1208 / Management optimization of patients with bacteremia

SPAIN
Classification of the PSP
Type of Patient Safety Practice Potentially Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Infection control / Prevention of surgical site infections
Preventing sepsis There is no specified text here
Topic of the reported practice
Clinical guidelines or pathways
Aim and the benefit of the Patient Safety Practice
 
To get better clinical outcomes of patients with bacteremia.
To optimize the use of antimicrobials in patients with bacteremia.
To assess the adequacy and implementation of the recommendations of empirical antimicrobial treatment.
Description of the Patient Safety Practice
 
Task 1. Identification and notification of bacteremia. 1.1• The identification and notification of bacteremia is a function of the microbiology. 1.2• The notification will take place daily (Monday to Friday) at the meeting of bacteremia advisers team. When a new bacteremia is detected, the microbiology will contact with the clinic adviser. Task 2. Analysis of available information about the episode (bacteremia). 2.1• We will proceed to the analysis of the most relevant information about the episode of bacteremia available in different information systems which are accessed from the hospital. This may include: 1. Emergency reports, hospitalization and consultations 2. Nursing information 3. Antibiotic prescription information 4. Information laboratory determinations and microbiological 5. Primary Care information. 2.2• The purpose of the first evaluation of the available information to make an approach to: 2.2.1. The severity of the episode: assessment of hemodynamic status and the presence of organ failure . 2.2.2. The most likely source of infection and possible steps to control the focus 2.2.3. The risk of antimicrobial resistance (acquisition place and existence of individual risk factors). 2.2.4. The risk of treatment failure. 2.2.5. The risk and consequences of inappropriate treatment. 2.3• The analysis of the available information should preferably be during the daily meeting with the participation of the adviser team: microbiology and clinic. 2.4• After the assessment by the team, the type of interaction with the patient's clinical service charge will be decided. • Task 3. Interaction between the advisor team with the clinical service responsible the patient with bacteremia. 3.1• Telephone contact by the Service of Microbiology for notification of the episode. It should record the moment of contact and the identity of the person to whom the information is transmitted. 3.2• Contact the clinic’s team. The aim is to discuss the different therapeutic (and occasionally diagnostic) options with physicians responsible for the patient. The interaction of the clinic's team is a continuum that ranges from the re-notification of the event until the formal interconsultation, to demand the physician responsible for the patient. This interaction also includes other intermediate options: 1. The distribution of printed material or reminder formative intention. 2. Discussion about doubts that the doctor responsible for the patient wants to raise. 3. Systematic review of the principles of diagnostic evaluation and therapeutic anti-infective applicable to the case. Task 4. Record the information for the episode The registration information includes the following: 1. Affiliation episode 2. Evaluation of infection 3. Patient Characteristics 4. Clinical Management 5. Antimicrobial treatment 6. Clinical course (at 30 and 60 days from the date of obtaining the blood culture) Task 5. Evaluation. 5.1. Activity indicators 5.1.1. Absolute number of bacteremia evalued by advisers team 5.1.2. Proportion of bacteremia evaluated (Bacteremia evaluated / bacteremia evaluable). 5.1.3. Absolute number of bacteremia in hospitalized patients not evaluated by the advisers team. 5.1.4. Proportion of bacteremia in not admitted patients evaluated by the advisers team. (Bacteremia in not admitted patients evaluated / bacteremia in patients not admitted) 5.2. Process indicators (specific microorganism) 5.2.1. Proportion of eligible patients with bacteremia in which formally interconsultation is made. 5.2.2. Proportion of patients with S. aureus bacteremia with control blood cultures. 5.2.3. Proportion of patients with S. aureus bacteremia with echocardiogram during the episode (before suspension of antibiotics). 5.2.4. Proportion of patients with bacteremia sensitive S. aureus treated with cloxacillin / cefazolin. 5.2.5. Proportion of patients with candidemia to control blood cultures. 5.2.6. Proportion of patients with candidemia with fundus examination. 5.2.7. Proportion of patients with candidemia by susceptible strains to fluconazole treated with fluconazole 5.2.8 Proportion of patients with bacteremia detected after discharge that they are referred to the ER 5.3. Outcome indicators * * For each of the 5 most common organisms (also include Candida and comprehensively all bacteremia in patients discharged). 5.3.1. 30-day mortality 5.3.2. Mortality at 60 days 5.3.3. Initial hospital stay after intervention (median; IQR25-75) 5.3.4. Transfer to ICU from 48 hours after the initial intervention 5.3.5. Hospital readmission within 30 days of discharge
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
There is no specified text here
There is no specified text here
There is no specified text here
Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, partly
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Not known
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
No
Evaluation of a "positive" effect of the reported practice on Patient Safety
Effect not known or the intervention has not yet been evaluated
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
The implementation has been recent and still not have results
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Pharmacists
Clinical manager
Quality manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Motivated staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
Yes
Total number of person days required to implement this Patient Safety Practice
Clinical staff: 30
External consultants: 2
Support staff: 30
Managerial staff: 5
Others: 0
Not relevant: 0
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: 40
External consultants: 2
Support staff: 10
Managerial staff: 10
Others: 0
Not relevant: 0
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
3000
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
0
Contact information
 
Name: JULIAN MOZOTA
Country: SPAIN
Organisation: SERVICIO ARAGONÉS SALUD
E-mail: jmozota@salud.aragon.es
Phone: 976 76 88 41
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