Issues and stopping unnecessary
prescriptions.
Results:
Preliminary data from a one-month period (April 2016)
demonstrated that:
1.
503 interventions were made
2.
the most common AMS intervention is for antimicrobials
requiring TDM and the least common patient counselling and IV
to oral switching
3.
most interventions are made on intensive care wards and the
fewest on neurology wards
4.
number of interventions made increases with grade of pharmacist
5.
most interventions have
‘
medium
’
clinical impact
ID: 4840
Personalised feedback of antibiotic prescribing data to primary
care teams
Jacqueline Sneddon
1
, William Malcolm
2
, Marion Bennie
2
,
Helen Storkey
3
, Terry McLaughlin
2
, James Smith
2
, Charis Marwick
4
,
Bruce Guthrie
5
, Sean Macbride-Stewart
6
, Dilip Nathwani
4
.
1
Healthcare
Improvement Scotland,
2
NHS National Services Scotland,
3
NHS national
Services Scotland,
4
NHS Tayside,
5
University of Dundee,
6
NHS Greater
Glasgow and Clyde
Background:
In Scotland feedback of prescribing data has proved
successful with GPs for high risk medicines and dental practitioners
for antimicrobial. A similar approach was designed to complement
other interventions to reduce unnecessary antibiotic use by GPs.
Aim(s)/Objective(s):
This study aimed to establish a programme to
provide GP practices with quarterly reports on their own antibiotic
prescribing data along with benchmarking information.
Method(s):
A study steering group was established and funding
secured for creation of data reports. The pilot phase involved 50% of
practices in four health board areas, randomly selected using a
stratified sampling frame, receiving the report. Details of these
practices were obtained and automated email messaging set up.
Results:
Practices will receive quarterly reports containing their rates
of antibiotic prescribing compared to local and national benchmarks
along with suggested actions and details of support resources. The first
report focussed on total antibiotic use and included key messages
about improving use of antibiotics for respiratory tract infections.
Reports were emailed directly to GP Practices along with a letter from
the Chief Medical Officer. The next three reports will focus on urinary
tract infection, risk of Clostridium difficile infection and skin and soft
tissue infections. Following a time series analysis of changes in
prescribing rate in the intervention practices compared to control
practices we plan to implement the intervention across all GP practices
in Scotland.
Discussion and/or Conclusion(s):
This automated feedback interven-
tion is an attractive addition to our stewardship programme as it is
supported by good evidence and can be implemented nationally at
relatively low cost.
ID: 4846
The nursing influence: Antimicrobial stewardship in Community
Hospitals
Jo McEwen
1
, Charis Marwick
2
, Dilip Nathwani
1
.
1
NHS Tayside,
2
Dundee
University
Background:
Multidisciplinary antimicrobial stewardship pro-
grammes are essential in optimising antimicrobial use and minimising
associated collateral damage. Many antimicrobial stewardship initia-
tives have primarily targeted doctors and pharmacists, however the
potential contribution that nurses could make in this area has not yet
been fully explored.
Aim(s)/Objective(s):
The primary aim of this initiative was to enhance
nursing knowledge around antimicrobial stewardship by focusing on
the key areas of nursing influence. A secondary focus was to encourage
appropriate urine sampling in the older adult population and those
with indwelling urinary catheters through the promotion of the
Scottish Antimicrobial Prescribing Group UTI management resources.
Method(s):
Educational programmes were delivered to all community
hospital nursing teams in NHS Tayside over a 12 month period.
Questionnaires were issued pre and post intervention to assess the
impact of the intervention.
Results:
Comparisons between the pre-intervention and post-
intervention questionnaire demonstrate an improvement in nursing
knowledge in relation to antimicrobial stewardship and infection
management. This was statistically significant in six of the fourteen
questions (p =
≤
0.01).
There was a statistically significant reduction in urine samples
submitted for culture after the intervention, from mean 20.9 to 14.9
per 1000 OBD per month (difference 6.0, t-test p = 0.009).
Discussion and/or Conclusion(s):
Nurses are the constant in the
delivery of patient care, therefore, as a profession they are ideally
placed to enhance antimicrobial management within the multi-
disciplinary team. Through education and awareness nurses can
significantly impact on infection outcomes and contribute to optimis-
ing antimicrobial treatment whilst delivering high quality, safe and
patient focussed care.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S41