1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
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Introduction of VITEK 2 and EUCAST Guidelines in Microbiology
Cara Wrenn, MSc in Healthcare Management
Abstract
Aims: The aims of this project were to introduce the VITEK 2 Compact and to implement EUCAST guidelines in a small microbiology department. Rationale: The VITEK 2 Compact is an automated analyser for the identification and antimicrobial susceptibility testing of bacteria and has been associated with decreased sample turn-around-times, cost savings and improved detection of multi-drug resistant organisms. There are 10 different guidelines for the clinical interpretation of antimicrobial susceptibility data. A national decision was made in 2010 to harmonise susceptibility data reporting in Ireland, by adopting EUCAST guidelines. This will enable the comparison of data between institutions at the patient, national and internationally level. Methodology: The HSE Change Model was used to guide the change process. A vision for change, aligned with the organisations strong commitment to quality was created along with the key stakeholders. The vision was communicated along with the drivers for change. A plan was developed and implemented which included validation of the new processes and a training program. Mini-successes during the initial stages of the project were celebrated to ensure mainstreaming. Evaluation: Evaluation results demonstrated cost savings of €2.90-€10.28 per isolate and reduced turn-around-times of 1-20 hours, depending on organism complexity. Higher scores for external quality assurance samples were achieved in a direct comparison with historical procedures, demonstrating both trainee proficiency and process accuracy. Conclusion: Consumable costs and turn-around times were standardised irrespective of pathogen complexity and resistance. The turn-around-times for healthcare associated infections has been decreased by 20 hours, which has the potential to have a positive impact on infection control in the organisation. The implementation of the VITEK 2 Compact and EUCAST guidelines will also facilitate the application of national guidelines for the control of multi-drug resistant organisms in the department.

2. Introduction of VITEK 2 and EUCAST Guidelines in Microbiology
Cara Wrenn, MSc in Healthcare Management
Introduction & Background
Methodology
Evaluation
Bacterial identification and antibiotic susceptibility testing (AST) is required to enable the correct prescription of antibiotics for infections. The VITEK 2 Compact is an automated analyser for the identification and AST of bacteria. The rapid identification and AST of pathogens is also important to identify multi-drug resistant organisms (MDRO). Automated methods are associated with reduced turn-around-times (TATs) and consumable costs1 as well as supporting the implementation of guidelines to screen for MDRO2.
There are 3 different AST guidelines used in Ireland. In 2010 a national decision to harmonise AST data and to adopt the European Committee on Antimicrobial Susceptible Testing (EUCAST) guidelines was made, to enable comparsion of AST data in Ireland.
The HSE Change Model3 was used to guide this project (Figure 1)
Initiation: Assessment tools were used to create the vision for change, identify stakeholders, driving and resisting forces. The Force Field Analysis4 (FFA) is shown in Figure 2.
Figure 2. FFA
Drivers Resistors
Planning: A shared vision which was aligned with the organisations values was developed and an implementation plan was created. This was communicated and feedback welcomed.
Implementation: New procedures were introduced and training (formal presentations/hands-on workshops) was provided.
Mainstreaming: Medical Scientists processed samples (clinical, quality control and EQA) as per new procedures. Successes were celebrated to maintain momentum.
In comparison to historical methods higher EQA scores (Figure 3), reduced TAT (Figure 4) and standardised consumable costs (Figure 5) were achieved using automation and EUCAST guidelines.
Training was satisfactorily evaluated using the four levels of Kirkpatrick’s Model5. The highest level; return on investment is illustrated in Figure 5.
Figure 1: HSE Change Model 3
Drivers
Cost Savings,
Improved Quality, Reduced TAT,
Management buy-in,
Accreditation, National Guideline compliance.
Resistors:
Validation workload, Fear of unknown, Upskilling.
Aims & Objectives
Aim: To introduce the VITEK 2 for the identification and AST of clinically significant bacteria and to implement EUCAST guidelines for the clinical interpretation of AST data 1st April 2014.
Objectives:
Train Medical Scientist to use the VITEK 2 Compact and EUCAST guidelines.
Obtain >95% accuracy in cumulative external quality assurance (EQA) samples.
Standardise consumable costs irrespective of bacterial complexity.
Reduce TATs for processing clinical samples.
Organisational Impact
The TAT for the detection of MDRO has been decreased by 20 hours which can improve patient care and infection control1. The quality of AST data has improved and can now be compared nationally6. Consumable costs are standardised which can improve budgetary planning.
Conclusion
Investment in laboratory automation resulted in quality improvements as demonstrated by TATs and EQA samples. This quality initiative will facilitate the implementation of Irish guidelines for the control of MDRO2 a further quality improvement project for the organisation.
References
1.Barenfanger et al. (1999). Clinical and financial benefits of rapid bacterial identification and antimicrobial susceptibility testing. Journal of Clinical Microbiology, 37(5). 2. HSE RCPI clinical advisory group on HCAI. (2013). Guidelines for the Prevention and Control of Multi-drug resistant organisms (MDRO). 3. Health Service Executive (2008) Improving our services; A users guide to managing change. 4. Lewin, K. (1951). Field theory in social science. 5. Kirkpatrick, D. (1979). Techniques for evaluating training. Training & Development Journal.6. Kahlmeter, G., & Brown, D. F. J. (2004). Harmonization of Antimicrobial Breakpoints in Europe- Can It Be Achieved? Clinical Microbiology Newsletter, 26(24), 187–192.