5PSQ-070 Prompt switching of intravenous to oral antibiotics – a quality improvement approach

<h3>Background and Importance</h3> NHS England identified a Commissioning for Quality and Innovation (CQUIN) indicator for Intravenous antibiotics to oral switch (IVTOS). After the pandemic the use of antibiotics increased in our Trust. Evidence shows benefits to IVTOS: increase bed capacity, optimise administration nurse’s time in preparing and administering antibiotics as well as reducing carbon footprint of medicines and reducing infections from the IV site. <h3>Aim and Objectives</h3> To identify the number of patients on intravenous (IVA) antimicrobials that could be eligible for oral switch, aligning with Commissioning for Quality and Innovation (CQUIN) indicators, as per national recommendations about IVTOS to be considered within 48 hours of the first dose of IV antimicrobial being administered. <h3>Material and Methods</h3> Snap tool designed to conduct audit on adult wards quarterly (aiming to include 100 patients’ each quarter). Patients had to be on IVA for a minimum of 48 hours. Collaboratively auditors were clinical nurses, pharmacist and junior doctors at each quarter, including 3–5 patients on IVA per ward. If the defined IVTOS criteria were met, the patient was considered eligible for IVTOS: <b>AFEBRILE:</b> Temperature 36–38 for past 24 hours <b>CLINICALLY IMPROVING:</b> Clinical signs and symptoms of infection are improving, reduction in NEWS score, WCC trending normal, CRP decreasing <b>EATING AND DRINKING:</b> Patient is tolerating oral food or enteral feeding. No vomiting within last 24 hours. No evidence of malabsorption <b>NO DEEP-SEATED INFECTION</b>: Not at high-risk of deep-seated infection i.e. endocarditis, blood stream infection, empyema, meningitis, severe or necrotising soft-tissue infection, septic arthritis or undrained abscess <h3>Results</h3> A total of 443 patients were audited. The patients receiving IVA that met criteria for IVTOS were reduced. One in four patients remained on IVA past the criteria for switching in Q1. The year ended with 1 in 6 patients remaining on IVA past the criteria for switching. <h3>Conclusion and Relevance</h3> Collaborative approach auditing in a multidisciplinary way showed engagement and a reduction of patients eligible to IVTOS. <h3>References and/or Acknowledgements</h3> National antimicrobial intravenous-to-oral switch (IVOS) criteria for early switch - GOV.UK (www.gov.uk)Improving Antimicrobial Use to Protect the Environment: What Is the Role of Infection Specialists? - PMC (nih.gov)British Journal of Nursing - Saving time when preparing intravenous antibiotics <h3>Conflict of Interest</h3> No conflict of interest