In order to measure and improve key aspects of our care delivery, Mediclinic has developed a strong focus on clinical performance.
These case studies demonstrate how we constantly monitor and develop our clinical performance to ensure we provide the best possible care for our patients.
ANTIBIOTIC STEWARDSHIP PROGRAMME
Andriette van Jaarsveld, Clinical Pharmacy Specialist at Mediclinic Southern Africa, explains how the Antibiotic Stewardship Programme has reduced the inappropriate use of certain antibiotics for surgical prophylaxis and has reduced the unnecessary use of multiple drugs in treatment.
Studies have shown that hospital-based programmes dedicated to improving antibiotic use, known as Antibiotic Stewardship Programmes (ASPs), can both optimise the treatment of infections and reduce adverse events associated with antibiotic use.
In 2010, South Africa had only a few ASPs at specific hospitals. In addition, there was a limited number of the recommended specialist resources (such as infectious disease specialists and clinical pharmacists) needed for ASPs.
In 2011, Mediclinic introduced ASPs to all 52 hospitals.
We identified three key focus areas to measure:
- Inappropriate antibiotic drug choices for surgical prophylaxis
- Prolonged antibiotic therapy
Pharmacists’ are in the ideal position to intervene and prevent unnecessary antibiotic use. In Mediclinic we use qualified clinical pharmacists as well as ward and general pharmacists in the programme. A clinical pharmacist has a post graduate degree in clinical pharmacy and a ward pharmacist is a qualified pharmacist with an interest in clinical pharmacy.
All of these pharmacists attend regular training workshops. Based on international references and consultation with local experts, a guideline on the use of antibiotics for surgical prophylaxis was compiled. The pharmacists use this reference as a starting point for their hospital programmes.
MEASUREMENT AND RESULTS
Antibiotic usage data was collected electronically from January 2010 from pharmacy billing data. The results found that:
- The average percentage of surgical cases with an inappropriate antimicrobial drug choice for surgical prophylaxis has decreased from 18% to 3% in June 2019
- The duration of antimicrobial treatment longer than 7 days improved by 22.3% from 9.97 – 7.71 per 1000 patient days.
The graph below depicts the reduction in inappropriate Surgical Prophylaxis drug choice between 2013 and 2019. The current rate of 3% has been maintained for the past 2 years.
PERCENTAGE OF INAPPROPRIATE SURGICAL PROPHYLAXIS FROM JANUARY 2013 - DECEMBER 2019
Clinical and ward pharmacists equipped with evidence-based guidelines and a uniform measurement report helped to improve Antibiotic Stewardship in both these target areas. The automated electronic data reports we introduced have been essential in helping us evaluate progress; identify problem areas where attention should be given in future; facilitate discussions in the hospitals between the doctors, clinical pharmacists and other health care professionals; and show the way forward with the Antibiotic Stewardship Programme.
Carina van der Walt, Patient Safety Manager at Mediclinic Panorama, explains how anti-fall protocol has reduced the number of fall-related injuries at the hospital.
The US Centres for Disease Control and Prevention (CDC) has identified fall-related injuries as a serious healthcare issue.
The World Health Organization (WHO) and other agencies have made fall prevention a priority in ensuring patient safety.
The international guideline for reducing the risk of patient falls is to:
- Inappropriate antibiotic drug Assess and identify patients that are at high risk of falling.
- Develop the necessary precautions to address the risks identified.
From 2009 to 2013 Mediclinic Panorama had an average rate of 138 patient falls per year. During that time, protocols to identify patients at risk of falling were not well embedded and standard precautions throughout all units to prevent patient falls were not well established.
At the beginning of 2014, a Fall Task Team was established, comprising of a nursing manager, risk manager, clinical facilitator, unit managers, physiotherapist and registered nurses.
The team used the framework provided by the Institute for Healthcare Improvement (IHI) ‘Model for Improvement’ to tackle the problem at hand. Through this structured quality improvement process the team identified five focus areas:
- Fall risk assessment
- Standard precautions
- High fall risk precautions
- Identifying high fall risk patients
- Patient and family education regarding fall risk and fall precautions
The solutions designed were first tested in a single ward and changes and adjustments were then made in response to the findings. A fall prevention protocol was then drawn up and actioned in all hospital wards at Mediclinic Panorama.
Current fall prevention protocol includes:
- Fall risk assessment on admission of each patient. This risk is re-assessed post-operatively, on transfer, post-fall or when the patient’s condition changes.
- Standard precautions are applied for all patients. High fall risk precautions are applied if the patient is assessed as a high fall risk.
- Where possible, the patient and family are educated regarding fall risk during the fall risk assessment. Precautions are put in place.
- High fall risk patients are identified with a yellow ID band, a yellow sticker on daily nursing care plan and a yellow poster above bed. The patient’s fall risk is also identified on the diet list. Yellow rubber-soled socks are made available to the patient.
Each patient fall is investigated. System analysis determines where the flaw in system occurred. Patient Safety Managers are actively involved in investigating patient falls to ensure the correct contributing factors are identified and that effective action and education is implemented to prevent future patient harm.
2009 – 2013: 1.54 patient falls per 1000 bed days
2014 – 2018: 1.038 patient falls per 1000 bed days
January 2019 – September 2019: 0.8 patient falls per 1000 bed days
CHALLENGES AND LESSONS LEARNT
There must be a constant focus on preventing patient falls. Regular audits have to be done in wards to ensure patients are assessed correctly regarding their fall risk. There is no room for complacency, especially when results are good. Each patient fall, with or without injury, must be managed as a possible patient safety event.