QIP: Improving Infection Management and Antibiotic Prescribing on a Geriatric Ward

Background: Antimicrobial stewardship is essential for patient safety and reducing antimicrobial resistance. Key components include obtaining appropriate cultures prior to antibiotic initiation, prescribing in line with local guidelines, and accurately documenting allergy status—particularly penicillin allergy, given that over 90% of patients labelled as penicillin-allergic are not truly allergic.

Aims: This quality improvement project assessed and aimed to improve practice on Ward 19, a geriatric ward at Queen Elizabeth Hospital, Woolwich (Lewisham and Greenwich NHS Trust), across three domains: culture collection prior to antibiotic initiation, adherence to trust antimicrobial guidelines, and thoroughness of allergy documentation.

Methods: A retrospective baseline audit was conducted of 34 patients discharged from Ward 19 in April 2026 who received antimicrobial treatment. Two sequential PDSA cycles followed: Cycle 1 comprised MDT education and a ward poster (n=14); Cycle 2 added a prescribing checklist on staff computers (n=20). Data were collected prospectively against standards derived from NICE guidance (QS61, NG15), with a target of 100% compliance.

Results: Culture collection improved progressively from 26.5% at baseline to 35.7% (Cycle 1) and 40.0% (Cycle 2). Guideline-concordant prescribing rose from 61.8% to 71.4% in Cycle 1, then fell to 55.0% in Cycle 2. Full allergy clarification fell from 28.6% at baseline to 0% in Cycle 1, before rising to 37.5% in Cycle 2.

Discussion: Culture collection showed consistent, cumulative improvement, though compliance remained well below target. Guideline adherence and allergy documentation followed less consistent trajectories, likely confounded by staffing turnover, intermittent checklist availability, and small cycle sample sizes. Lead clinicians making prescribing decisions may have had less exposure to the checklist than juniors completing documentation, limiting its reach.

Conclusion: A combined educational and checklist-based intervention produced sustained improvement in culture collection, but guideline adherence and allergy documentation results were inconsistent, likely reflecting staffing variability and limitations of paper-based prompts rather than true intervention failure. Future work should extend this project to other wards, secure pharmacist integration, and explore electronic prompts within the patient record system.