Mike Simmons and Sharon Daniel
Hywel Dda University Health Board
Hywel Dda University Health Board (HDUHB) acknowledged that infection in our elderly population arriving from primary to secondary care is a major concern with exponential numbers of Escherichia coli (E. coli) bacteraemia by the end of 2013.
They agreed to take a complexity approach to solving and set a target of reducing E. coli bacteraemia as a common patient-focused endpoint.
Initiatives to be tested by two competing rules:
- First do no harm; and
- Second, seek and take the positive action.
Quality Interventions Introduced:
- Enhanced laboratory reporting: educating to “nudge” requesting clinicians towards evidence based infection management.
- End user engagement in education sessions for GPs, secondary care, nursing and residential homes, frailty, diabetic, incontinence and other specialist services.
- Social media engagement as well as more direct targeted work with local population.
Fall in urine submissions (approx 12,000 per year) across HDUHB but primary loss is in negative samples: quality improvement through education of service users in when it is appropriate to send urine samples – positive samples continue at similar number per month.
E. coli bacteraemia rate plateau by end of 2015 and was maintained to end April 2016 but more recently has seen a further increase.
However, review of positive blood cultures across Wales shows a possible plateau now developing in the Hywel Dda population while other health board areas may be approaching the levels formerly only seen in Hywel Dda.
This Project Supports Prudent Healthcare:
- Goal one is, “First do no harm,” which is fundamental to Prudent principles.
- We have engaged in public with focus groups, readers panel, monthly public facing publication, blogging (http://phw.org.uk ) and Twitter.
- We are seeking to educate the use of nationally agreed approaches through education of teams in primary and secondary care to ensure a consistent, quality based approach to infection management.
Increased understanding of the infection management needs of patients in primary care.
- An increasingly knowledgeable patient population.
- Reduction in all aspects of infection through better management and reduction in E. coli bacteraemia as a surrogate marker of all infection but also seeing other infections decline. However, other markers are being reviewed as discussed and may prove a better marker of “all infections”.
- Empowerment of all staff in the understanding and management of all aspects of infection.
- Reduction in waste of NHS resources through more appropriate sampling practices and reduction in antimicrobial prescribing.