AbstractObjectivesTo explore the patient perspective on the administration of IV and oral antimicrobials.BackgroundImproving IV to Oral antimicrobial switch (IVOS) rates facilitates patient flow, reduces nursing time spent reconstituting iv antibiotics, increases the use of cost-effective antibiotics, reduces the ward level carbon footprint, and decreases the risk of developing line related infections. This work aims to explore patient experience, perception and views, in a secondary care setting, around the administration routes of antimicrobials.MethodsAfter patient consent, a semi-structured interview comprising both open and closed ended questions, was conducted. This allowed clarification or further explanation of answers, providing mid-level insights. Interviews were carried out with 31 patients who were randomly selected across medical wards over one week. Eligible participants were required to have mental capacity, must have received both IV and oral antibiotics for at least 48 h during their hospital admission, and consented to participate in the interview.ResultsOral antibiotics were preferred by 67% (16/24) of patients, as they enabled them to ‘move around and go to the shops’, they can ‘go home on them’, and many expressed a preference for avoiding needles when possible, stating they would ‘rather swallow a tablet than have a needle’. Those who preferred IV antibiotics felt IVs helped them ‘get better quicker’, and a patient felt ‘oral antibiotics disturbed my stomach’. When asked whether patients felt IV antibiotics were more effective than oral, 32% (12/31) patients were unsure, as ‘they did not know how they work’, 23% (7/31) patients felt that IV were not more effective as ‘they are the same thing’ and ‘oral is better’, and 39% (12/31) patients felt that IV antibiotics were more effective as they ‘go straight into the bloodstream’, and ‘have worked in the past’. When asked if they required more information on their prescribed antibiotics, 8/31 (23%) of patients felt they had been adequately informed. From the sample of 31 patients, 74% of participants expressed how they would like more information around the antibiotics prescribed for them, why and how they are given to them while in hospital.ConclusionsProviding patients with the opportunity to discuss and receive additional information regarding antimicrobials prescribed would be valued. The patients interviewed have built perceptions around antibiotic administration routes based on previous experiences. Patient targeted approaches to antimicrobial stewardship would be well received, potentially challenging existing beliefs and empowering patients.

AbstractObjectivesTo reduce IV antibiotic use by 10% across the medical wards at an acute teaching hospital between May and July 2024.BackgroundImproving IV to oral antimicrobial switch (IVOS) rates facilitates patient flow, reduces nursing time spent reconstituting IV antibiotics, increases the use of cost-effective antibiotics, reduces the ward level carbon footprint, and decreases the risk of developing line related infections. The project aimed to reduce IV antimicrobial use across medical wards through the training of champions to implement an ABCDE protocol sticker. The protocol was developed from the ‘Antimicrobial IV-to-oral switch: criteria for prompt switch’ (gov.uk).1MethodsA small-scale test of change showed that the ABCDE protocol increased the rate of IVOS by 50% on a respiratory ward. This project set out to replicate that success across all medical wards. To ensure success of the project at least one nurse and doctor champions were identified on each of the medical wards, and a ‘train the trainer’ approach was adopted. Training materials were developed for all champions and education sessions were held to empower them to cascade the teaching to nursing and clinical staff on the target wards. Throughout the project our champions ensured there was ongoing engagement at ward level throughout the months of implementation of the test of change. To maintain motivation, updates on progress were circulated to the teams.ResultsAlthough the IV antibiotic use was not reduced by 10%, there was an overall reduction in the use of IV antibiotic usage. Over the 3-month period 555 antibiotic doses were avoided saving 185 nursing hours that would have been spent preparing IV antibiotics. There was also a saving of £395 on antibiotics, £1876 on consumables, a saving of 108/3kgCO2 and £117.71 on high temperature waste. The project also trained 15 nurse and doctor champions and the resident doctor cohort on when to appropriately switch from IV to oral antibiotics. Pre- and post-teaching questionnaires highlighted that nursing staff felt empowered by the protocol, and medical staff felt the prompt was a useful reminder to review antibiotics. We are also influencing national best practice, with the ABCDE protocol having been included in national evidence bundles for other trusts to utilize.ConclusionsAntimicrobial stewardship (AMS) interventions are even more powerful when involving the multi-disciplinary team. The ABCDE protocol empowered staff groups to take a proactive role in the reviewing of IV antibiotics.