Trust Guideline for the Management of: Condition or Procedure in Adults and / or Children

Transcription

1 Trust Guideline for the Management of: Condition or Procedure in Adults and / or Children A clinical guideline recommended for use In: By: For: Key words: Written by: Acute Medicine Unit Medical Staff Adult patients with confirmed multi-resistant urinary tract infection suitable for outpatient ESBL, UTI, multi-resistant, parenteral, outpatient Computerised Tomography Pulmonary Angiogram (CTPA), Thrombolysis Dr. Jo Southgate, Consultant in Acute Medicine Supported by: Dr Catherine Tremlett, Consultant Microbiologist Dr Hugh Wilson, Consultant in Acute Medicine Dr James Edwards, Consultant in OPM Approved by: Catherine Tremlett for the Antimicrobial sub Group and By Dr L Barker 25 November 2014 for the Clinical Guidelines Assessment Panel Reported as approved to the: Clinical Standards Group Effectiveness Sub-Board Date of approval 25 November 2014 To be reviewed before: 25 November 2017 To be reviewed by: Guideline supersedes: Guideline Reg. No: Dr Jo Southgate, Acute Medicine Consultant Dr James Edwards, OPM Consultant Nil CA6002v1 Author/s: (Insert names) Valid until: (Insert Month and year) Document: (Insert name of guideline) docx Copy of complete document available from: Trust Intranet Page 1 of 7 Date of issue: (Insert Month and year) Guideline Ref No (Ref) Version (No)

2 1. Quick reference guideline 2

3 2. Objectives of Guideline Guideline for OPAT Management of Multi-resistant UTI OPAT (Outpatient Parenteral Antibiotic Therapy) guidelines for the treatment of multiresistant and extended spectrum beta-lactamase (ESBL) producing urinary tract infections. These guidelines are for the outpatient treatment of multi-resistant and ESBL producing UTI s, for in-patient management please refer to the general antibiotic guidelines on the intranet. 3. Recommendations Once patients are clinically stable but still require IV (Intra-venous) therapy, assess suitability for OPAT. Exclusion Criteria: If any of the following are present, patients are not suitable: Sepsis - 2 or more signs: temperature >38 or <36, HR >90/min, respiratory rate >20, systolic BP <100, Marked inflammatory response - WCC >15 Immunosuppression or leucopaenia - WCC >4 & <15 IVDU Psychiatric history Pregnancy Renal Function: For patients with a CrCL of <30ml/min or those on dialysis then ertapenem is contraindicated. Previous anaphylaxis to penicillin Other factors influencing the decision to treat at home are: Frailty Confusion Home circumstances Obesity Alcoholism Patient choice. Authors J Southgate Date of issue: November 2014 Valid until: November 2017 Guideline Ref: CA6002 v1 Document: OPAT management of patients with multi-resistant UTI Copy of complete document available from: Trust Intranet Page 3 of 7

4 OPAT Management: On Acute Medical Unit or OPM Ward: Confirm microbiology MSU result, taking note of susceptibilities of organism isolated. Confirm clinical picture that patient has symptoms of an upper or lower urinary tract infection: e.g. frequency, dysuria, haematuria, abdominal (flank or suprapubic) pain, fever, confusion If there are no symptoms consider colonisation with multi-resistant or ESBL producing organism. Colonisation without symptoms of infection does not require treatment. Discussion with Microbiology may be required, in particular if the patient is pregnant. Prescribe antibiotic on the drug chart and give the 1st dose Treatment for uncomplicated UTI: Indication Antibiotic course length review date Multi-resistant UTI Ertapenem 1g OD 5 days day 6 UTI:ESBL producer Ertapenem 1g OD 7 days day 8 Insert cannula, test blood for FBC, U+E, LFT, CRP, and print form for repeat bloods (see below) Telephone community IV nurses to confirm availability and fax details of the patient to the community IV nurses. Give the patient letter and drug chart to patient with instructions of cannula care, plan and date/time of return to ambulatory clinic, and the antibiotic prescription for the community IV nurses. Community IV nurses: Administer treatment daily and check vital signs. Check cannula daily and change appropriately A day prior to review date, repeat bloods: FBC, U+E, LFT, CRP 4

5 Guideline for OPAT Management of Multi-resistant UTI Dear Date: dd/mm/yyyy Home IV treatment for urinary tract infection: We have arranged for you to have your infection treated at home. We hope you will find this more convenient then having to stay in hospital. Please return to the ambulatory clinic, reporting to AMU at the following times: Date Time Call us at any time, on the number above, if you are feeling unwell or having problems with your cannula, to speak to the nurse in charge. Alternatively you can call the IV nurses between 8am and 8pm If you feel very unwell call an ambulance or go to the Emergency Department in the usual way. Cannula care Your cannula sits in a blood vessel for up to 72 hours, following which it will be removed and changed if necessary. There is no needle present but it is important you look after it. Keep your cannula dry and covered with the dressing provided If your cannula does come out apply pressure with a clean dressing. A new cannula will be inserted the next day Sometimes the cannula site becomes infected. If skin around the cannula becomes red or painful call the above number for advice. If you are concerned in anyway feel free to call on the above numbers. OPAT UTI Pathway Check List Authors J Southgate Date of issue: November 2014 Valid until: November 2017 Guideline Ref: CA6002 v1 Document: OPAT management of patients with multi-resistant UTI Copy of complete document available from: Trust Intranet Page 5 of 7

6 (please circle as appropriate) Attendance with a symptoms of urinary tract infection Yes No Suitable for OPAT service (See criteria in policy) Yes No Ensure MSU result reviewed and susceptibilities confirm multi-resistant UTI or UTI secondary to ESBL producing organism Yes No Patient given information letter with return date/time added Yes No Patient given drug chart Yes No Cannula secure and flushed with saline Yes No Insertion date is present and VIP score completed Yes No Blood sent for FBC, U+E, LFT, CRP Yes No Form printed for repeat FBC, U+E, LFT, CRP Yes No Allergy status checked Yes No 1st dose of antibiotic given Yes No Home IV antibiotic doses prescribed Yes No Book patient into ambulatory clinic book Yes No Discharge letter Yes No Signature:... Print Name:... Date: dd/mm/yyyy... 6

7 Guideline for OPAT Management of Multi-resistant UTI Patient Details Surname Forename Address Postcode Referring Consultant Name Department/Ward Telephone NCHC Community IV Service Referral Form Please telephone to refer this patient and fax completed form to Hospital Number DOB Daytime tele no Evening tele no Mobile no Bleep Clinical Diagnosis Organism (s) Current Antibiotic therapy Drug Allergies Type of IV Access Does the patient have any of the following? If YES then the patient is NOT suitable for Out Patient IV Therapy Service Sepsis IVDU Marked inflammatory response Psychiatric history Immunosuppression or leucopaenia WCC >4 & <15 Renal impairment (CrCL< 30ml/min) or dialysis Pregnancy Previous anaphylaxis to penicillin Non Norfolk Address Additional comments.. Doctor Print name. Signature:... Date: dd/mm/yyyy. IV Nurse Please retain and return to office once referral accepted Authors J Southgate Date of issue: November 2014 Valid until: November 2017 Guideline Ref: CA6002 v1 Document: OPAT management of patients with multi-resistant UTI Copy of complete document available from: Trust Intranet Page 7 of 7