The management of adult patients with meningitis at Arrowe Park Hospital – A complete audit cycle

Anecdotal experience suggested there were areas for improvement in meningitis management. To address this, we conducted a complete audit cycle of the management of meningitis in adult patients at Arrowe Park Hospital.

Method:

We utilised the abbreviated audit tool from the McGill et al 2016 meningitis guidelines.

Time period: 1/1/2017 to 31/12/2017. Cases audited: 20

A series of interventions were made.

Time period for second cycle: 1/2/2019 to 31/5/2019. Cases audited: 6

Audit standards were met for 1 out of 14 criteria for the first cycle and 2 out of 14 criteria for the second cycle.

Of note, there was reasonable compliance with empiric choice of antibiotic (80% à 83%), definitive choice of antimicrobials (95% à83%) and duration of antimicrobials (84% à 100%).

Improvements in investigations were seen in the second cycle:

1.Pneumococcal and Meningococcal EDTA PCR was sent (15% à 67%)

2.CSF glucose with concurrent plasma glucose sent (6.3% à 67%)

3.CSF for pneumococci and meningococci sent in all cases of suspected bacterial meningitis (22% à 67%)

The re-audit identified no improvement in the following areas:

1.Blood cultures taken within 1 h of arrival at hospital (30% à 33%)

2.LP performed within 1 h of arrival at hospital provided that it is safe to do so (0% à 0%)

3.Antibiotics started within 1 hr of arrival in hospital (35% à 33%)

In both audit cycles, 0% of patients were made aware of voluntary sector support.

Whilst improvements were achieved, there remains considerable scope for further improvement.