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Journal articleJheeta S, Franklin BD, 2017,
The impact of a hospital electronic prescribing and medication administration system on medication administration safety: an observational study
, BMC Health Services Research, Vol: 17, ISSN: 1472-6963BackgroundThe aim of the study was to explore the impact of the implementation of an electronic prescribing and medication administration system (ePA) on the safety of medication administration in an inpatient hospital setting. Objectives were to compare the prevalence and types of: 1) medication administration errors, and 2) documentation discrepancies, between a paper and an ePA system. Additionally, we wanted to describe any observed changes to medication administration practices.MethodsThe study was based on an elderly medicine ward in an English hospital. From December 2014 to June 2015, nurses’ medication administration rounds were observed every 5 days before and after ePA implementation using an interrupted time-series approach. Medication administration error and documentation discrepancy rates pre- versus post-ePA were analysed descriptively and chi-squared tests used to test for any difference; segmented regression analysis was used to determine changes in longitudinal trend.ResultsObservations were made at 15 pre- and 15 post-ePA implementation time-points. Pre-ePA on paper, there were 18 medication administration errors in 428 opportunities for error (4.2%; 95% confidence interval 2.3–6.1%), and with ePA there were 18 in 528 (3.4%; 95% confidence interval 1.9–5.0%; p = 0.64). Regarding documentation, pre-ePA on paper there were 5 discrepancies in 460 observed documentations (1.1%; 95% confidence interval 0.1–2.0%); with ePA there were 18 in 557 (3.2%; 95% confidence interval 1.8–4.7%; p = 0.04). The most common electronic documentation discrepancy was documentation that a dose had been administered when it had not. Segmented regression analysis was unable to detect any significant longitudinal changes. Changes to working practices post-ePA were observed, such as nurses demonstrating less-consistent self-checking when preparing and administering medications.ConclusionsFindings suggest no change in medication error rate, alth
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Journal articleSartelli M, Weber DG, Ruppe E, et al., 2017,
Erratum to: Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)
, World Journal of Emergency Surgery, Vol: 12, ISSN: 1749-7922 -
Journal articleSartelli M, Labricciosa FM, Barbadoro P, et al., 2017,
The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey
, WORLD JOURNAL OF EMERGENCY SURGERY, Vol: 12, ISSN: 1749-7922BackgroundAntimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world.MethodsA cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery.ResultsThe response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4–6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%).ConclusionThe
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Journal articlePulcini C, Morel CM, Tacconelli E, et al., 2017,
Human resources estimates and funding for antibiotic stewardship teams are urgently needed
, Clinical Microbiology and Infection, Vol: 23, Pages: 785-787, ISSN: 1469-0691Antibiotic stewardship (AS) teams are essential actors for combating antibiotic-resistant bacteria in healthcare and community settings, and are routinely mentioned in national and international guidelines, recommendations and action plans. Usually, AS teams in resource-rich settings are multidisciplinary, made up of different experts, commonly including infectious diseases (ID) specialists, clinical microbiologists and pharmacists, adequately trained in antibiotic prescribing and stewardship [1].
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Journal articleRawson T, Castro Sanchez E, Charani E, et al., 2017,
Involving citizens in priority setting for public health research: implementation in infection research
, Health Expectations, Vol: 21, Pages: 222-229, ISSN: 1369-7625BackgroundPublic sources fund the majority of UK infection research, but citizens currently have no formal role in resource allocation. To explore the feasibility and willingness of citizens to engage in strategic decision making, we developed and tested a practical tool to capture public priorities for research.MethodA scenario including six infection themes for funding was developed to assess citizen priorities for research funding. This was tested over two days at a university public festival. Votes were cast anonymously along with rationale for selection. The scenario was then implemented during a three-hour focus group exploring views on engagement in strategic decisions and in-depth evaluation of the tool.Results188/491(38%) prioritized funding research into drug-resistant infections followed by emerging infections(18%). Results were similar between both days. Focus groups contained a total of 20 citizens with an equal gender split, range of ethnicities and ages ranging from 18 to >70 years. The tool was perceived as clear with participants able to make informed comparisons. Rationale for funding choices provided by voters and focus group participants are grouped into three major themes: (i) Information processing; (ii) Knowledge of the problem; (iii) Responsibility; and a unique theme within the focus groups (iv) The potential role of citizens in decision making. Divergent perceptions of relevance and confidence of “non-experts” as decision makers were expressed.ConclusionVoting scenarios can be used to collect, en-masse, citizens' choices and rationale for research priorities. Ensuring adequate levels of citizen information and confidence is important to allow deployment in other formats.
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Journal articleBirgand GJC, Troughton R, Moore L, et al., 2017,
Blogging in infectious diseases and clinical microbiology: Assessment of the 'blogosphere' content
, Infection Control and Hospital Epidemiology, Vol: 38, Pages: 832-839, ISSN: 1559-6834Objective.To analyzeinfluential infectious diseases, antimicrobial stewardship, infection control, or medical microbiology blogs and bloggers.Setting. World Wide WebDesign. We conducted a systematic search for blogs in accordance with the PRISMA guidelines in September 2015.Methods.A snowball sampling approach was applied to identify blogs using various search engines. Blogs were eligible if they: 1) focused on infectious diseases (ID), antimicrobial stewardship (AMS), infection control (IC), or medical microbiology (MM); 2) were intended for health professionals, 3) were written in English and updated regularly. We mapped blogs/bloggers characteristics and used an innovative tool to assess their architecture and content. Motivations and perceptions of bloggers and readers were assessed. Results.A total of 88 blogs were identified. 28 (32%) focused on ID, 46 (52%) on MM and 14 (16%) in IC or AMS. Bloggers were mainly male, MD and/or PhD, 32 (36%) posted at least weekly, and 51 (58%) for a research purpose. The aims were considered clear for 23 (26%) blogs, the field covered was broad for 25 (28%), presentation was good for 22 (25%), 51 were easy to read (58%) and 46 included expert interpretation (52%). Among the top 10 blogs (2 equally-ranked), 3 focused on ID, 6 on MM and 2 on IC. Bloggers questioned were motivated by sharing independent expertise/opinion. Readers appreciated the concise messages given on scientific and practical updates.Conclusions.This study describes high level blogs in ID/IC/MM suggesting how bloggers should build/orientate blogs for readers, and highlighting current gaps in topics such as AMS.
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Journal articleNaylor NR, Zhu N, Hulscher M, et al., 2017,
Is antimicrobial stewardship cost-effective? A narrative review of the evidence
, Clinical Microbiology and Infection, Vol: 23, Pages: 806-811, ISSN: 1198-743XAIMS: This narrative review aimed to collate recent evidence on the cost-effectiveness and cost-benefit of antimicrobial stewardship (AMS) programmes, to address the question 'is AMS cost-effective?', while providing resources and guidance for future research in this area. SOURCES: PubMed was searched for studies assessing the cost-effectiveness, cost-utility or cost-benefit of AMS interventions in humans, published from January 2000 to March 2017, with no setting inclusion/exclusion criteria specified. Reference lists of retrieved reviews were searched for additional articles. CONTENT: Recent evidence on the cost-effectiveness and cost-benefit of AMS is described, studies suggest persuasive and structural AMS interventions may provide health economic benefits to the hospital setting. However, overall, cost-effectiveness evidence for AMS is severely limited, especially for the community setting. Recommendations for future research in this area are therefore provided, including discussion of appropriate health economic methodological choice. IMPLICATIONS: Health systems have a finite and decreasing resource, decision makers currently do not have necessary evidence to assess whether AMS programmes provide sufficient benefits. Although the evidence-base of the cost-effectiveness of AMS is increasing, it remains inadequate for investment decision-making. Robust health economics research needs to be completed to enhance the generalizability and usability of cost-effectiveness results.
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Journal articleCastro Sanchez EM, Gilchrist M, McEwen J, et al., 2017,
Antimicrobial stewardship: widening the collaborative approach
, Journal of Antimicrobial StewardshipAnti microbial stewardship programs (ASPs) would benefit from the participation of nurses to strengthen the increasingly complex mix of clinical, educational, research, organizational and political interventions included within ASPs.
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Journal articleMearkle R, Saavedra-Campos M, Lamagni T, et al., 2017,
Household transmission of invasive group A Streptococcus infections in England: a population-based study, 2009, 2011 to 13
, Eurosurveillance, Vol: 22, ISSN: 1560-7917Invasive group A streptococcal infection has a 15% case fatality rateand a risk of secondary transmission.This retrospective studyusedtwo national data sourcesfrom England; enhanced surveillance (2009) and a case management system(2011-13) to identify clustersof severegroup A streptococcaldisease.24household pairswere identified.The median onset interval between cases was 2 days (range 0-28)with simultaneous onset in 8pairs.The attack rate during the 30 days after first exposure to aprimarycase was 4520per 100000 person-years at risk (95% CI2900-6730)a 1940(1240-2880) fold elevation over the background incidence.The theoretical number needed to treat (NNT)to prevent one secondary case using antibiotic prophylaxis was 271(194-454)overall,50formother-neonate pairs (27-393) and 82for couples aged75 yearsand over(46-417). Whilst a dramatic increased risk of infection was noted in all household contacts, increased risk was greatest for mother-neonatepairs and couplesaged 75 and over, suggesting targeted prophylaxis could be considered.Offering prophylaxis is challenging due to the shorttime interval between casesemphasising the importance of immediate notificationand assessment of contacts.
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Journal articleCharani E, Ahmad R, Tarrant C, et al., 2017,
Opportunities for system level improvement in antibiotic use across the surgical pathway
, International Journal of Infectious Diseases, Vol: 60, Pages: 29-34, ISSN: 1201-9712Optimizing antibiotic prescribing across the surgical pathway (before, during, and after surgery) is a key aspect of tackling important drivers of antimicrobial resistance and simultaneously decreasing the burden of infection at the global level. In the UK alone, 10 million patients undergo surgery every year, which is equivalent to 60% of the annual hospital admissions having a surgical intervention. The overwhelming majority of surgical procedures require effectively limited delivery of antibiotic prophylaxis to prevent infections. Evidence from around the world indicates that antibiotics for surgical prophylaxis are administered ineffectively, or are extended for an inappropriate duration of time postoperatively. Ineffective antibiotic prophylaxis can contribute to the development of surgical site infections (SSIs), which represent a significant global burden of disease. The World Health Organization estimates SSI rates of up to 50% in postoperative surgical patients (depending on the type of surgery), with a particular problem in low- and middle-income countries, where SSIs are the most frequently reported healthcare-associated infections. Across European hospitals, SSIs alone comprise 19.6% of all healthcare-acquired infections. Much of the scientific research in infection management in surgery is related to infection prevention and control in the operating room, surgical prophylaxis, and the management of SSIs, with many studies focusing on infection within the 30-day postoperative period. However it is important to note that SSIs represent only one of the many types of infection that can occur postoperatively. This article provides an overview of the surgical pathway and considers infection management and antibiotic prescribing at each step of the pathway. The aim was to identify the implications for research and opportunities for system improvement.
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