Sticking to minimum standards: implementing antibiotic stewardship in intensive care.

Link to article at PubMed

Sticking to minimum standards: implementing antibiotic stewardship in intensive care.

Intern Med J. 2014 Jul 29;

Authors: Chaves NJ, Ingram RJ, MacIsaac CM, Buising KL

BACKGROUND: In Australia, antimicrobial stewardship programs are a compulsory component of hospital accreditation. Good documentation around antimicrobial prescribing aids communication and can improve prescribing practice in environments with multiple decision-makers.
AIM: To develop and implement an intervention to improve antimicrobial prescribing practice in a 24-bed intensive care unit in a tertiary referral adult hospital.
METHODS: We conducted a 4-phase (observation, reflection, implementation, evaluation) prospective collaborative before-after quality improvement study. Baseline audits and surveys of antimicrobial prescribing practices identified barriers to and enablers of good prescribing practice. A customized intervention was then implemented over six weeks and included a yellow medication record sticker, quarterly education sessions, and ICU-specific empiric antimicrobial prescribing guidelines. Post-implementation, the effects were monitored by serial antimicrobial prescribing audits for one year. The primary outcomes were clear documentation of: the start date, a planned stop date or review date, and, the indication for an antibiotic. These were all considered the 'minimum standards' for an antimicrobial prescription on the medication record.
RESULTS: Documentation of minimum standards specifically addressed by the sticker improved [start date (72% to 90%, p<0.001), stop date (16% to 63%, p<0.001), antimicrobial indication documented on medication chart (58% to 83%, p<0.01)]. Overall, adherence to all three minimum standards (start date, stop date and indication) improved from 41/306 (13%) to 306/492 (63%) (p<0.001). One-year post-implementation, the yellow sticker had become embedded into daily practice.
CONCLUSION: A systematic approach to quality improvement combined with the implementation of a tailored, multi-faceted intervention can improve antimicrobial prescribing practices.

PMID: 25070720 [PubMed - as supplied by publisher]

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