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Scottish Antimicrobial Pharmacist Group SNAP-CAP & Empirical Prescribing Indicator Audit

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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Scottish Antimicrobial Pharmacist Group SNAP-CAP & Empirical Prescribing Indicator Audit

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  1. Scottish Antimicrobial Pharmacist Group SNAP-CAP & Empirical Prescribing Indicator Audit 8th June 2010

  2. 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

  3. 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

  4. ….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

  5. 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

  6. 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

  7. ‘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

  8. 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

  9. 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.

  10. 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

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