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Scottish Antimicrobial Pharmacist Group SNAP-CAP & Empirical Prescribing Indicator Audit 8 th June 2010. NHS Borders : smallest mainland Health Board area in Scotland population 112760 Age >60years group is above Scottish average

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Presentation Transcript
slide1
Scottish Antimicrobial Pharmacist Group

SNAP-CAP

&

Empirical Prescribing Indicator Audit

8th June 2010

slide2
NHS Borders :
  • smallest mainland Health Board area in Scotland
  • population 112760
  • Age >60years group is above Scottish average
  • Increased incidence of hospitalization in older age groups.
  • 1 district Hospital
  • 293 beds
audit plan for snap cap
Audit Plan for SNAP-CAP
  • Data collection/audit process
    • Medical Admission Unit/ A&E
    • Medical and nursing staff to capture appropriate patients
    • Aim to collect 10 a month
    • Lead Antimicrobial Nurse to collect material for monthly update to IHI.org
    • Feedback to clinicians by poster/ email
the story so far
….the story so far
  • Data collection
    • 2 referrals from A&E and then nothing
    • A few from MARU
    • What ‘no pneumonias?’
  • Review
    • Raising SNAP-CAP/CURB65 profile
    • Active pursuit of CAP’s
    • LRTI/Pneumonia: Data validated Respiratory Consultant
curb65 i ve heard of it
CURB65: ‘I’ve heard of it’
  • Raising the profile of SNAP-CAP & CURB65
    • Nursing/ junior medical staff education
      • Small group/ face to face interaction
      • Daily pursuance of pneumonias
      • Rising above the challenges of doctor rotations
  • Number of patients with CAP collected
    • Variable: 8-18
    • Median monthly: 12
chasing cap s
Chasing CAP’s
  • Active seeking of community acquired pneumonias
    • EDIS
    • Checking notes/ admission board/ asking etc
    • Unscheduled Care (BECS)
    • When is LRTI a pneumonia?
    • Reviewing X-ray reports
itu have someone with cap
‘ITU have someone with CAP’
  • How the admission pathway actually operates!
    • Patients requiring supported care e.g. CURB65=3
      • Ward 5 (High Dependency Care)
      • ITU aware
  • Feedback to medical teams
    • Where did that poster go?
    • Opt-in email system for Junior Doctors
    • Micro site
summary
Summary
  • Greater awareness of SNAP-CAP/CURB65
  • Consistency in data
  • Time consuming
  • Change may impact on results
  • However, imperfect results / variability
  • Challenge to improve implementation
empirical prescribing indicator audit
Empirical Prescribing Indicator Audit
  • Medical Acute Receiving Unit
    • 30 bedded unit
    • High turnover of patients with infections
    • Usually good compliance with recording of indication and prescribing within the local guidelines
    • Medical staff on hand, usually several.
slide11
Surgical Acute Admissions Unit
    • Small 11 bedded unit
    • Some issues
      • Challenge to capture 20 monthly
      • Indicator for antibiotic treatment not always clear
      • Do patients always require antibiotics?
      • Medical staff not always present but nursing staff appraised of any issues
ad