ABMU Antibiotic Audits An Update

1. ABMU Antibiotic AuditsAn Update Siân Price Antimicrobial Pharmacist

2. The Background Cardiff and Vale stickers introduced Care bundle introduced and monthly care bundle audits started

3. The ABMU Antimicrobial Care Bundle Applies to all antimicrobials prescribed on the regular side of the medication chart: • Documentation of allergy status on medication chart • Clear indication for antimicrobial(s) on medication chart • Documentation of a stop or review date on medication chart • Consistency with Health Board guidelines • Use of antimicrobial sticker(s)

4. The Background Smaller stickers introduced Infection Prevention Board established First monthly audit report

5. Issues with original audit format • Labour intensive for ward pharmacists and AM pharmacists • Focus on documentation rather than clinical appropriateness • Relied on assessment of appropriateness by ward pharmacist – results consistently (falsely?) high • Lack of familiarity with guidelines? • Lack of confidence in clinically checking antimicrobial prescriptions?

6. Issues with original audit format • No patient/antibiotic details recorded • No quality check by AM pharmacist • No intervention into patient care

7. So…… Progress came to a standstill without achieving the targets and…… ….there was a need to move forward and audit more clinical and relevant aspects of antimicrobial prescribing…… ….and further engage with prescribers

8. Jan 2015 – new format audits • Frequency reduced to two monthly • Data still collected by clinical pharmacists • All patients prescribed systemic antibiotics • All acute areas audited • Every audit quality checked by AM Pharmacist • Coding used to enable automation

9. Patient details Day of therapy Indication Antibiotic Route

12. Data Reported • Care bundle data: • Clear indication for antimicrobial(s) on medication chart • Documentation of a stop or review date on medication chart • Use of antimicrobial sticker(s) • Documentation of allergy status no longer audited (duplication of All Wales patient safety thermometer data)

13. 4 Key Prescribing Indicators • Percentage of antimicrobial prescriptions assessed as appropriate in terms of choice of antimicrobial • Percentage of antimicrobial prescriptions over 7 days (excluding deep seated and high risk infections) • Percentage of prescriptions for surgical prophylaxis over 24 hours • Percentage of IV antimicrobial prescriptions over 72 hours (excluding deep seated and high risk infections)

14. Trigger Points • Directorates reaching these trigger points highlighted to the C. difficile Improvement Group and asked to investigate further

15. Exclusions > 7 days IV > 72 hours Neutropenic sepsis Liver abscess Osteomyelitis Septic arthritis Empyema Cavitating pneumonia S. aureus bacteraemia Severe necrotising soft tissue infections Infected implants/prostheses Meningitis Encephalitis Intracranial abscess Mediastinitis Endocarditis Exacerbation bronchiectasis/CF Hospital-acquired pneumonia • Liver abscess • Osteomyelitis • Septic arthritis • Empyema • Cavitating pneumonia • S. aureus bacteraemia • Severe necrotising soft tissue infections • Infected implants/prostheses • Meningitis • Encephalitis • Intracranial abscess • Mediastinitis • Endocarditis • Exacerbation bronchiectasis/CF • Medical prophylaxis

16. Benefits of new format • Information more relevant to prescribers • Identify poorly performing areas • Identify gaps in pharmacists’ knowledge • Intervene in individual cases to improve patient care • Reported to Clostridium difficile group for directorates to investigate • Enables directed, in-depth audits by clinicians (minimum 2 audits per year)

17. The First Report Directorate Feedback received from directorates – mostly positive/constructive

18. Teething Problems…. • Approximately 20% prescriptions excluded from assessment of appropriateness as indication not featured in guidelines • Low numbers of surgical prophylaxis audited • Needed to change some exclusions e.g. HAP (IV>72 hours) • More codes/code changes needed • Help from PHW to simplify and ensure only necessary data collected • More education of pharmacists needed • Some prescribing indicators may not be applicable to some specialities

19. The Future • Interactive data (Tableau) down to speciality level via Public Health Wales • Care bundle data to be inputted automatically into FOC database • Continue to adapt based on feedback and amend/add to guidelines • Trend data • ? Audit by consultant (anonymously)

20. Summary • Major changes to ABMU audit format introduced Jan 2015 • Modifications made after Jan and March data collections • Data appears to be more meaningful • Still a work in progress……

21. Thank you for listening Any Questions?