CLINICAL AUDIT ON FEVER WORKUP AND TIMELINESS OF ANTIBIOTICS ADMINISTRATION IN FEBRILE PATIENTS

Abstract

Objective: This clinical audit evaluated the timeliness of antibiotic administration in the emergency department for patients who attended Lady Reading Hospital, Peshawar. It had the objective of identifying delays and putting in place interventions to increase adherence to the one-hour guideline for antibiotic administration recommended by NICE.

Methodology: The methodology followed was an initial audit, followed by a re-audit. More than 350 febrile patients were assessed for each. The time from arrival to initial clinical assessment and the time from diagnosis to the administration of antibiotics were measured during the initial audit phase. Thereafter, on identifying the delays, targeted interventions were incorporated, comprising training of the staff, introduction of standardized fever work-up protocols, and real-time monitoring. This re-audit was undertaken to evaluate the effectiveness of these interventions.

Key Findings: The initial audit showed that only 40% of patients received an antibiotic within the recommended hour; in fact, it had actually averaged 95 minutes from diagnosis to antibiotic administration. There were slight increases in delays for the male patient group compared with the female patient group. The reaudit showed remarkable improvements: adherence to the one-hour guideline increased to 75% and the average time from diagnosis to antibiotic administration decreased to 60 minutes. These improvements were replicated in both male and female patients.

Conclusions: The audit revealed gross delays in the delivery of antibiotics to feverish patients, which had been very effectively overcome by the target interventions put in place. Substantial improvements during the reaudit lend support to the need for continuous quality improvement exercises. Thus, further sustained monitoring and continuous training of the staff with respect to the practices, as well as periodic audits, are recommended in order to maintain these gains and further improve practice while enhancing patient care in the emergency department. These findings provide some evidence that treating gaps in clinical practice with systematic approaches may really improve patient outcome.