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ARK study teaching and cases

ARK study teaching and cases. Which of the following do we do when prescribing antibiotics?. Review pts previous micro results. Obtain relevant samples Document indication/duration in drug chart Review antibiotics at 48-72 hours.

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ARK study teaching and cases

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  1. ARK study teaching and cases

  2. Which of the following do we do when prescribing antibiotics? • Review pts previous micro results. • Obtain relevant samples • Document indication/duration in drug chart • Review antibiotics at 48-72 hours

  3. Outcome of 48-72 hours review antibiotic prescriptions-September 2017-Wexham Park Hospital 24.7% did no have a review within 72 hours 7.5% antibiotics reviewed were stopped

  4. ARK-hospital provides • Educational material: Information for prescribers about Review and Revise decision making: On line tool (10 mins) • A decision aid (categorisation tool): 2.1 when antibiotics are started the diagnosis usually isn’t certain. Are you prescribing for a probable diagnosis of infection or a possible risk from infection? 2.2 Encourages prescribers to review taking a “stop or justify continue” approach (at least at 72 hours) 2.3 Leads to a finalised antibiotic prescription • Monitoring and feedback programme to clinical teams to support Review and Revise through team meetings • Information for patients. Patient leaflet.

  5. Categories Flow Diagram

  6. ARK-Hospital case 1 – Respiratory A 29 yr old female with known asthma presented with SOB and cough productive of whitish/green sputum. O/E she was in respiratory distress and on auscultation had bilateral wheeze but no crackles. Bloods: CRP 15. NAC 8.4, CXR The working diagnosis? Antibiotic treatment? The working diagnosis was of asthma? triggered by infection. The clerking doctor started amoxicillin for a possible LRTI. Within 72 hour review patient was feeling better: The next day as the patient had improved with acute asthma management and antibiotics were stopped.

  7. ARK-Hospital case vignette 2 – General Medicine 71 yr old female, with a background of epilepsy and alcohol excess, admitted with confusion and drowsiness following a tonic-clonic seizure. O/E she was tachycardic and agitated. Apyrexial with no signs of meningism. Bloods: CRP 9 . NAC 7, The working diagnosis? Antibiotic treatment? The working diagnosis was a seizure secondary to self-induced alcohol detox. However, due to the confusion and drowsiness antibiotics were started to cover for a probable meningo-encephalitis. Within 72 hour review, a LP was done which showed 2 WBC, 1RBC, prot 0.3, glucose 2: Normal CSF ruled out this diagnosis and antibiotics were stopped within 48 hours.

  8. ARK-Hospital case vignette 3 – General Medicine 37 yr old female, 12 weeks pregnant, admitted with urinary frequency, flank pain, haematuria and feeling nauseus. O/E she was tachycardic. Apyrexial. Lower abdominal tenderness. Bloods: CRP 125 . NAC 9.5. Urine dip: ++ blood, ++ leucocytes, nitrates +. The working diagnosis? Antibiotic treatment? The working diagnosis was a probable complicated UTI in pregnancy. Started on iv cefuroxime. Within 72 hour review: At 48 hours she was feeling better. Able to take orally. USS kidneys was normal. As at 48 hours she was feeling better and was able to take orally, she was switched to oral cephalexin to complete 10 days

  9. [insert start date] 1. On line tool: [insert link]. It is Trust specific; you register with your Trust email 2. Document Possible/Probable in every new antibiotic in ARK sticker. 3. Review and Revise: Review antibiotic prescriptions ≤ 72 hours. “stop or justify continue” Those in need of QIA!! Ward audit and feedback

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