EBP II PRESENTATION. Autumn Burns

Transcription

1 EBP II PRESENTATION Autumn Burns

2 INTRODUCTION v PICO question: In adult heart transplant patients receiving antibiotic medications does prophylactic Lactobacillus probiotic therapy versus no probiotic therapy decrease the risk of developing antibiotic-associated diarrhea (AAD). v This power point will discuss the plan for Implementation and Evaluation for this PICO question

3 IMPLEMENTATION PLAN v Will be initiated on Heart and Lung Transplant ICU at UAB Hospital in Birmingham, al v Target population Will include heart transplant patients Will require patients to be initiated on antibiotic therapy with hours Ideally will all be inpatient Ideally will be on similar antibiotics, such as Vancomycin

4 IMPLEMENTATION PROCESS v Patients will be given a log to use as a daily journal for documentation Bowel movement consistency, color, and frequency Other symptoms experienced, such as nausea or vomiting Compliance with taking probiotics

5 PLAN SPECIFICS v Patients will be given a log to use as a daily journal for documentation Bowel movement consistency, color, and frequency Other symptoms experienced, such as nausea or vomiting Compliance with taking probiotics v Diarrhea would be characterized as three or more loose stools occurring for more than 48 hours v These patients will then need to get a stool sample performed This is to ensure that patient s are not developing a more serious illness from antibiotic-associated diarrhea (AAD), Clostridium difficle

6 ANTICIPATED BARRIERS v Patients that will be discharged I am going to attempt to pick patients that will be hospitalized longer to try to ensure that most of their antibiotic therapy will be received in the hospital setting v Nurse documentation While the patient is an inpatient, I have to rely on nursing documentation I plan to have an educational in-service to inform nurses of the changes that will come with the study and the importance of their diligence v Patient compliance I plan to communicate frequently, at least weekly, with these patients to promote compliance I will also provide patient s with multiple ways to contact me

7 TEAM/STAKEHOLDERS v Dr. Pamboukian, Heart failure attending v Kathy Eppers, HTICU Pharmacist v Kelsey Blair, HTICU Pharmacist v Jody White, Nurse Manager

8 OUTCOMES ACHIEVED v Decreased incidence of antibiotic-associated diarrhea Research supports that probiotics decrease the incidence of AAD At this point, there is no research that involves the use of probiotics in heart failure/heart transplant patients v Decreased length of hospital stay This will increase patient satisfaction and decrease overall costs for th hospital This also decrease the potential for patient s developing another illness, such as sepsis. This again will decrease costs for the hospital.

9 NEED FOR A CHANGE v In a meta-analysis performed on probiotics and the prevention of AAD, the outcome of that study showed the consequences of AAD and Clostridium difficle disease (CDD) extended hospital stays three to seven days, increased rates of subsequent infections by 20% 65%, increased two to three time the mortality rates, and increased hospital cost up to one billion per year (McFarland, 2006, pg.1).

10 EVALUATION METHODS v Patient compliance documented through the patient s diary and through phone interviews/face-to-face interviews Phone interviews will be conducted weekly if the patients are discharged Face-to-face interviews will be conducted with patients that are inpatient once weekly Dairies will be collected at the end of the trial The trial will extend up to two months Studies show that AAD can occur up to two months after antibiotic therapy is completed (Jones, 2010).

11 DATA ANALYSIS v Data analysis will be completed at the end of the test of change v This data will be interpreted and then compiled in an easy to read graph using excel v This information will then be presented to the stakeholders v It is my hope that the results will facilitate a unit policy to add probiotic therapy for patients receiving antibiotic medication

12 QUESTIONS v Do you think that I should include left ventricular assist device and lung transplant patients? One of the reasons that I would be considering this, would be to be able to potentially use patients that are on the same antibiotic regimen. v Do you think that two months is a practical time frame? v Questions, comments, or concerns??

13 REFERENCE McFarland, L.V. (2006). Meta-analysis of probiotics for the prevention of antibiotic-associated diarrhea and the treatment of clostridium difficle disease. American Journal of Gastroenterology. Doi: /j x Jones, K. (2010). Probiotics: Preventing antibiotic-associated diarrhea. Journal for Specialists in Pediatric Nursing, 15(1), Doi: /j x