4 August 2022
Improving antibiotic prescribing for
cellulitis: a collaboration between three rural health services
Dr Jaclyn Bishop
BPharm (Hons), GradCert(Mgt), MPH, PhD
University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences Department of Medicine- Royal Melbourne Hospital
National Centre for Antimicrobial Stewardship
East Grampians Health Service & Grampians Health
Improving antibiotic prescribing for cellulitis:
a collaboration between three rural health services
Inappropriate antibiotic prescriptions for cellulitis was higher in regional and remote hospitals compared to major-city hospitals
(25.7% v 19.0%, p <0.001)11. Bishop J et al Int J Antimicrob Agents. 2019;53(2):170-6 Ethics approval: S.AM/50735/BHSSJOG-2020-200568
Research question
Can a cellulitis bundle of care improve the appropriateness of antibiotic prescribing for cellulitis in rural health services?
C Confirm diagnosis (considering differential diagnosis) E Evaluate severity and assess for danger signs L Location of care and antibiotic choice
L Limb elevation plan
L Look for predisposing factors I IV to oral switch
T Treatment duration review daily
Bundle of care Collaborators
Cellulitis management plan
Outcomes
Primary outcome
• percentage of antibiotic prescriptions assessed as appropriate on day 1 of antibiotic therapy before and after the introduction of the cellulitis management plan
Outcomes
1-Mar 8-Mar 15-Mar 22-Mar 29-Mar 5-Apr 12-Apr 19-Apr 26-Apr 3-May 10-May 17-May 24-May 31-May 7-Jun 14-Jun 21-Jun 28-Jun 5-Jul 12-Jul 19-Jul 26-Jul 2-Aug 9-Aug 16-Aug 23-Aug 30-Aug 6-Sep 13-Sep 20-Sep 27-Sep 4-Oct 11-Oct 18-Oct 25-Oct
0 10 20 30 40 50 60 70 80 90 100
% of patients with cellultis plan
Patient satisfaction with a lower limb cellulitis leaflet
• 64% (81/127) patients (or carers) were contactable, consented and answered the questions
• Satisfaction (4 or 5) with the information provided to them about cellulitis – 100% for those who received and read the leaflet (22/22)
– 78% in those who did not receive the leaflet (46/59)
(95% CI 4.8% to 34%, p = 0.02)
I think where it sort of stands on its own, with a lot of the other pathways and things in the
hospital, is that it does actually include a very structured and well thought out patient education component as well, which is often lacking. [P3, Pharmacist, interview]
Bishop J, et al Patient satisfaction with a consumer co-designed lower limb cellulitis.
Aust Health Rev. 2021;46: 115-120
Successes
• Collaboration
• Consistent resource
• Increased research capacity
This Photo by Unknown Author is licensed under CC BY-SA
