Antibiotic hang-time improvement leads to protocol improvement in Bone Marrow Transplant Unit (BMTU)

Abstract

Background: This project was designed and implemented throughout a 214 bed private hospital in Gauteng, South Africa. Admissions to this hospital are from general practitioners, physicians, paediatricians, surgeons, neuro-surgeons, gastro-enterology surgeons, cardio-thoracic surgeons and cardiologists. In a study by (Kumar et al.) hang-time has been identified as a majordeterminant of patient survival and has been identified as an antibiotic stewardship intervention. When dispensing, it was noticed, that the initiation of antibiotic therapy was sometimes delayed until 6am/6pmwhen daily or twice daily doses are given, so as tomake administrationmore convenient. This is in contradiction with the findings of Kumar et al. in which antibiotic therapy is recommended to be initiated within one hour of the prescription being written as it results in a survival rate of 80% in patients with septic shock induced hypotension. Methods & Materials: Staff members throughout the hospital were given training on hang-time and the benefits thereof. The implementation of the antimicrobial chart was done and used as a means of measuring hang-time in wards where clinical ward rounds were not performed. The percentage compliance was illustrated on run charts over a period of time to demonstrate the improvements made. Results: The project has provided baseline data for hang-time in all wards in the hospital with the target being above 80%. Training has been provided been provided after the measurement of baseline data. Major improvements have been noticed in the medical ward, with an overall increase in compliance to greater than 80%. Conclusion: The involvement of doctors and encouraging them towrite the timeof prescription is a vital step and requires frequent reminders. The training of casualty nursing staff anddoctors should not be overlooked as many antibiotics are initiated in casualty. The reduction of hang-time to less than an hour is a greatway to improve patient outcomes and highlight the role nursing and pharmacy staff plays onpatient outcomes. It is a simple intervention and can also help gain the medical practitioners buy-in to Antibiotic Stewardship.