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Root cause analysis to identify medication and non-medication strategies to prevent infection-related hospitalizations from Australian residential aged care services

Sluggett, JK, Lalic, S, Hosking, S, Ritchie, B, McLoughlin, J, Shortt, T, Robson, L, Cooper, T, Cairns, KA, Ilomӓki, J, Visvanathan, R and Bell, JS 2020, Root cause analysis to identify medication and non-medication strategies to prevent infection-related hospitalizations from Australian residential aged care services, International Journal of Environmental Research and Public Health, vol. 17, no. 9, pp. 1-16, doi: 10.3390/ijerph17093282.

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Title Root cause analysis to identify medication and non-medication strategies to prevent infection-related hospitalizations from Australian residential aged care services
Author(s) Sluggett, JK
Lalic, S
Hosking, SORCID iD for Hosking, S orcid.org/0000-0002-9225-5101
Ritchie, B
McLoughlin, J
Shortt, T
Robson, L
Cooper, T
Cairns, KA
Ilomӓki, J
Visvanathan, R
Bell, JS
Journal name International Journal of Environmental Research and Public Health
Volume number 17
Issue number 9
Start page 1
End page 16
Total pages 16
Publisher MDPI
Place of publication Basel, Switzerland
Publication date 2020-05-08
ISSN 1661-7827
1660-4601
Keyword(s) infection
residential aged care
long-term care
hospitalization
root cause analysis
antimicrobial stewardship
medication review
Australia
Summary Infections are leading causes of hospitalizations from residential aged care services (RACS), which provide supported accommodation for people with care needs that can no longer be met at home. Preventing infections and early and effective management are important to avoid unnecessary hospital transfers, particularly in the Australian setting where new quality standards require RACS to minimize infection-related risks. The objective of this study was to examine root causes of infection-related hospitalizations from RACS and identify strategies to limit infections and avoid unnecessary hospitalizations. An aggregate root cause analysis (RCA) was undertaken using a structured local framework. A clinical nurse auditor and clinical pharmacist undertook a comprehensive review of 49 consecutive infection-related hospitalizations from 6 RACS. Data were collected from nursing progress notes, medical records, medication charts, hospital summaries, and incident reports using a purpose-built collection tool. The research team then utilized a structured classification system to guide the identification of root causes of hospital transfers. A multidisciplinary clinical panel assessed the root causes and formulated strategies to limit infections and hospitalizations. Overall, 59.2% of hospitalizations were for respiratory, 28.6% for urinary, and 10.2% for skin infections. Potential root causes of infections included medications that may increase infection risk and resident vaccination status. Potential contributors to hospital transfers included possible suboptimal selection of empirical antimicrobial therapy, inability of RACS staff to establish on-site intravenous access for antimicrobial administration, and the need to access subsidized medical services not provided in the RACS (e.g., radiology and pathology). Strategies identified by the panel included medication review, targeted bundles of care, additional antimicrobial stewardship initiatives, earlier identification of infection, and models of care that facilitate timely access to medical services. The RCA and clinical panel findings provide a roadmap to assist targeting services to prevent infection and limit unnecessary hospital transfers from RACS.
Language eng
DOI 10.3390/ijerph17093282
Indigenous content off
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2020, The Author(s)
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30139858

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.