Education, Vaccination and Antibiotics. - PowerPoint Presentation

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Education, Vaccination and Antibiotics. Improving the management of our splenectomy patients.

Katie Jodrell and Karen WattAMS Clinical PharmacistsOctober 2017

PHARMACY DEPARTMENT

Background

More than 25000 Australians have a non-functioning spleen

Asplenia

or

hyposplenism

Lifetime higher risk of contracting bacterial infections

Infections may become life-threatening

Encapsulated bacteria

Occurs post-splenectomy in ~4% patients without prophylaxis

Highest risk in children and those on

immunosuppressants

Greatest risk of mortality is in the first 2 years and is ~50%

Coroners report into the death of Lilli Sweet

Lilli was born 4

th

December 2006 as one of twins

Hereditary spherocytosis

Splenectomy to manage condition aged 4.5yrs

2 day history of vomiting, diarrhoea and headache

GP referred to ED 25

th

August 2013 stating she had a splenectomy and it was unclear if fully immunised

On arrival temp 37.6, given IV fluids and paracetamol/ibuprofen

White cell count at midnight 46.5 – no further action taken at this time

Following morning severe headache, high fever and neck stiffness. Antibiotics then started

Soon after Lilli became unresponsive.

CT scan showed brain stem herniation.

BC grew Streptococcus

pneumoniae

.

Lilli died 27

th

August 2013

Findings

A letter in plain terms should have been addressed to Lilli’s GP and her mother setting out the vaccination schedule

Antibiotics should have been given much earlier

St John of God Subiaco Hospital SJGSH

Splenectomy patients had been identified as high risk patients by AMS (Antimicrobial Stewardship) Committee

Incidents

Splenectomy patient almost not seen by the Infectious Diseases (ID) Physician and didn’t receive vaccines, antibiotics and education in hospital

Supply and administration of the incorrect meningococcal ACWY vaccine (polysaccharide supplied instead of conjugate vaccine)

Management of splenectomy patients

Management

Immunisations

Prophylactic antibiotics

Emergency antibiotics

Education

More than a quarter of patients who undergo splenectomy in Australia do not receive the appropriate vaccines

Critical role of patient education

Risk of OPSI (overwhelming post-splenectomy infection) can be reduced by half with education, vaccination and antibiotics

Patients and families need to be educated about

Possible consequences of splenectomy

Recognising early signs of infection

Vaccination can NOT provide protection against all bacterial infections

Need for early presentation for medical care

Spleen Australia and WATAG

Aims to reduce the occurrence of OPSI in asplenic/hyposplenic patients 70% reduction in severe infection risk shownRegistry with names and relevant medical information on these peopleCost effective serviceProvide information and strategies to both patients and health professionals to help prevent serious infectionWA patients are currently NOT eligible to register with Spleen Australiahttps://spleen.org.au/VSR/Index.html WATAGExcellent resourcesVaccination and prophylaxis for asplenia: Guideline for clinicians (adult and paediatric)Immunisation plan templatePatient informationhttp://www.watag.org.au/watag/publications.cfm

St John of God Subiaco Hospital

Strategy to improve management of splenectomy/

asplenic

patients

Improve identification of these patients

Improve patient education

Improve staff education

Improve dispensary procedures to ensure correct vaccine supply

Develop Pharmacy Ward Manual Guideline

1. Improve identification of these patients

Pre-admissions clinic (PAC) email alert to infection control and AMS pharmacistsFor patients being admitted for a splenectomyPatients with a prior history of splenectomyInfection control alertAdded if either a history of splenectomy or admitted for a splenectomyNew patients added when email receivedOld patients added retrospectively during setupCan click on and see detailsPatients flagged for review on AMS roundsSeen by ID Physician

2. Improve patient education

AMS Pharmacist to provide counsellingReview vaccination status, prophylactic and emergency antibioticsDeveloped patient information sheet (adapted from Spleen Australia)Developed wallet card (adapted from Spleen Australia)Provide vaccination card (WA Health)Provide copy of vaccine schedule clearly identifying what further vaccines are requiredProvide MedicAlert® form

3. Improve staff education and awareness

Education sessions to pharmacists and infection control staff

Grand round planned

Education for resident medical officers planned

Strategy presented at various executive meetings

Drug and Therapeutics

Infection Prevention and Control

Nursing and Midwifery Practice Council

Medication Safety Committee

4. Improve dispensary procedures

Splenectomy kit

Contains information on the supply process and patient information including:

Required vaccinations

WA Health vaccination card

SJGSH patient information splenectomy leaflet

Spleen Australia information

Medic alert brochure

SJGSH patient wallet card to identify splenectomy status

Notification of the need to add emergency antibiotics as prescribed by the doctor

Checked by AMS Pharmacist BEFORE supply to the ward

5. Pharmacy Ward Manual Guideline

Collated all the information

Available hard copy and online

Conclusion

Guidelines, alerts and procedures should significantly improve our management of splenectomy patients

We are recording the details of all our patients that are seen and the outcomes for their management

Spleen Australia and WATAG Guidelines