ANTIBACTERIALS
Become An Antibiotic Guardian
How to become an antibiotic Guardian
I have pledged to be an #AntibioticGuardian. You can make a pledge too via http://www.antibioticguardian.com”
European Antibiotic Guardianship Day 18th November 2016
Antibiotic Stewardship ~ Start Smart then Focus
This encompasses key interventions and audits that will support antibiotic stewardship in hospitals.
Start Smart - this means:
- do not start antimicrobial therapy unless there is clear evidence of infection
- take a thorough drug allergy history
- initiate prompt effective antibiotic treatment within one hour of diagnosis (or as soon as possible) in patients with severe sepsis or life-threatening infections. Avoid inappropriate use of broad-spectrum antibiotics
- comply with local antimicrobial prescribing guidance
- document clinical indication (and disease severity if appropriate), drug name, dose and route on drug chart and in clinical notes*
- include review/stop date or duration
- obtain cultures prior to commencing therapy where possible (but do not delay therapy)
- prescribe single dose antibiotics for surgical prophylaxis where antibiotics have been shown to be effective
- document the exact indication on the drug chart (rather than stating long term prophylaxis) for clinical prophylaxis
Then Focus – this means:
reviewing the clinical diagnosis and the continuing need for antibiotics at 48*-72 hours and documenting a clear plan of action - the ‘antimicrobial prescribing decision’
the five ‘antimicrobial prescribing decision’ options are:
1. Stop antibiotics if there is no evidence of infection
2. Switch antibiotics from intravenous to oral
3. Change antibiotics – ideally to a narrower spectrum – or broader if required
4. Continue and document next review date or stop date
5. Outpatient Parenteral Antibiotic Therapy (OPAT) 10
it is essential that the review and subsequent decision is clearly documented in the clinical notes and on the drug chart where possible eg stop antibiotic.
CASE STUDY - Doreen, AGE 72
Doreen: Age 72
Mandy: Doreen's Nurse
I am going to speak to Rahil, (the F1 doctor on duty today), she thought.
Rahil: F1 Doctor on duty
See question 5 on case study below.
DOREEN'S TEST RESULTS AND DRUG HISTORY
Sodium levels 135mmol/litre (ref range 135-145mmol/l)
Potassium 5.5mol/litre (ref range 3.5-5mmol/l)
Urea 14mmol/litre (ref range 2.5-6.7mmol/l)
Creatine 186micromol/litre (ref range 70-150micromol/l
Glomerular filtration rate (GFR) 26ml/minute
C-reactive protein (CRP) 30mg/l (ref range less than 10mg/l)
Temperature 37.5oC
Chest X ray Clear - clinically not pneumonia
Drug History
Co-codamol 8/50mg: Two tablets four times a day
Prednisolone 10mg: in the morning
Case Study Questions
Please use the CPPE Antibacterials booklet 1 and answer the following questions. Please share your thoughts using the link below.
Questions:
- What other biochemicals or microbiological tests should have been undertaken and when?
- The medical team believe Doreen may have an infection and want to start antibacterials. Make a note of the factors you would take into consideration to help you select an appropriate antibacterial regime.
- Why might her temperature be normal in the presence of sepsis?
- Apart from the rationalising her antibacterial therapy; identify two other medicines optimising issues which need addressing urgently. Suggest monitoring parameters for these issues.
- Is it appropriate to prescribe metronidazole for Clostridium difficile at this point?
- Would you recommend the use of IV metronidazole for this indication.
CPD Entry
There are two ways of recording the aseptic workshop learning for your CPD records
Planned Learning:
Start at reflection if: Undertaking this workshop could help you improve your effectiveness in your practice.
Start at planning if: This aseptic workshop is important to re-enforce your knowledge or add to it. If so you will need to address what you learnt & the time frame to complete your learning.
If this learning was unplanned start your learning at action. You need to address any new learning points, identify what else you need to add to your knowledge.
Evaluation; The most important element here is how are you going to use this knowledge in your everyday working environment. What is going to change and how are you going to achieve this.
2. Change in practice
Start at reflection : To reflect on the effectiveness of this learning. Did you gain any new ideas, knowledge.
Start at reflection if: Any of the knowledge you gained you will use in changing your activity
In the action segment: Describe the key learning points in particular any that will improve patient care.
Evaluation; The most important element here is how are you going to use this knowledge in your everyday working environment. What is going to change and how are you going to achieve this.
Virtual Branch Contact Details
Email: l.gallagher@kent.ac.uk
Website: http://aptuk.org/Branches/
Location: Medway School of Pharmacy, Central Avenue, Gillingham, United Kingdom
Phone: 01634 202940
Facebook: https://www.facebook.com/VirtualBranch1/
Twitter: @AptukB