improving iv antibiotic use; the role of the nurse课件

ImprovingIVantibioticuse theroleofthenurse Overview Introduction theproblemsThesolutionsEmpiricantibioticpolicyImprovingIVvancomycinandgentamicinuseIVOSTAlertantibioticsSummaryandquestions Introduction theproblems 1 3ofinpatientswillreceiveanantibiotic 1 3ofantibioticsgivenviatheIVroute 40 ofthedrugbudgetspentonantibiotics upto50 ofantibiotictherapyisinappropriate Empiricantibioticpolicy Restrictstheuseofthe 4c antibiotics greatestCdifficilerisk Co amoxiclavCephalosporinsCiprofloxacin otherquinolones Clindamycin ImprovingIVvancomycinandgentamicinuse Vancomycinandgentamicinuse NarrowtherapeuticindexagentsNephrotoxicandototoxicWhengivenIV monitoringandinterpretationofbloodlevelsessentialforsafeandeffectiveuse Consistentlyintop10drugsassociatedwithreportedmedicationincidents Gettingitright1 Istheprescriptionclear Dose frequency especiallyif48hourly statdose Isthedosereasonable Sharedresponsibility liability Gentamicinusually180 400mgdoseVancomycinusually500 1500mgdoseDoyouneedtospeaktothedoctor LevelsnotbeingcheckedSignificantlydelayeddose e g lostIVaccess Prescribedin onceonly section unsureifongoingIsitOKtodoseafterleveltaken Gettingitright2 UsetheAdministrationRecordingChartsEssentialforsafeandeffectivetreatmentRecordaccurateinfusionstartandstoptimesSpacetorecordaccuratesampletimesforlevelsGentamicinInfuseover30 60minutesCheckthelevelaftertheinitialdosethenatleastevery2 3daysSeeinformationsheetforfurtherdetails Gettingitright3 VancomycinBewareofloadingdosesprescribedinthe onceonly sectionIntermittentinfusion maximum500mg hourVancomycincontinuousinfusion 24hourdosesplitinto2equal12hourcontinuousinfusionsLevelsarerequiredifgivenIV notforPO Checkthelevelwithinthefirst12 48hoursthenatleastevery2 3daysSeeinformationsheetforfurtherdetails IVOST IVOSTGuideline IVOST IVtooralswitchtherapyIVantibiotictherapyoftenprolongedunnecessarilyinhospitalIncreasedriskoflineinfection bacteraemiaIncreasedlengthofstayIncreasedexpenditureIncreaseddemandsonnursingtimeIVOSTguidelinedevelopedtoenableaswitchtooraltherapytobemadeearlyandappropriately IVOSTGuideline ReviewtheneedforIVtherapyDAILY Oralroutecompromised e g vomiting nilbymouth severediarrhoea swallowingdisorder unconscious or Deterioratingclinicalcondition Continuingsepsis i e 2ormoreof temp 38 Cor90bpm respiratoryrate 20 minute WCC12 or Specialindication e g meningitis CNSinfeciton endocarditis immunosuppression bone jointinfection deepabscess cysticfibrosis moderatetoseverecellulitis severepenumonia or Nooralformulationofthedrugavailable NO Switchtooraltherapy NurseinvolvementwithIVOST PromptfordailyreviewofIVroute alertmedicalstafftochangesinavailabilityoforalrouteAlertmedicalstaffwhensepsisisresolvingNursesobtainanddocument ofthecriteriaiftemp36 38oC pulse 90bpmandRR 20thenthepatientwillnotmeetthedefinitionofsepsis regardlessoftheWCCPromptmedicalstafftoconsultmicrobiologywhenIVgentamicinisrequiredfor 72hours AlertAntibiotics AlertAntibiotics AlertAntibioticsareBroadspectrumToxicExpensiveValuableagentsreservedforspecifiedpermittedindicationsotherindicationsonlyontheadviceofamicrobiologist IDphysician AlertAntibiotics PharmacycanonlysupplythesealertantibioticswhenanAlertAntibioticFormhasbeencompletedfully AlertAntibioticForm AvailablefromPharmacydistributionIntranet Clinicalinfo antimicrobialguidelines Completedbymedicalstaffand orpharmacistsNursesOrderingwithoutaformcanleadtodelaysinsupplySendthecompletedformtopharmacywiththefirstindentrequestingthealertantibioticRe orderthesameantibioticforthesamepatientbyincludingthepatient sname unitnumberontheindent Alertsupplyofatweekends OOH DosesmustnotbeomittedduetoinabilitytohaveaformcompletedIfnecessary pharmacywillsupplylimitedamountsatweekendswithoutanalertformAlertantibioticswillcontinuetobeheldinemergencycupboardsandbeavailableviatheon siteco ordinator on callpharmacistAcompletedAlertAntibioticFormshouldbesenttopharmacyassoonaspossibleonthenextworkingday Furtherinformation PostersonwardsTherapeuticsHandbookIntranet Clinicalinfo antimicrobialguidelines BNFIVmonographsNurseinformationsheetsLocalAntimicrobialsPharmacist Summary YouwillseemanyantibioticprescriptionsUpto50 ofthesewillbeinappropriate