1. Improvement Methodology: Introduction of ALERT Second Line Antibiotic Policy Steve McCormick Lead Antimicrobial Pharmacist NHS Lanarkshire

2. Restrictive Use Policy

3. Pilot across three acute sites in July 2009 –Benchmark Practice => challenging areas first Followed the Scottish Patient Safety Programme (SPSP) Test of Change approach –1 => 3 => 5 spread Following analysis of pilot data, the policy was rolled out across all NHSL wards in January 2010 AP SD Data AP SD AP SD

4. “What does ALERT mean ?” Second Line Antibiotic Policy - Isobel Patterson C [Sister ICU MK]

5. Key Driver = Quality NOT Savings

6. SBAR REPORT DOTS

7. Appropriate Prescribing

8. Non ALERT Use

9. Site X Total number of alert antibiotic forms completed = 81 Ward AWard BWard CWard DWard ETotal Tazocin 2125101452 Meropenem 1132613 Ceftazidime ------ IV levofloxacin --2-46 IV ciprofloxacin ----33 Usage Hotspots Monthly report will enable drill down to ward, consultant, patient – retrospective analysis of use

10. Role Models or Outliers

11. Pareto Chart Analysis

12. “..but we use these all the time” “Our area will be exempt” “We are not joining the pilot” “Ok FY’s will do it” “Seems to be working” “Non compliance – how can we minimise?”