The overuse of antibiotics and consequent resistance is a common problem in medical practice worldwide. Switch therapy is a technique that can be applied to streamline antibiotic therapy reducing unnecessary prolonged Intravenous (IV) antibiotic therapy. Antibiotic switch therapy has several other benefits such as: decreasing length of hospital stay; decreasing the incidence of adverse events associated with the administration of IV antibiotics; decreasing direct and indirect hospitalisation costs while improving patients’ comfort and mobility; and decreasing the risk of acquiring nosocomial infections. Certain elements are required to make the implementation of any guideline, including a switch therapy guideline, a success and probably one of the most important is the support from a motivated multidisciplinary team. The role of such a team, in the South African context, would be filled by the Pharmacy and Therapeutics Committee (PTC). In addition, to make a guideline successful it should be continuously implemented. This responsibility traditionally falls to a pharmacist. In the United Kingdom (UK) and the United States of America (USA) pharmacists are used to promote the appropriate use of antibiotics in hospitals as this has shown to have several economic advantages. The objectives of the study were: to determine, by means of a survey, whether guidelines for IV to oral switch were employed in South African regional, tertiary and national government hospitals; to design and implement an IV to oral antibiotic switch therapy (IVOST) guideline for a local public sector tertiary level hospital; to evaluate the effectiveness of guideline implementation; and to capture, via a questionnaire, the perceptions of prescribers regarding antibiotic prescribing, including switch therapy. The Survey of Current IV Switch Therapy Practice Questionnaire was distributed to Responsible Pharmacists at regional, provincial tertiary and national central government hospitals to determine whether IVOST guidelines were employed in South African government hospitals. Following the survey, an IVOST Guideline was designed by the researcher in consultation with the Department of Medicine and the Department of Pharmacy. The IVOST Guideline was implemented following approval by the PTC at a local tertiary level government hospital. A presentation was held for prescribers, guideline documents were distributed, posters were placed in the medical wards and the ward pharmacist/researcher integrated the guideline into daily practice by placing “reminder stickers” in patient medical folders. A pre-implementation audit and two post-implementation audits, each consisting of 150 patient medical records, were conducted and compared to determine the effect of IVOST guideline implementation on prescribing patterns and to determine whether any changes could be sustained. The Prescriber Antibiotic Survey was then conducted to capture the perceptions of prescribers regarding antibiotic therapy, including switch therapy.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:nmmu/vital:10160 |
| Date | January 2010 |
| Creators | Van Niekerk, Anida |
| Publisher | Nelson Mandela Metropolitan University, Faculty of Health Sciences |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis, Masters, MPharm |
| Format | xxxi, 449 leaves, pdf |
| Rights | Nelson Mandela Metropolitan University |
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