ADAPT-Quality Improvement Project for Aspiration Detection,Antimicrobial Prescribing & Treatment reviews in care-of-elderly ward

Introduction
Aspiration pneumonia (AP) is a common and potentially life-threatening respiratory infection that is often under-recognised in clinical practice. The British Thoracic Society (BTS) recommends early identification of aspiration risk, medication review, and antimicrobial stewardship; however, variation in clinical practice persists. This quality improvement project aimed to standardise doctor-led aspiration risk assessment and optimise antimicrobial prescribing.

Method
A quality improvement project was conducted across two acute care-of-the-elderly wards over four months, comprising a two-month baseline phase followed by two Plan–Do–Study–Act (PDSA) cycles over one month each. Data were collected on aspiration risk factors, antibiotic prescribing, Speech and Language Therapy (SLT) input and inpatient outcomes. PDSA cycle 1 involved displaying posters on antimicrobial stewardship, promoting early antibiotic review and short course therapy (3-5 days, in accordance with local/ national guidance). PDSA cycle 2 reinforced early aspiration risk assessment, medication review and recognition of clinical signs of aspiration through targeted education.

Results
Neurological and neurocognitive conditions, namely Parkinson’s disease, stroke, and dementia, were the predominant risk factors. Medication review identified opioids, antipsychotics, benzodiazepines, and tricyclic antidepressants associated with increased aspiration risk. During baseline phase (n=20), 37% patients underwent intravenous-to-oral switch (IVOS), after a mean of 6 days. Following the intervention (PDSA cycles 1 and 2; n=4 each), 25% received oral antibiotics alone (vs 16% at baseline) while 66% had IVOS after a mean of 4.5 days. Documentation of aspiration risk factors improved from 25% to 100% following PDSA cycle 2. Inpatient mortality remained unchanged at 25%, and mean length of stay was 23, 13, and 22 days over baseline phase, PDSA cycles 1 and 2 respectively.

Conclusion(s)
Simple, low-cost interventions improved recognition of aspiration risk factors and antimicrobial prescribing. This scalable approach facilitates earlier interventions including timely SLT referral with potential to reduce morbidity in patients with aspiration pneumonia.