Buckinghamshire Healthcare NHS Trust: Using the Tendable app to host and create Antibiotic Care Bundle audits

Background:

Buckinghamshire Healthcare NHS Trust (BHT) is an integrated provider of acute hospital and community services for people living in Buckinghamshire as well as some people living across the borders in surrounding counties.

We provide care to over half a million patients every year in our hospitals, community settings and in people’s own homes. With more than 6,000 staff including clinical colleagues, such as doctors, nurses, midwives, health visitors, therapists, support workers and healthcare scientists, all supported by corporate and administrative

colleagues. Our vision is to provide outstanding care, create healthy communities as our patients are at the heart of everything that we do, providing you with safe and compassionate care, every time.

The challenge:

Previously, BHT used a paper-based version of this tool, which involved monthly data collection from wards. However, the feedback to clinicians was delayed due to the labour-intensive process of creating graphs and reports from paper ACB audits.

The solution:

The digital ACB audit was implemented in 2020 for use on in-patient areas throughout BHT and aims to prioritise patient safety and quality.

Tendable allows ACB audit reports to be produced in real time, identifying areas of best practise and highlighting areas for improvement which can be discussed with the multi-disciplinary teams working on the wards at the time of the audit.

The ACB audit tool was designed to consider individual elements of antimicrobial prescribing, which incorporates the right drug, right dose, right route, right duration, right time, as well as interventions delivered together as a care bundle to optimise antimicrobial use and balance the benefits and risks of use to patients.

Antimicrobials delivered by the right route and for the right duration, dfrees up time to care and enables patients to go home quicker. This is in addition to reducing the costs and side-effects associated with excess treatment.

An overall score is generated for comparison with other areas and over time. This demonstrates concordance with the Health and Social Care Act 2008, Criterion 3 - To ensure appropriate antimicrobial use and stewardship to optimise service user outcomes and to reduce the risk of adverse events and antimicrobial resistance.

The innovative system offers data capture through photos to illustrate examples of good or poor antimicrobial prescribing.

Outcomes

The audit reports are used to generate action plans for AMS, which are presented to the Infection Prevention and Control (IPC) Committee by each Service Delivery Unit. The report from these IPC meetings are then fed into a Trust board for assurance purposes. For example, the Head of Nursing for Integrated Elderly and Community Care found that:

"The results of those audits indicated a concern relating to red wrist bands (which are used to identify patients with an allergy) not being worn… these concerns culminated into a risk where we, as a division, were not assured of the practice in our wards and departments relating to the identification and management of allergies"

This prompted a review of practices and a deep dive into allergies with a subsequent change to Trust policy and the introduction of a new guideline. Since Tendable allows photographs to be taken, this feature is used to provide visual examples to illustrate good and poor practices and they are used in education and training sessions.

What's next?

With the introduction of updated “Start Smart then Focus” guidance from UKHSA in September 2023, the ACB audit tool has been updated in line with the latest recommendations as this audit tool evolves with the latest evidence-base. It is hoped that these questions will prompt IV to oral switching when suitable.

Tendable also hosts other audits such as Medicines Management and IPC audits, providing evidence on performance in these areas to enable a more holistic overview of clinical governance for the organisation.

In some areas, Tendable champions have been identified, who share the audit reports with teams and at safety huddles to highlight opportunities for improvement.