Transcript Cellulitis (1/4)

Admission criteria
Cellulitis (1/4)
Diagnosis of cellulitis requiring IV antibiotics?
Yes
Patient able to attend Ambulatory Care as an outpatient day 3
& 7 as a minimum? If patient immobile can community
services provide daily service for I/V’s
Yes
Does the patient have ≥2 signs of systemic sepsis?
 Temperature >38 or <36°C
 Pulse >90/min
 Systolic BP <100
 RR >20
No
No
Hospital admission required
Yes
Hospital admission required
Does the patient have >1 of the following?
▪ WBC >14 or <4
▪ Severe lymphangitis, blistering or large affected area
▪ Immunosuppression
▪ Pregnant
▪ Poorly controlled diabetes
▪ Peripheral vascular disease
▪ Live alone
▪ Have poor vision/hearing
▪ Psychological or alcohol/drug misuse. Issues that would make
outpatient attendance unsafe
▪ Previous / Current intra-venous drug use
No
Yes
Patient suitable for ambulatory care centre
IV administration protocol
 Consent given and documented?
 Administer antibiotics using outpatient
protocol or community nurse referral
Person completing
Sign:___________
Hospital admission required
Print:___________
SOURCE: NHS Institute for Innovation and Improvement website (www.institute.nhs.uk)
Ambulatory protocol
Cellulitis (2/4)
1. Initial
I/V Teicoplanin 400mg
(as bolus over 3-5mins)
teicoplanin 1st drug of choice
Photograph & measurement of wound site
Repeat 400mg loading dose after 12hrs (can they return for this?)
Final 400mg loading dose
after further 12 hours
2. Daily attendance or
community service
Should there be
alternative antibiotic
option for
contraindications?
Teicoplanin 400mg
(as bolus over 3-5mins)
? wound checked
For medical review day 3 & day 7. To consider increase of teicoplanin at day 3 & 7 consider the
next stage of treatment
3. Oral conversion
Once patient is apyrexial for 48 hours and has evidence of definite
improvement in the appearance of their cellulitis
Flucloxacillin 500mg qds
AND
Amoxycillin 500 tds
(for minimum 7 days)
OR if
penicillin
allergic
Clarithromycin 500mg
bd
(for minimum 7 days)
The antibiotics are prescribed on an A&E prescription located on the MGPU or within
the MGPU referral box located on the MAC behind the reception desk. The total duration of the antibiotic
course (both iv and oral) should be a minimum of 7days and may need to be significantly longer. Prepacks of
the oral antibiotics will be kept on the MGPU and MAC and issued as per the medicines management policy.
We need to organise this aspect with pharmacy
SOURCE: NHS Institute for Innovation and Improvement website (www.institute.nhs.uk)
Daily checklist
Cellulitis (3/4)
Ensure pt added to IPM as day attended and
discharged for each review
▪
Date:
Date:
Day 1
Day 2
Day 3
Yes
Assess patient
▪
▪
Date:
No
Yes
No
Yes
No
Patient systemically better?
Side effects of anti biotics
–
GI upset
–
Rash
Celluitic area:
–
Site marked?
–
Improved?
If area unchanged on 2 visits – Doctor to
review
▪
Dressing intact & secure?
▪
▪
Venflon – VIP chart checked?
Check observations
–
Normal?
If abnormal, must be discussed with doctor
▪
Abnormal bloods to be repeated at 48
hours
–
Normal?
If abnormal, must be discussed with doctor
Antibiotic administration
▪
▪
Check identity of patient
Check for allergy
Duration of treatment
▪
▪
▪
Has the cellulitis improved?
Apyrexial for 48 hours?
Blood tests normal/better?
If YES convert to oral antibiotics as per Appendix A. Antibiotics can be prescribed using EDL and TTA
packs or FP10. Treat for a total course (iv and po) for a minimum of 7 days. Complete NOD letter
Any Grey boxes ticked require action
Person completing
Sign:___________
Print:___________
SOURCE: NHS Institute for Innovation and Improvement website (www.institute.nhs.uk)
Discharge checklist
Cellulitis (4/4)
Yes
▪
Attendance with diagnosis of Cellulitis
▪
Suitable for outpatient cellulitis service
(See criteria below)
▪
Consent documented in notes
▪
Mark cellulitic area with indelible pen
▪
Photograph of area (if possible)
Complete discharge checklist below
▪
Patient given information leaflet
▪
Ensure cellulitic area clearly marked
▪
Venflon secure, flushed with saline and dressed with solfa band and comfigrip
▪
Insertion date is present and VIP score completed
▪
Identifying first return point and time
(EAU if next day). Timing to occur as close to 24 hours after last antibiotic dose as
is feasible)
▪
Electronic Discharge Letter
▪
Book patient into EAU outpatient antibiotic book
▪
In Box leave
–
Medical and nursing notes
–
Observation chart
–
Drug chart and antibiotics
All boxes must be ticked and clear for patient to be entered into the pathway
SOURCE: NHS Institute for Innovation and Improvement website (www.institute.nhs.uk)
No