Lincolnshire Care Pathway Partnership Integrated Care Pathway
THIS DOCUMENT MAY BE USED FOR TWO SEPARATE ADMISSIONS
Is the patient following another Integrated Care Pathway?…………………….Yes / No
If yes, record which other Integrated Care Pathway/s is/are in use:
Inclusion Criteria This Integrated Care Pathway is for use with known and newly diagnosed MRSA adultpatients.
Exclusion CriteriaThis Integrated Care Pathway is not for use with patients 16 years or younger. ContactInfection Control Team for risk assessment.
For further advice, please contact the Infection Control Nurses. This Integrated Care Pathway is intended as a guide to care only and does not replace clinical judgement.
Integrated Care Pathway Document Information
2005 Lincolnshire Care Pathway Partnership
United Lincolnshire Hospitals NHS Trust MRSA ICP Version 05, April 2005 Page 1 of 10 Lincolnshire Care Pathway Partnership Signature Record
All members of staff who are using this Integrated Care Pathway should use black ink and complete this section. You can then use initials when recording care. Print Name Job Title Bleep/Ext Signature Initials United Lincolnshire Hospitals NHS Trust MRSA ICP Version 05, April 2005 Page 2 of 10 Lincolnshire Care Pathway Partnership 1st Admission 2ndAdmission Summary of colonisation details and initial actions
The initial date the patient was identified as beingcolonised was …………………… Site …………………
The patients notes were labelled on……………………….
The nurse in charge of the ward is advised to follow theMRSA policy
Does the patient have a resistance to any of the treatment,e.g. Mupirocin, Gentamicin? Yes NoComments:
1st Admission 2nd Admission Screening
A full MRSA screen has been taken, labelledas per policy and submitted to microbiology. Initial screening and results 1st Admission Site of swab Initial screening and results 2nd Admission Site of swab United Lincolnshire Hospitals NHS Trust MRSA ICP Version 05, April 2005 Page 3 of 10 Lincolnshire Care Pathway Partnership 1st Admission 2nd Admission Communication
13 The Infection Control Team is informed of
the patient’s admission if previouslyidentified as a carrier.
14 If newly identified patient, Infection Control
Nurse has labelled notes and providedinformation to ward staff, e.g. Booklets.
15 The patient is informed of the isolation
measures to be undertaken and therationale. (see risk assessment page 10)
16 The patient is given information leaflets to
support this explanation e.g. pictorialpathway, MRSA and isolation leaflet.
17 Does the patient have any questions? If
yes, specify in patient’s own words onAdditional Information / Variance sheet.
18 The patient agrees to be compliant with
ICP. If no, liaise with the Infection ControlTeam and record patient reasons on theAdditional Information sheet.
19 A yellow “Standard Isolation” card is
displayed at the entrance to the room. The lower portion of the card is completedand returned to the Infection ControlNurses. Not applicable
maintain high standard of ward cleaning.
decisions is informed of the patient’spositive MRSA status.
antibiotic regime with microbiologist, ifrequired. Medical team to ensureantibiotic levels are checked and reviewedas discussed with ConsultantMicrobiologist.
24 Prescribed medications are obtained from
United Lincolnshire Hospitals NHS Trust MRSA ICP Version 05, April 2005 Page 4 of 10 Lincolnshire Care Pathway Partnership 1st Admission 2nd Admission Treatment / Decolonisation of positive patients
25 The patient is isolated in a side room.
Not appropriate for patient group,discussed with Infection Control Nurse.
26 Universal precautions are in use i.e.
gloves, aprons, hand hygiene solutions asper Trust policy.
27 Skin and nasal decolonisation treatment to
be given for 5 days as instructed on p.7. NB nasal mupirocin 2% should not be used for more than 10 days in total
28 Superficial wounds treatment to be given
29 The patient has a two day rest period from
treatment. State dates……………………
30 The next day the patient has a full re-
screen ensuring swabs are taken as perpolicy.
This treatment continues until a fullnegative screen is received. The InfectionControl Team will advise the clinical areaof a negative screen.
continue treatment until 3 consecutive fullnegative screens are received. Screen 1 – state date…………. patient isre-swabbed. Screen 2 – state date…………. patient isre-swabbed.
33 If patient is positive, continue treatment.
34 If patient is negative, go to number 38 and re-integrate the patient onto the ward. United Lincolnshire Hospitals NHS Trust MRSA ICP Version 05, April 2005 Page 5 of 10 Lincolnshire Care Pathway Partnership Guidelines for the treatment of patients who are skin carriers of MRSA
¾ Patients should bathe (bed bath/bath/shower) for five consecutive days with detergent
¾ Wash hair twice weekly with the same solution.
¾ Apply @ 30mls directly onto the skin using a wet disposable cloth.
¾ Pay particular attention to the hair, around the nostrils, axillae, groins and feet.
¾ Dry using a hospital towel – treat towel as infected linen.
¾ Clean bed linen should be provided after treatment.
¾ Hands of staff and carers should be decontaminated after this procedure.
¾ Treatment should continue until three consecutive negative swabs are obtained. Applying nasal bactroban (Mupirocin 2%)
¾ A small amount of bactroban (about the size of a match head) should be placed on a cotton
bud or on the little finger and applied to the inner surface of each nostril.
¾ Apply three times daily for five days (concurrently with Aquasept).
¾ The nostrils should be closed by pinching the sides of the nose together at each application
(spreads the ointment throughout the nares). Applying iodine impregnated dressings e.g. inadine
¾ To be used on superficial wounds.
¾ Apply twice daily on two consecutive days only then discontinue.
¾ If wound appears infected seek advice of tissue viability nurse.
ReferencesBritish National Formulary, September 2002. British Medical Association, London. United Lincolnshire Hospitals NHS Trust. Infection Control Policy
United Lincolnshire Hospitals NHS Trust MRSA ICP Version 05, April 2005 Page 6 of 10 Lincolnshire Care Pathway Partnership Treatment / Decolonisation checklist - 1st Admission Start date of 5 Treatment / Decolonisation checklist – 2nd Admission Start date of 5
• Nasal mupirocin 2% should not be used for more than 10 days in total.
• Iodine impregnated dressings e.g. inadine, to be used on superficial wounds twice daily for 2
consecutive days, then discontinue. If wound appears infected seek the advice of the tissueviability nurse. United Lincolnshire Hospitals NHS Trust MRSA ICP Version 05, April 2005 Page 7 of 10 Lincolnshire Care Pathway Partnership 1st Admission 2nd Admission Patient is integrated back into the clinical area
negative screens or the Infection ControlNurse advises the patient is a low risk.
39 The negative results and changes to care
40 Does the patient have any questions? If
yes, specify in patient’s own words onAdditional Information / Variance.
41 Isolation nursing is discontinued.
42 The patient washes and dresses in clean
Patient is discharged back into primary
43 Has receiving organisation been informed
of MRSA status prior to discharge ofpatient?
United Lincolnshire Hospitals NHS Trust MRSA ICP Version 05, April 2005 Page 8 of 10 Lincolnshire Care Pathway Partnership Additional Information / Variance Identify the problem, cause of problem and action taken United Lincolnshire Hospitals NHS Trust MRSA ICP Version 05, April 2005 Page 9 of 10 Lincolnshire Care Pathway Partnership
MRSA RISK ASSESSMENT TOOL FOR PLACEMENT OF
All patients identified as being colonised / infected with MRSA should be nursed in a singleroom, however in the event of unavailability of single room accommodation please riskassess using the following guidance. HIGH RISK
MRSA identified at the following sites:- • Deep leaking wounds
IF POSSIBLE PATIENTS MEETING WITH ANY OF THE ABOVE CRITERIA SHOULD BENURSED IN A SINGLE ROOM WITH FULL STANDARD ISOLATION PRECAUTIONS
MRSA identified at the following sites:- • Nasal only
• One or two superficial wounds, healing & covered with dressings
• One or two body sites i.e. groin/nasal
• One full site of negative screening swabs
• Patient able to be confined to bed area
IN THE ABSENCE OF SINGLE ROOM ACCOMMODATION, PATIENTS MEETING ANYOF THE ABOVE CRITERIA SHOULD BE NURSED IN A BAY AREA OF THE WARD NEXTTO A HANDWASH BASIN – AVOID PLACING NEXT TO PATIENTS WITH WOUNDS, IVIs,URINARY CATHETERS WHERE POSSIBLE. United Lincolnshire Hospitals NHS Trust MRSA ICP Version 05, April 2005 Page 10 of 10
Monica Zolezzi, BPharm, MSc. Long-acting injectable antipsychotics, also known as "depots", were developed in the late 1960s as an attempt toimprove compliance and long-term management of schizophrenia. Despite their availability for over 30 years,guidelines for their use and data on patients for whom long-acting injectable antipsychotics are most indicated aresparse and vary consider
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