Delivering the 48-hour antimicrobial review on inpatient drug charts.

BACKGROUND: Prolonged or inappropriate antibiotic therapy increases the risk of health-care-associated infections and the development of resistance to antibiotics, and lengthens hospital admissions. There are clear guidelines on antimicrobial stewardship which state that antibiotics should be reviewed between 48 and 72 hours from commencement ( National Institute of Health and Care Excellence, 2015 ). Despite these guidelines this review was often not documented as having been carried out on the authors' inpatient wards. METHODS: A quality improvement project was undertaken with the aim of improving the percentage completion of the 48-hour antimicrobial review box section of the inpatient drug charts to over 90% across two 30-bed acute respiratory wards within 7 weeks. The primary outcome measures were percentage completion of 48-hour antibiotic review and number of days on intravenous antibiotics. The quality improvement programme took place over 7 weeks and included seven interventions designed to improve completion of the 48-hour review. RESULTS: During the study, the percentage completion of 48-hour review rose from a baseline median of 68% to 100% and was accompanied by a reduction in the number of days on intravenous antibiotics from a baseline median of 2.25 days to 1.5 days. CONCLUSIONS: This simple quality improvement project led to a greatly improved review of antimicrobial therapy which was associated with significantly reduced time on intravenous antibiotics. The quality improvement methodology could easily be adapted for other inpatient medical wards.

Lack of effect of influenza immunisation on anticoagulant control in patients on long-term warfarin.

PURPOSE: The effect of influenza vaccination on oral anticoagulant control is uncertain but important to establish since anticoagulants are widely used and most patients taking them are candidates for immunisation because of age or underlying cardiac disease. We therefore prospectively evaluated the effect of influenza vaccination on International Normalised Ratio (INR) control in patients on long-term warfarin. METHODS: We undertook a prospective audit of patients on long-term warfarin attending a single hospital anticoagulant clinic who reported receiving influenza vaccination within the 10 days prior to a clinic visit. We compared the stability of anticoagulant control in the 12 months prior to and 10 days after immunisation, restricting analysis to those patients whose warfarin dosage was unchanged before and after vaccination. RESULTS: Of 106 consecutive patients who reported receiving influenza vaccination within the 10 days prior to a clinic visit, results were evaluable in 78 because the dose of warfarin was unchanged before and after vaccination. Influenza immunisation had no apparent effect on anticoagulant control. No bleeding or thrombotic complications were reported. CONCLUSIONS: Our findings suggest that it is not necessary to routinely monitor the INR more closely after influenza vaccination.