Nurse Prompting for Prescriber-Led Review of Antimicrobial Use in the Critical Care Unit

2020 ◽  
Vol 29 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Sumit Raybardhan ◽  
Tiffany Kan ◽  
Bonnie Chung ◽  
Danielle Ferreira ◽  
Marina Bitton ◽  
...  
Keyword(s):  
Critical Care ◽  
Critical Care Unit ◽  
Outcome Measure ◽  
Process Analysis ◽  
Interrupted Time Series ◽  
Multiple Organ ◽  
Antimicrobial Use ◽  
Positive Trend ◽  
Multiple Organ Dysfunction Score ◽  
Days Of Therapy

Background Developing a sustainable strategy for prescriber-led review of antimicrobial use in a critical care unit may improve antimicrobial use without the need for additional resources. Methods Using a quality improvement framework, the researchers created a prompt for prescriber-led review of antimicrobial use. The outcome measure was antimicrobial use (days of therapy per 1000 patient days). The process measure was the proportion of relevant cases for which an antimicrobial prompt was provided. Balancing measures included mortality rate, length of stay, 48-hour readmission rates, and multiple organ dysfunction score. Interrupted time series with segmented regression analysis was used for the outcome measure. Results Process analysis identified critical care unit nurses for antimicrobial use prompting. A standard script was developed to incorporate a days of therapy prompt into nurse rounds, with primed prescriber responses. Before the intervention, monthly antimicrobial use was 804 days of therapy per 1000 patient days, with a positive trend (7.3 days of therapy per 1000 patient days, P < .05). After the intervention, there was an immediate reduction of 217 days of therapy per 1000 patient days (P < .05), with a nonsignificant negative trend, representing a 20% (95% CI, −15% to −25%) reduction. No significant change was noted in use of the control class of medications. The proportion of relevant cases for which an antimicrobial prompt was provided increased from 21% to 48% during the intervention period. Balancing measures were comparable before and after the intervention. Conclusions Nurse prompting can lead to significant reductions in antimicrobial use, providing a sustainable mechanism for independent antimicrobial reassessment.

Multiple organ support in an ageing population

2019 ◽  
pp. 133-144
Author(s):  
Matt Oliver ◽  
Dave Murray
Keyword(s):  
Critical Care ◽  
Critical Care Unit ◽  
Daily Practice ◽  
Multiple Organ ◽  
Care Staff ◽  
Organ Support ◽  
Ageing Population ◽  
Standard Textbook ◽  
Learning Points

This chapter is centred on a case study on multiorgan support in the ageing population. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, together with relevant images, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

scholarly journals Assembly Line ICU: what the Long Shops taught us about managing surge capacity for COVID-19

2020 ◽  
Vol 9 (4) ◽  
pp. e001117
Author(s):  
Callum Oakley ◽  
Craig Pascoe ◽  
Daivd Balthazor ◽  
Davinia Bennett ◽  
Nandan Gautam ◽  
...  
Keyword(s):  
Critical Care ◽  
Critical Care Unit ◽  
Assembly Line ◽  
Tertiary Hospital ◽  
Multiple Organ ◽  
Adaptive Responses ◽  
Whole Process ◽  
The Uk ◽  
Care Capacity ◽  
And Training

ObjectivesTo safely expand and adapt the normal workings of a large critical care unit in response to the COVID-19 pandemic.MethodsIn April 2020, UK health systems were challenged to expand critical care capacity rapidly during the first wave of the COVID-19 pandemic so that they could accommodate patients with respiratory and multiple organ failure. Here, we describe the preparation and adaptive responses of a large critical care unit to the oncoming burden of disease. Our changes were similar to the revolution in manufacturing brought about by ‘Long Shops’ of 1853 when Richard Garrett and Sons of Leiston started mass manufacture of traction engines. This innovation broke the whole process into smaller parts and increased productivity. When applied to COVID-19 preparations, an assembly line approach had the advantage that our ICU became easily scalable to manage an influx of additional staff as well as the increase in admissions. Healthcare professionals could be replaced in case of absence and training focused on a smaller number of tasks.ResultsCompared with the equivalent period in 2019, the ICU provided 30.9% more patient days (2599 to 3402), 1845 of which were ventilated days (compared with 694 in 2019, 165.8% increase) while time from first referral to ICU admission reduced from 193.8±123.8 min (±SD) to 110.7±76.75 min (±SD). Throughout, ICU maintained adequate capacity and also accepted patients from neighbouring hospitals. This was done by managing an additional 205 doctors (70% increase), 168 nurses who had previously worked in ICU and another 261 nurses deployed from other parts of the hospital (82% increase).Our large tertiary hospital ensured a dedicated non-COVID ICU was staffed and equipped to take regional emergency referrals so that those patients requiring specialist surgery and treatment were treated throughout the COVID-19 pandemic.ConclusionsWe report how the challenge of managing a huge influx of patients and redeployed staff was met by deconstructing ICU care into its constituent parts. Although reported from the largest colocated ICU in the UK, we believe that this offers solutions to ICUs of all sizes and may provide a generalisable model for critical care pandemic surge planning.

scholarly journals Effect of Antimicrobial Stewardship on Oral Quinolone Use and Resistance Patterns over 8 Years (2013–2020)

Antibiotics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1426
Author(s):  
Atsushi Uda ◽  
Katsumi Shigemura ◽  
Koichi Kitagawa ◽  
Kayo Osawa ◽  
Mari Kusuki ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Retrospective Study ◽  
Antimicrobial Resistance ◽  
Tertiary Hospital ◽  
Antimicrobial Use ◽  
Positive Trend ◽  
National Guidelines ◽  
Significant Positive Trend ◽  
Days Of Therapy ◽  
Resistance Patterns

Since 2014, several global and national guidelines have been introduced to address the problem of antimicrobial resistance. We conducted a campaign in a tertiary hospital to promote appropriate quinolone use through educational lectures in 2018. The aim of this retrospective study was to evaluate the changes in the following: prescription characteristics, trend of oral quinolone use, and antibiotic susceptibility of bacteria from 2013 to 2020. Antimicrobial use was assessed as days of therapy per 1000 patient-days. We found a significant reduction in unnecessary antibiotic prescriptions between December 2013 and December 2020. Significant negative trends were detected in the use of quinolones over 8 years (outpatients, coefficient = −0.15655, p < 0.001; inpatients, coefficient = −0.004825, p = 0.0016). In particular, the monthly mean use of quinolones among outpatients significantly decreased by 11% from 2013 to 2014 (p < 0.05) and reduced further by 31% from 2017 to 2020 (p < 0.001). A significant positive trend was observed in the susceptibility of Pseudomonas aeruginosa to levofloxacin (p < 0.001). These results demonstrate that the use of oral quinolones was further reduced following educational intervention and the bacterial susceptibility improved with optimal quinolone usage compared to that in 2013.

Audit and Feedback to Reduce Broad-Spectrum Antibiotic Use among Intensive Care Unit Patients A Controlled Interrupted Time Series Analysis

2012 ◽  
Vol 33 (4) ◽  
pp. 354-361 ◽  
Author(s):  
Marion Elligsen ◽  
Sandra A. N. Walker ◽  
Ruxandra Pinto ◽  
Andrew Simor ◽  
Samira Mubareka ◽  
...  
Keyword(s):  
Time Series ◽  
Critical Care ◽  
Intensive Care ◽  
Broad Spectrum ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Broad Spectrum Antibiotic ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback

Objective.We aimed to rigorously evaluate the impact of prospective audit and feedback on broad-spectrum antimicrobial use among critical care patients.Design.Prospective, controlled interrupted time series.SettingSingle tertiary care center with 3 intensive care units.Patients and Interventions.A formal review of all critical care patients on their third or tenth day of broad-spectrum antibiotic therapy was conducted, and suggestions for antimicrobial optimization were communicated to the critical care team.Outcomes.The primary outcome was broad-spectrum antibiotic use (days of therapy per 1000 patient-days; secondary outcomes included overall antibiotic use, gram-negative bacterial susceptibility, nosocomial Clostridium difficile infections, length of stay, and mortality.Results.The mean monthly broad-spectrum antibiotic use decreased from 644 days of therapy per 1,000 patient-days in the preintervention period to 503 days of therapy per 1,000 patient-days in the postintervention period (P < .0001); time series modeling confirmed an immediate decrease (± standard error) of 119 ± 37.9 days of therapy per 1,000 patient-days (P = .0054). In contrast, no changes were identified in the use of broad-spectrum antibiotics in the control group (nonintervention medical and surgical wards) or in the use of control medications in critical care (stress ulcer prophylaxis). The incidence of nosocomial C. difficile infections decreased from 11 to 6 cases in the study intensive care units, whereas the incidence increased from 87 to 116 cases in the control wards (P = .04). Overall gram-negative susceptibility to meropenem increased in the critical care units. Intensive care unit length of stay and mortality did not change.Conclusions.Institution of a formal prospective audit and feedback program appears to be a safe and effective means to improve broad-spectrum antimicrobial use in critical care.

scholarly journals Postprescription Review With Threat of Infectious Disease Consultation and Sustained Reduction in Meropenem Use Over Four Years

2020 ◽  
Author(s):  
Nandita S Mani ◽  
Kristine F Lan ◽  
Rupali Jain ◽  
Chloe Bryson-Cahn ◽  
John B Lynch ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Medical Center ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Percentage Change ◽  
Antimicrobial Use ◽  
Sustained Reduction ◽  
Days Of Therapy ◽  
The University ◽  
The Impact

Abstract Background Following a meropenem shortage, we implemented a postprescription review with feedback (PPRF) in November 2015 with mandatory infectious disease (ID) consultation for all meropenem and imipenem courses &gt; 72 hours. Providers were made aware of the policy via an electronic alert at the time of ordering. Methods A retrospective study was conducted at the University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC) to evaluate the impact of the policy on antimicrobial consumption and clinical outcomes pre- and postintervention during a 6-year period. Antimicrobial use was tracked using days of therapy (DOT) per 1000 patient-days, and data were analyzed by an interrupted time series. Results There were 4066 and 2552 patients in the pre- and postintervention periods, respectively. Meropenem and imipenem use remained steady until the intervention, when a marked reduction in DOT/1000 patient-days occurred at both hospitals (UWMC: percentage change −72.1% (95% confidence interval [CI] −76.6, −66.9), P &lt; .001; HMC: percentage change −43.6% (95% CI −59.9, −20.7), P = .001). Notably, although the intervention did not address antibiotic use until 72 hours after initiation, there was a significant decline in meropenem and imipenem initiation (“first starts”) in the postintervention period, with a 64.9% reduction (95% CI 58.7, 70.2; P &lt; .001) at UWMC and 44.7% reduction (95% CI 28.1, 57.4; P &lt; .001) at HMC. Conclusions PPRF and mandatory ID consultation for meropenem and imipenem use beyond 72 hours resulted in a significant and sustained reduction in the use of these antibiotics and notably impacted their up-front usage.

Antimicrobial use in a critical care unit: a prospective observational study

2011 ◽  
Vol 20 (3) ◽  
pp. 164-171 ◽  
Author(s):  
Christina L. Candeloro ◽  
Lynne M. Kelly ◽  
Elke Bohdanowicz ◽  
Claudio M. Martin ◽  
Anne Marie Bombassaro
Keyword(s):  
Critical Care ◽  
Observational Study ◽  
Critical Care Unit ◽  
Prospective Observational Study ◽  
Antimicrobial Use

Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 13-14
Author(s):  
Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽  
Maryam Al Ali, MBBS
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Case Report ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Critical Care Unit ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

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