Antimicrobial audit: Appropriate prescribing of antibiotics

I would plan to visit the ward everyday for 5 days. Looking not only at the patients drug chart, but also in the patients clinical notes. I would be checking to see if cultures and sensitivities were available before the usage of the antibiotics. Also under investigation would be if the recommended antimicrobials for the indication were selected and appropriate review arrangements made.

Feedback

Antimicrobial audit:

Appropriate prescribing of antibiotics at

ward level

I would analyse the results with the rest of the antimicrobial team and microbiologists. Seeking feedback from doctors, nurses and pharmacy staff also.

If it is seen to be beneficial then other wards should be included to use the antimicrobial review stickers.

I would hope to see an improvement in results from the monthly antimicrobial audit if the review stickers are rolled out across all wards.

Aims

My Proposed antimicrobial audit

It is important to give feedback to all involved with prescribing antibiotics as improving patient care is essential to the Trust as a whole.

Looking at antimicrobials in my current role

• Work towards the government plans to stop the over usage of antibiotics

Execution

• Minimise hospital acquired infections (C-Diff and MRSA)

Currently the antimicrobial monthly audit that I have been involved in looks only at patients drug charts.

The audit that I am proposing focuses on one ward where there is significant usage of antibiotics. It looks a little deeper to determine if the prescriber has followed the recommend guidelines from the antimicrobial prescribing pathway. I would then like to implement a change in practice before re-auditing and comparing my results.

Sources:

• York & Scarborough antimicrobial stewardship antimicrobial prescribing pathway
• Department of health advisory committee on antimicrobial resistance and healthcare associated infection
• www.bmj.com

In my current role as a rotational pharmacy technician I see antibiotics prescribed all the time whether I am working on the wards or in the dispensary.

I know the Government and our Trust are working towards improving the quality of prescribing antibiotics. I believe this audit will help indicate areas for aiding the way doctors prescribe antimicrobials in the future.

Firstly I will visit the same ward every day for 5 consecutive days completing the audit form.

I will then leave a period of 4 weeks before returning to the same ward again for another 5 consecutive days.

If my predicted results are correct I expect to see a number of antibiotics prescribed incorrectly and not according to the clear prescribing pathway.

• Reduce the development of antimicrobial resistant organisms

Poppy Cottrell

Pharmacy Technician

I would then introduce the antibiotic review stickers to this ward and return 4 weeks later. On this occasion I will add an additional column to the original audit form to detect if the antibiotic review stickers have been used in the patients notes.

Plan

If the results have shown the stickers to be successful in improving the quality of prescribing antibiotics on this ward then more wards could be included. Wards at Scarborough hospital could also be introduced.

Using the data from the monthly antimicrobial audit that is already conducted. I would choose a ward with a significant usage of antibiotics to look at in more detail.

Predicted results

Design

Implementing change

From my recent experience and from researching similar audits, I would expect to see a percentage of prescribing which does not follow the antimicrobial prescribing pathway.

This could be attributed to Junior or Locum doctors being unaware of the Trust guidelines relating to antimicrobials and them needing extra support and guidance.

Pharmacists and medicine management technicians have suggested the use of antimicrobial review stickers to aid the quality of prescribing antibiotics.

The initial design of the audit would be looking to see if the clear prescribing pathway of antibiotics has been followed. It will indicate errors that are made not only in the initial prescribing but also in the follow up and review.

I would discuss with the ward sister/manager about the nature of the audit and its importance. I would also agree an appropriate time to carry out the audit. Informing also the ward pharmacist as I would like their input and cooperation to help with improvements of prescribing antibiotics on the ward.

I would introduce these on a trial basis to the ward.

After stating the significance and importance of the review stickers to key members of staff, I would ask the ward pharmacist and med man techs to use the stickers in patient's notes where they identify an antimicrobial with prescribing issues.

Visiting the same ward for consecutive days should mean I will see the same patients.This will mean I am able to monitor the journey of antibiotic prescribing from initial prescribing, the 48 hour review and if any stops or changes are made.

I would then carry onto audit this same ward to see if the stickers had made an improvement to the results of the audit and document my findings.

I predict that some of these stickers could be missed or not seen in the patients notes. Stickers for the front of the drug chart may also need to be introduced.

Right drug, Right dose, Right time, Right duration..... Every patient