479 Closed Loop Quality Improvement Project Improving Time to Peripherally Inserted Central Catheters (PICCs) and Intravenous (IV) Antibiotic Administration in Patients with Complex Orthopaedic Infections

Abstract

Abstract Aim Bone, joint and soft tissue infections often require long term antibiotic therapy. Reliable IV access is essential for IV antibiotic administration and monitoring. PICCs provide consistent, long-term IV access. Aim: improve time to PICC request, insertion, and reduce issues with poor IV access in patients requiring long term IV antibiotics. Method Standard audit protocol. Data tool was developed and tested. Data was collected retrospectively from departmental database and online records for all patients admitted with suspected bone, joint or soft tissues infection from 01/11/19–29/2/20. Department policy and induction programme were updated. Cycle 2 included all patients from 1/8/20–30/11/21. Results Cycle 1 included 91 patients. 30 PICCs were requested with 26 inserted. Mean time to PICC request from diagnosis was 8.7 days(1–33). Mean time to PICC from request was 6.7 days(1–15). Mean time to PICC from diagnosis was 15.9 days(4–39). 10 of 30(33.3%) patients missed antibiotics due to lack of IV access. Cycle 2 included 156 patients. 36 PICCs were requested with 18 inserted. Mean time from diagnosis to request was 4.4 days(1–15). Mean time from request to insertion was 4.2(1–8) days. Mean time from diagnosis to insertion was 8.6 days(1–21). Missed IV antibiotics were reduced from 33.3% to 15.4%. Conclusions Time to PICC insertion was improved through education and introduction of new policy at departmental induction. This low-cost change can significantly improve both treatment and patient experience when admitted for complex orthopaedic infection through reliable antibiotic administration and reducing the number of IV access attempts.