Improving Appropriateness of Injectable Antibiotics Dilution and Administration in the Multidisciplinary Wards in Tanjung Karang Hospital

Abstract

Injectable antibiotics with rapid delivery to infection sites are preferable in hospital settings, particularly in treating patients with moderate to severe infections. Therefore, inappropriate dilution and administration of injectable antibiotics can cause antimicrobial resistance, thrombophlebitis and mortality. A verification study conducted from August to September 2018 in Tanjung Karang Hospital (HTK) demonstrated that only 14.2% of injectable antibiotics had appropriate dilution and administration out of 148 samples. Subsequently, a cross-sectional study was undertaken from August 2018 to February 2019 to improve the dilution and administration of injectable antibiotics among nurses in the HTK. This was followed by the intervention phase (October to December 2018) and post-intervention evaluation (January to February 2019). The indicator measured was the percentage of appropriate injectable antibiotics dilution and administration out of the total injectable antibiotics. The standard was set at 100%. Observations of the six aspects of the appropriateness of injectable antibiotics dilution and administration were carried out. A data collection form was used to document the observations in this study. Results showed that the least appropriate aspects were administration duration and reconstitution concentration. Pareto chart analysis identified the major factors contributing to inappropriate dilution and administration of injectable antibiotics as being unaware of uncommon procedures, unavailability of local protocols, inadequate references and reminders, insufficient knowledge or experience, and a lack of monitoring. Therefore, strategies introduced were the “SWeFT” approach, improving ward pharmacists’ roles in monitoring dilution and administration of injectable antibiotics and antimicrobial stewardship. The percentage of appropriate injectable antibiotics dilution and administration successfully improved to 49.3% after interventions. Among the six aspects assessed, reconstitution concentration and administration duration revealed marked improvements. The rates for uncommon antibiotics also substantially improved by up to 100%. Strategies introduced, especially the “SWeFT” approach, were shown to be effective and hence should
be enhanced to include other medications and disciplines.