The development of a quality improvement project to improve infection prevention and management in patients with asplenia or hyposplenia

Abstract

Asplenia and hyposplenia (a/hyposplenia) are associated with increased morbidity and mortality from complications including infection. The recommended measures to reduce the risks associated with infection include patient education, vaccination and early initiation of antibiotic therapy for fever. Despite these recommendations, there is poor adherence to best practice management of patients with asplenia or hyposplenia (PWA/H). We present the development methodology and pilot data of a quality improvement project that explored whether a programme involving a novel medical alert card together with a patient and healthcare provider educational booklet increased vaccination rates and improved awareness and understanding of the infectious implications of a/hyposplenia. Our aim was to increase the proportion of those appropriately vaccinated and the proportion of patients with proper understanding of fever management by twofold in 18 months. Questionnaires were used locally as a root-cause-analysis to confirm the need for education and evaluate the effectiveness of the programme, as well as patient satisfaction. An interdisciplinary team developed a toolkit composed of a medical alert card and booklet. The toolkit was distributed to PWA/H who presented for a haematology clinic visit at a tertiary care centre. A separate set of questionnaires was then used to evaluate satisfaction and obtain feedback from patients and practitioners receiving the toolkit for the first time. Changes suggested by patients and practitioners with unanimous agreement among study investigators were made to the toolkit. The pilot study showed an increase in vaccination rates and awareness of vaccination status and appropriate fever management. The majority of the patients and practitioners found the information provided by the toolkit helpful. Given these promising single-centre findings, the intervention is being extended to another tertiary care centre with a large red blood cell disorders programme to evaluate its generalisability. The next step will be to expand the scope to paediatric PWA/H.

Impact of era of diagnosis on cause‐specific late mortality among 77 423 five‐year European survivors of childhood and adolescent cancer: The PanCareSurFup consortium

“…We also saw a steady drop in deaths from infections, possibly related to changes in treatment-less radiotherapy, 35 better management of asplenia 36 for the primary malignancy, and improved supportive therapies, and deserving of further study. Deaths from external causes (accidents, homicides and suicides) dropped by one-third over the observation period (P for trend <.005), maybe due to survivors' improved overall health, since the presence of chronic medical conditions may be linked to risky behaviors.…”

Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline

“…The treated group showed a significantly higher adherence to guideline‐based preventive control measures 40 . A small Canadian pilot study of a toolkit including patient information supplied as an educational booklet and a medical alert card demonstrated increased uptake of vaccinations and appropriate fever management 41 …”

“…40 A small Canadian pilot study of a toolkit including patient information supplied as an educational booklet and a medical alert card demonstrated increased uptake of vaccinations and appropriate fever management. 41 In France, national guidelines are published annually. Adherence by general practitioners was assessed in three hospitals and found to be insufficient.…”

How to sustainably build capacity in quality improvement within a healthcare organisation: a deep-dive, focused qualitative analysis

“…SALHN’s Improvement Faculty and associated researchers were interested in understanding the principles and components of the CIP and the improvement projects themselves that were generalisable to other organisations and programs attempting to undertake sustainable QI in healthcare. Too little research focuses on this meso-level capacity – mostly, studies are of a specific project (infection control or use of radiology in the clinical microsystem [ 17 , 18 ]) or system wide studies [ 19 – 21 ]. The aim of this research was to explore the facilitators and barriers to implementing the CIP QI projects and the influence of the scaled CIP capacity and capability building program on the success of these QI projects (Table 2 ).…”