A novel ‘bundle of care’ approach to cellulitis management in western Victorian hospitals (CELL-IT).

Abstract

Aim: Data from 2014-2016 National Antimicrobial Prescribing Survey (NAPS) showed that the rate of inappropriate antibiotic prescribing for cellulitis was higher in regional and remote hospitals (rural hospitals) compared to major-city hospitals (25.7% v 19.0%, p+<0.001). This suggested that rural hospitals required support to translate the well-established treatment guidelines for cellulitis into practice. Methods: This study involves the implementation of a co-designed cellulitis bundle of care across three hospitals in the Western District of Victoria. Outcome data (pre- and post-implementation) is being collected and analysed for patients with lower-limb cellulitis. This includes appropriateness of antibiotic prescribing (Day-1 and discharge), length of stay, 30-day readmission rates for lower- limb cellulitis, self-reported recurrence of lower-limb cellulitis and duration of antibiotic therapy. Results: Baseline data collection to date suggest the average age of patients admitted to hospital for lower-limb cellulitis is 64 years (range 24-93), with 64% being male (39-61). Antibiotic prescribing at Day-1 was inappropriate in 17% (12/70) of prescriptions reviewed, which was lower that the NAPS figure. Antibiotic prescribing at discharge was inappropriate in 20% (9/46) of prescriptions reviewed. The most common reason for classifying an antibiotic prescription as inappropriate was an inadequate dose. Readmission for cellulitis within 30 days of discharge was self-reported in 21% of patients (8/39). Conclusion: Preliminary data indicates that antibiotic prescribing for cellulitis can be improved, focusing on correct dosing. The co-designed lower-limb cellulitis bundle of care, education and a patient leaflet will be implemented in early 2020.