The 3-Day Antibiotic Bundle

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The 3-Day Antibiotic Bundle

• Shadi Botros
• Principal Clinical Pharmacist

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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
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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
Sep40(1)1-15.
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SBAR

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

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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

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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
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RESULTS
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RESULTS
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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
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RESULTS

• Vascular Surgery (Ward 12)

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SPREAD

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

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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

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Remember.

• Trying to improve patient safety has its ups
  and downs..
• ........ but its a hell of a ride!

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QUESTIONS?