Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK.
BMJ Open Qual. 2022 Sep;11(3). doi: 10.1136/bmjoq-2022-001886.
COVID-19 management guidelines are constantly evolving, making them difficult to implement practically. was a neutralising monoclonal antibody introduced into UK COVID-19 guidelines in 2021. It reduces mortality in seronegative patients infected with non-omicron variants. Antibody testing on admission is therefore vital in ensuring patients could be considered for as inpatients.
We found that on our COVID-19 ward, 31.4% of patients were not having anti-S tests despite fulfilling the other criteria to be eligible for . This was identified as an important target to improve; by not requesting anti-S tests, we were forgoing the opportunity to use an intervention that could improve outcomes.
We analysed patient records for patients with COVID-19 admitted to our ward over 4 months to observe if awareness of the need to request anti-S increased through conducting plan-do-study-act (PDSA) cycles.
Our first intervention was an multidisciplinary team (MDT) discussion at our departmental audit meeting highlighting our baseline findings and the importance of anti-S requesting. Our second intervention was to hang printed posters in both the doctors' room and the ward as a visual reminder to staff. Our final intervention was trust-wide communications of updated local COVID-19 guidance that included instructions for anti-S requesting on admission.
Our baseline data showed that only 68.6% of patients with symptomatic COVID-19 were having anti-S antibody tests requested. This increased to 95.0% following our three interventions. There was also a reduction in the amount of anti-S requests being 'added on', from 57.1% to 15.8%.
COVID-19 guidelines are constantly evolving and require interventions that can be quickly and easily implemented to improve adherence. Sustained reminders through different approaches allowed a continued increase in requesting. This agrees with research that suggests a mixture of educational sessions and visual reminders of guidelines increase their application in clinical practice.
COVID-19 管理指南在不断演变，这使得它们在实际执行中变得困难。在 2021 年，一种中和单克隆抗体被引入英国 COVID-19 指南。它降低了感染非奥密克戎变异株的血清阴性患者的死亡率。因此，入院时进行抗体检测对于确保患者可以被考虑作为住院患者接受至关重要。
我们发现在我们的 COVID-19 病房中，尽管符合其他标准有资格使用 ，但仍有 31.4%的患者没有进行抗-S 检测。这被确定为一个需要改进的重要目标；由于没有要求进行抗-S 检测，我们错过了使用可能改善结果的干预措施的机会。
我们分析了在我们病房住院的 COVID-19 患者的病历，以观察通过进行计划-执行-研究-行动（PDSA）循环是否增加了对需要请求抗-S 的认识。
我们的第一个干预措施是在部门审计会议上进行多学科团队（MDT）讨论，突出了我们的基线发现和请求抗-S 的重要性。我们的第二个干预措施是在医生办公室和病房内悬挂印刷海报，以提醒工作人员。我们的最后一个干预措施是在整个信托范围内传达更新的本地 COVID-19 指南，其中包括入院时请求抗-S 的说明。
我们的基线数据显示，只有 68.6%的有症状 COVID-19 患者接受了抗-S 抗体检测请求。在我们的三项干预措施之后，这一比例增加到 95.0%。“添加”的抗-S 请求数量也从 57.1%减少到 15.8%。
COVID-19 指南在不断演变，需要能够快速、轻松实施的干预措施来提高其依从性。通过不同方法持续提醒，允许请求的持续增加。这与研究结果一致，即教育课程和指南的视觉提醒的组合可以增加它们在临床实践中的应用。
