Improving IV antibiotic use; the role of the nurse课件.ppt

Improving IV antibiotic use; the role of the nurse Overview Introduction; the problems The solutions Empiric antibiotic policy Improving IV vancomycin and gentamicin use IVOST Alert antibiotics Summary and questions Introduction: the problems ~1/3 of inpatients will receive an antibiotic ~1/3 of antibiotics given via the IV route ~40% of the drug budget spent on antibiotics Empiric antibiotic policy Improving IV vancomycin and gentamicin use Vancomycin and gentamicin use Narrow therapeutic index agents Nephrotoxic and ototoxic When given IV, monitoring and interpretation of blood levels essential for safe and effective use Getting it right 1 Is the prescription clear? Dose frequency (especially if 48 hourly/stat dose) Is the dose reasonable? Shared responsibility ( liability) Gentamicin usually 180-400mg dose Vancomycin usually 500-1500mg dose Do you need to speak to the doctor? Levels not being checked Significantly delayed dose (e.g. lost IV access) Prescribed in ‘once only’ section unsure if ongoing Is it OK to dose after level taken? Getting it right 2 Use the Administration Recording Charts Essential for safe and effective treatment Record accurate infusion start and stop times Space to record accurate sample times for levels Gentamicin Infuse over 30-60 minutes Check the level after the initial dose then at least every 2-3 days See information sheet for further details Getting it right 3 Vancomycin Beware of loading doses prescribed in the ‘once only’ section Intermittent infusion; maximum 500mg/hour Vancomycin continuous infusion; 24 hour dose split into 2 equal 12 hour continuous infusions Levels are required if given IV (not for PO) Check the level within the first 12-48 hours then at least every 2-3 days See information sheet for further details IVOST IVOST Guideline IVOST = IV to oral switch therapy IV antibiotic therapy often prolonged unnecessarily in hospital Increased risk of line infection bacteraemia Increased length of stay In