Department of Clinical Nursing, Kamuzu College of Nursing, University of Malawi, Blantyre, Malawi.
Department of Pharmacy, School of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
BMC Infect Dis. 2018 Dec 27;18(1):697. doi: 10.1186/s12879-018-3620-9.
Timely initiation of antibiotics within one hour of prescription is one of the recommended antibiotic stewardship interventions when managing patients with pneumonia in the emergency department. Effective implementation of this intervention depends on effective communication, a well-established coordination process and availability of resources. Understanding what may influence this aspect of care by using process mapping is an important component when planning for improvement interventions. The aim of the study was to identify factors that influence antibiotic initiation following prescription in the Adult Emergency and Trauma Centre of the largest referral hospital in Malawi.
We conducted a prospective observational case study using process mapping of two purposively selected adult pneumonia patients. One of the investigators CM observed the patient from the time of arrival at the triage area to the time he/she received initial dose of antibiotics. With purposively selected members of the clinical team; we used simple questions to analyze the map and identified facilitators, barriers and potential areas for improvement.
Both patients did not receive the first dose of antibiotic within one hour of prescription. Despite the situation being less than ideal, potential facilitators to timely antibiotic initiation were: prompt assessment and triaging; availability of different expertise, timely first review by the clinician; and blood culture collected prior to antibiotic initiation. Barriers were: long waits, lack of communication/coordinated care and competency gap. Improvements are needed in communication, multidisciplinary teamwork, education and leadership/supervision.
Process mapping can have a significant impact in unveiling the system-related factors that influence timely initiation of antibiotics. The mapping exercise brought together stakeholders to evaluate and identify the facilitators and barriers. Recommendations here focused on improving communication, multidisciplinary team culture such as teamwork, good leadership and continuing professional development.
在急诊科管理肺炎患者时，建议在开处方后 1 小时内及时开始使用抗生素，这是抗生素管理干预措施之一。这项干预措施的有效实施取决于有效的沟通、完善的协调流程和资源的可用性。通过流程映射了解哪些因素可能会影响这方面的护理，是规划改进干预措施的重要组成部分。本研究的目的是确定在马拉维最大转诊医院的成人急诊和创伤中心，影响处方后开始使用抗生素的因素。
我们使用了前瞻性观察性病例研究，对两名经过有目的选择的成人肺炎患者进行了流程映射。其中一名调查员 CM 从患者到达分诊区到接受初始抗生素剂量的时间全程观察患者。我们与经过有目的选择的临床团队成员一起，使用简单的问题来分析该流程图，并确定了促进因素、障碍因素和潜在的改进领域。
两名患者都没有在开处方后 1 小时内接受第一剂抗生素。尽管情况并不理想，但及时开始使用抗生素的潜在促进因素包括：快速评估和分诊；有不同的专业知识，临床医生及时进行首次审查；以及在开始使用抗生素之前采集血培养。障碍因素包括：长时间等待、缺乏沟通/协调护理和能力差距。需要在沟通、多学科团队合作、教育和领导力/监督方面进行改进。
流程映射可以对影响抗生素及时使用的系统相关因素产生重大影响。该映射练习将利益相关者聚集在一起，以评估和确定促进因素和障碍因素。这里的建议侧重于改善沟通、多学科团队文化，例如团队合作、良好的领导力和持续的专业发展。
