Antimicrobial resistance
cross-sectoral engagement, supported by the UK Government, through the Department of Health and Social Care. The findings of the report clearly show that practice deviates from the guidelines produced by several UK organisations – including the National Infusion and Vascular Access Society’s guide on Intravenous Administration of Medicines to Adults 4
and the MEDUSA NHS Injectable
Medicines Guide, which state that all the prescribed medications should be administered. 5 So how do we overcome this problem? Ruth explained that there are two recommended methods. One involves attaching an additional bag of compatible fluid to rinse the line through at the end of the infusion. A second method is to use an administration set with an injection port above the drip chamber in which to instil the additional compatible fluid to flush the dose. Method two has benefits over method one as it does not require breaking the intravenous
circuit – reducing the risk of bloodborne infections and, additionally, the amount of fluid used to flush the line is limited to just the amount required. This is beneficial for fluid restricted patients. “We all know that the NHS is experiencing enormous operational pressures; any measures that improve patient outcomes and reduce additional burdens from ineffective practices are fundamental. Flush the line every time – it is an easy solution to a serious problem,” she concluded. To find out details of the next IPC conference, visit:
www.infectionpreventioncontrol.net CSJ
References 1. GLG report: Towards specific commitments and action in the response to antimicrobial resistance, Recommendations for consideration by UN Member States in the outcome document of the High-level Meeting on AMR in September 2024. Published 4 April
Practical solutions to underdosing
The topic of underdosing with IV antibiotic administration was further explored during a workshop, hosted by
B.Braun Medical. Phil Hazeldine, an A&E nurse and clinical therapy manager, and Claire Davies, a paediatric nurse and clinical therapy manager opened with a survey of the audience to find out how many people had heard of under delivery of IV antibiotics as an issue, prior to Ruth’s presentation at IPC. The majority (61%) said they were unaware. They also highlighted the fact that 336, 280
litres of prescribed IV antibiotics are discarded and not administered to patients, each year, in the NHS – the equivalent to a staggering 9 oil tankers. They pointed out that a total of 20 million IV gravity sets are used in the NHS each year for IV antibiotic administration. “By giving the total dose for delivery of
antibiotics, we can reduce some of that set usage,” Phil commented. Ruth joined the pair on stage to give more detail into her journey in implementing an improvement project at her Trust, to tackle this gap in care. A review of the guidance regarding line flushing was carried out and the Trust assessed the two methods of delivering a post-medication flush. In Critical Care, they chose to go with
SafeSet Flush, which has a needle-free injection port upstream of the drip chamber, instead of re-spiking a flush bag. This minimised the number of disconnections,
improved time efficiency for nurses and reduced the risk of fluid overload. “In looking at the process of IV medication administration in our units, it was interesting to analyse this in detail as it came to light that, for every medication given, a new line had to be used.
“It was an additional bonus, therefore, that the service adopting this practice would see a reduction in sets, used plastic waste and potential cost savings. These are significant benefits on top of the patient safety and antimicrobial improvements,” she explained. The next step was to achieve buy-in from
all relevant stakeholders, including the critical care nursing teams, procurement, pharmacy, microbiology and IPC, by presenting the issue of under-delivery of antibiotics and the implications. “This was met with a great deal of support
and there was an element of ‘how did we miss this?’ and ‘of course we must flush our lines to deliver the full dose’. Procurement teams were also very understanding of the need. Being able to evidence the patient safety and antimicrobial resistance improvements, as well as the anticipated reduction in sets, helped with their buy-in, as we could show how the additional cost of the set would be easily offset,” she continued. A Standard Operating Procedure (SOP) was
created, and the new practice was launched in Critical Care in January 2023. Implementation was supported by
B.Braun who educated 137
22
www.clinicalservicesjournal.com I November 2024
Critical Care Nurses. Ruth pointed out that the changes have led
to more sustainable ways of working in Critical Care. Data collected by the Trust showed that the implementation of the line flushing practice significantly reduced usage of IV administration sets by 53%, equating to a 312kg single use plastic reduction (the equivalent of 100 bowling balls). “This data was encouraging as it was
collected during a time period when the changes were not even fully embedded,” Ruth commented. The changes also resulted in a 21% reduction in IV antibiotic prescribing/usage in Critical Care, when comparing December 2022 (pre- launch) with 2023 (post-launch). Ruth concluded by calling for the approach to be adopted nationwide.
2024. Accessed at:
https://www.amrleaders. org/resources/m/item/glg-report
2. NICE press release, NICE reaches important milestone in the UK’s efforts to tackle antimicrobial resistance, 12 April 2022. Accessed at:
https://www.nice.org.uk/news/ articles/nice-reaches-important-milestone- in-the-uk-s-efforts-to-tackle-antimicrobial- resistance
3. Fady, P-E. and Bennett, N. 2023. Antibiotic underdosing and disposal in UK hospitals: Research Report & Policy Brief. DOI: 10.5281/ zenodo.10142995 Accessed at: https://www.
nataliebennett.org/UserFiles/File/Antibiotic- underdosing-and-disposal-in-UK-hospitals. pdf
4. NIVAS, Intravenous Administration of Medicines to adults: Guidance on “IV-line flushing”, 2023. Accessed at: NIVAS-flushing- guidelines-V5-June-2023.pdf
5. MEDUSA NHS Injectable Medicines Guide. Accessed at:
www.medusaimg.nhs.uk
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