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Improvement Methodology: Introduction of ALERT Second Line Antibiotic Policy
Steve McCormickLead Antimicrobial Pharmacist
NHS Lanarkshire
Restrictive Use Policy
• Pilot across three acute sites in July 2009– Benchmark Practice => challenging areas
first
• Followed the Scottish Patient Safety Programme (SPSP) Test of Change approach – 1 => 3 => 5 spread
• Following analysis of pilot data, the policy was rolled out across all NHSL wards in January 2010
A PS D
Data A PS D
A PS D
“What does ALERT mean ?”
•Second•Line•Antibiotic •Policy
- Isobel Patterson C [Sister ICU MK]
Key Driver = Quality NOT Savings
Alert Antibiotic Issues Value Financial Years 2008/2009 and 2009/2010
£0.00
£10,000.00
£20,000.00
£30,000.00
£40,000.00
£50,000.00
£60,000.00
£70,000.00
Months
Iss
ue
s V
alu
e
FY 2008/2009
FY 2009/2010
SBAR REPORTDOTS
Appropriate PrescribingPiperacillin/Tazobactam Use
3026
30
86
1623
18
57
0
10
20
30
40
50
60
70
80
90
100
Monklands Hairmyres Wishaw Total
Hospital
No
of
form
s
No of patient episodes forPiperacillin/Tazobactom
No of patient episodes forpermitted indication (alsoexpressed as percentage)
88% 60%53%
66%
Non ALERT Use
Analysis of non-ALERT indication use of Piperacillin/Tazobactam
5 585
136
3
3
12
0
5
10
15
20
25
30
35
Monklands Hairmyres Wishaw Total
Hospital
No
of
form
s
d/w Micro - ALERT antibioticagreed
d/w Micro unknown outcome
Not d/w Micro
Site X
Total number of alert antibiotic forms completed = 81
Ward A Ward B Ward C Ward D Ward E Total
Tazocin 2 1 25 10 14 52Meropenem 1 1 3 2 6 13Ceftazidime - - - - - -IV
levofloxacin
- - 2 - 4 6
IV ciprofloxacin
- - - - 3 3
Usage Hotspots
• Monthly report will enable drill down to ward, consultant, patient – retrospective analysis of use
Role Models or Outliers
Pareto Chart Analysis
Piperacillin/Tazobactam use in Monklands (Feb 2010)
01
234
56
18 14 5 4 26 (ITU) 17 15 ERU 2 7
Ward
No
of
epis
od
es o
f u
se
0
20
40
60
80
100Cumulative percentage
No of episodes of use Cumulative percent
50%
“..but we use these all the time”
“Our area will be exempt”
“We are not joining the pilot”
“Ok FY’s will do it”
“Seems to be working”
“Non compliance – how can we minimise?”
