Spanish adaptation of the Start Smart-Then Focus tool for optimizing the use of antimicrobials.

OBJECTIVE: The Start Smart-Then Focus tool of the United Kingdom's National Health System is a tool to be implemented in antimicrobial stewardship programs. The objective of this work is the adaptation of Start Smart-Then Focus tool to the Spanish health system. METHOD: Delphi methodology was used. Two rounds were conducted by  email. In the first, a questionnaire was sent out that included the criteria of the tool. These criteria were independently assessed by 16 experts. They rated the suitability and applicability of each criterion on a scale from 1 to 9 and made free comments on each one. The tool was modified and sent out again to all the experts. They re-scored the questionnaire individually, while aware of the anonymized results of the first round. RESULTS: The first questionnaire was made up of 19 indicators. Of these, 16 indicators had a median of more than 7 in suitability and applicability. However, regarding applicability, 3 indicators had a median of less than 7 and 10 had a minimum of less than 5. From the initial 19 indicators, we obtained 8 final indicators and 8 options were added to the sixth indicator. CONCLUSIONS: It would be very useful to implement the Spanish adaptation of the Start Smart-Then Focus tool in antimicrobial stewardship programs at a national level. It would also contribute to improving the use of antimicrobials.

Objetivo: La herramienta Start Smart-Then Focus del Sistema Nacional de Salud de Reino Unido es una herramienta de ayuda de los programas de optimización de antibióticos. El objetivo de este trabajo es la adaptación de la herramienta Start Smart-Then Focus al sistema de salud  español.Método: Se utilizó la metodología Delphi, mediante dos rondas de evaluación por correo electrónico. En la primera se envió un cuestionario con los criterios de la herramienta, estos fueron evaluados de  forma independiente por 16 expertos. Puntuaron de 1-9 la idoneidad y  aplicabilidad de cada criterio, y realizaron comentarios libres. La  herramienta fue modificada y enviada de nuevo a todos los expertos, volvieron a puntuar individualmente, pero conociendo los resultados de la primera ronda.Resultados: El primer cuestionario estaba constituido por 19 indicadores; 16 indicadores obtuvieron una mediana mayor de 7 en idoneidad y aplicabilidad, 3 indicadores obtuvieron mediana menor de 7 y  10 indicadores con mínimos menores de 5 en aplicabilidad. De 19 indicadores iniciales pasamos a 8; con 8 opciones dentro del sexto  indicador.Conclusiones: La adaptación de la herramienta Start Smart-Then Focus a nivel nacional puede ser de utilidad para implantarla en los programas de optimización de antibióticos y contribuir a la mejora del uso de los antimicrobianos.

The impact of implementing a pharmacy technician role as part of a nursing team in an acute admissions unit.

Background: The National Patient Safety Agency reported over 20 000 safety incidents over a 3-year period, including 68 severe harms and 27 deaths. Dose delays and omissions persistently contributed to more than 50% of the reported incidents. Methods: A pilot was designed and data were collected before and after to measure how these ward-based technician roles affected the reporting of omitted or delayed doses, time efficiency, cost implications and the general productivity of the ward. Results: Three months after the start of the pilot, omitted doses were reduced from 14% to 5% and no incidents of harm had been reported. The 'perfect medication ward round' with no interruptions lasted 23 min compared with the longest medication ward round which lasted 116 min and was interrupted 11 times. Conclusions: The pilot shows that the introduction of pharmacy technicians results in fewer omitted doses and also addresses persistent staffing issues by ensuring better use of nursing time.

Audit of a multidisciplinary approach to improve management of community-acquired pneumonia.

BACKGROUND: Community-acquired pneumonia (CAP) is a frequent cause of morbidity, mortality and hospital admission worldwide. An adequate choice of empirical antibiotic treatment and appropriate severity assessment of the disease are key aspects in the management of CAP. OBJECTIVE: To audit the adherence to standards of care, such as empirical prescribing of antibiotics, and evaluate the current multidisciplinary approach to the management of CAP. METHOD: Records of patients with CAP were identified and examined for CURB65 score documentation, discussion notes with microbiology and prescribed antibiotic treatments. RESULTS: Out of the 62 patients identified, 32 had a CURB65 score documented in their medical notes and 59 had documented chest X-ray findings. 85.5% of cases were compliant with antibiotic prescribing guidelines. CONCLUSION: The multidisciplinary approach has considerably improved compliance with most of the standards, especially adherence to empirical antibiotic guidelines, and ultimately the standard of care for patients with CAP.