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Title: | Root cause analysis to identify medication and non-medication strategies to prevent infection-related hospitalizations from australian residential aged care services. | Authors: | Cooper T.;Bell J.S.;Robson L.;Cairns K.A.;Visvanathan R.;Ilomki J.;Sluggett J.K.;Lalic S.;Hosking S.M.;Ritchie B.;McLoughlin J.;Shortt T. | Monash Health Department(s): | Pharmacy | Institution: | (Sluggett, Lalic, Hosking, Ilomki, Bell) Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia (Sluggett) University of South Australia, Adelaide 5001, Australia (Sluggett, Bell) NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby 2077, Australia (Lalic) Pharmacy Department, Monash Health, Melbourne 3168, Australia (Hosking, Visvanathan, Bell) National Health and Medical Research Council of Australia Centre of Research Excellence in Frailty and Healthy Aging, Adelaide 5005, Australia (Ritchie) Infectious Diseases Department, Women's and Children's Hospital, Adelaide 5006, Australia (McLoughlin, Shortt, Robson, Cooper) Resthaven Incorporated, Adelaide 5034, Australia (Cairns) Pharmacy Department, The Alfred, Alfred Health, Melbourne, VIC 3181, Australia (Ilomki, Bell) Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia (Visvanathan) School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5005, Australia (Visvanathan) Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, SA Health, Adelaide 5011, Australia | Issue Date: | 23-May-2020 | Copyright year: | 2020 | Publisher: | MDPI AG (Postfach, Basel CH-4005, Switzerland. E-mail: rasetti@mdpi.com) | Place of publication: | Switzerland | Publication information: | International Journal of Environmental Research and Public Health. 17 (9) (no pagination), 2020. Article Number: 3282. Date of Publication: 01 May 2020. | Journal: | International Journal of Environmental Research and Public Health | Abstract: | Infections are leading causes of hospitalizations from residential aged care services (RACS), which provide supported accommodation for people with care needs that can no longer be met at home. Preventing infections and early and effective management are important to avoid unnecessary hospital transfers, particularly in the Australian setting where new quality standards require RACS to minimize infection-related risks. The objective of this study was to examine root causes of infection-related hospitalizations from RACS and identify strategies to limit infections and avoid unnecessary hospitalizations. An aggregate root cause analysis (RCA) was undertaken using a structured local framework. A clinical nurse auditor and clinical pharmacist undertook a comprehensive review of 49 consecutive infection-related hospitalizations from 6 RACS. Data were collected from nursing progress notes, medical records, medication charts, hospital summaries, and incident reports using a purpose-built collection tool. The research team then utilized a structured classification system to guide the identification of root causes of hospital transfers. A multidisciplinary clinical panel assessed the root causes and formulated strategies to limit infections and hospitalizations. Overall, 59.2% of hospitalizations were for respiratory, 28.6% for urinary, and 10.2% for skin infections. Potential root causes of infections included medications that may increase infection risk and resident vaccination status. Potential contributors to hospital transfers included possible suboptimal selection of empirical antimicrobial therapy, inability of RACS staff to establish on-site intravenous access for antimicrobial administration, and the need to access subsidized medical services not provided in the RACS (e.g., radiology and pathology). Strategies identified by the panel included medication review, targeted bundles of care, additional antimicrobial stewardship initiatives, earlier identification of infection, and models of care that facilitate timely access to medical services. The RCA and clinical panel findings provide a roadmap to assist targeting services to prevent infection and limit unnecessary hospital transfers from RACS.Copyright © 2020 by the authors. Licensee MDPI, Basel, Switzerland. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.3390/ijerph17093282 | PubMed URL: | 32397193 [http://www.ncbi.nlm.nih.gov/pubmed/?term=32397193] | ISSN: | 1661-7827 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/29294 | Type: | Article | Subjects: | trimethoprim/dt [Drug Therapy] aged article Australia cellulitis/di [Diagnosis] cellulitis/dt [Drug Therapy] clinical protocol conceptual framework disease classification dysphagia health care access health care delivery health care need *hospital infection/di [Diagnosis] *hospital infection/dt [Drug Therapy] *hospitalization human long term care methicillin resistant Staphylococcus aureus patient transport physiotherapy pneumonia/di [Diagnosis] pneumonia/dt [Drug Therapy] polypharmacy *residential home respiratory tract infection/di [Diagnosis] respiratory tract infection/dt [Drug Therapy] root cause analysis urinary tract infection/di [Diagnosis] urinary tract infection/dt [Drug Therapy] urosepsis/di [Diagnosis] urosepsis/dt [Drug Therapy] vancomycin resistant Enterococcus cephalosporin/dt [Drug Therapy] macrolide/dt [Drug Therapy] nitrofurantoin/dt [Drug Therapy] oseltamivir/dt [Drug Therapy] penicillin derivative/dt [Drug Therapy] trimethoprim aged Australia cellulitis clinical protocol conceptual framework disease classification dysphagia health care access health care delivery health care need hospital infection hospitalization long term care methicillin resistant Staphylococcus aureus patient transport physiotherapy pneumonia polypharmacy residential home respiratory tract infection root cause analysis urinary tract infection urosepsis vancomycin resistant Enterococcus cephalosporin macrolide nitrofurantoin oseltamivir penicillin derivative health care access health care delivery health care need *hospital infection / *diagnosis / *drug therapy *hospitalization human long term care methicillin resistant Staphylococcus aureus patient transport physiotherapy pneumonia / diagnosis / drug therapy polypharmacy *residential home vancomycin resistant Enterococcus urinary tract infection / diagnosis / drug therapy root cause analysis urosepsis / diagnosis / drug therapy aged Article Australia cellulitis / diagnosis / drug therapy clinical protocol conceptual framework disease classification dysphagia respiratory tract infection / diagnosis / drug therapy |
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