Proposed antibiotic stewardship bundle:

There is evidence from other patient safety/improvement projects that focusing initially on a smaller number of high impact, measurable interventions can facilitate more rapid progress. Pilot BCA hospitals may test versions of an antibiotic stewardship care bundle. Refer to the BCA website or contact the lead BCA person in your hospital or hospital group for more information.

The bundle is a patient-specific evaluation of the appropriateness of antibiotic use. It is recognized that antibiotic prescribing is complex. A bundle does not guarantee optimal practice but it is likely to help eliminate patterns of clearly inappropriate use and also to provide a basis for initial measurement in a PDSA cycle.

Only the first systemic antibiotic prescribed during a patient’s stay in hospital is assessed in this manner.

The antibiotic prescription is first identified as being either for
A. Procedure-specific prophylaxis or
B. Therapy (either on the basis of clinical signs of infection or a verified culture)

A. Antibiotic Therapy Bundle:
Evaluation is performed by a member of the antibiotic stewardship team in each unit e.g. the pharmacist
Evaluation is done at two points:
o 24 hours (“day 1”) after an antibiotic has been prescribed, and
o on day 7.

B. Surgical Prophylaxis bundle:
Evaluation is performed by a member of the antibiotic stewardship team in each unit
e.g. the pharmacist
Evaluation is done 48 hours after an antibiotic has been prescribed.

Date commenced:
o Surgical Prophylaxis -- go to A.
o Therapeutic -- go to B.
o Undetermined

A. Antibiotic Therapy Bundle
Possible Responses
1. INDICATION. Confirm and record the type of presumed bacterial or fungal infection that is being treated
Day 1
o Cellulitis
o Intra-abdominal infection
o Meningitis
o Pneumonia
o Sepsis
o Surgical Site Infection
o Other infection
o No evidence of infection
2. SPECIMEN. A specimen has been sent
Day 1
o None
o Before antibiotic
o After antibiotic
o Not possible or needed
3. SOURCE. Record how the infection was acquired.
Day 1
o Hospital
o Community
o Unknown
4. STOP. A decision is documented to stop or continue therapy
Day 7
o Yes
o No
o N/A

B. Prophylaxis Bundle
1. An antibiotic was indicated (procedure-specific)
o Yes
o No
2. An appropriate agent was used
o Yes
o No
3. The timing was appropriate (antibiotic was administered 0-60 minutes before surgical incision)
o Yes
o No
4. The antibiotic was discontinued within 24 hours
o Yes
o No