Strategies to Improve Antibiotic use Flashcards
What is the problem with antimicrobial resistance?
Increased risk of worse clinical outcomes and death
Consume more healthcare resources
How do drug resistant strains arise?
•The use and misuse of antimicrobials accelerates the emergence of drug-resistant strains.
What is antimicrobial stewardship?
Balances managing infections with the outcomes of the patient and the wider society
What is the UK 5 year antimicrobial resistance strategy?
Improve knowledge and understanding of AMR
Conserve and steward the effectiveness of existing treatments
Stimulate the development of new antibiotics and novel therapies
What type of intervention is effective when trying to improve antibiotic presecribing?
•Advice/feedback more effective than restrictive interventions
What is the SAPG?
Scottish antimicrobial prescribing group
Co-ordinates & delivers a national framework for antimicrobial stewardship to enhance the quality of antimicrobial prescribing & management in Scotland
Provides guidance on antimicrobial stewardship to improve the quality of antimicrobial use
What are some of SAPG successes?
Decrease in CDIFF rates in scotland
New data systems
Development of new training materials
Improved clinical management of infections (CAP, sepsis 6)
What is the HEAT target for hospital prescribing?
–Indication for antibiotic is documented and compliant with local policy
–Duration of oral antibiotics is documented and compliant with local policy
What are the current targets?
–IV antibiotic review within 72h and outcome is documented
–1% Reduction in overall antibiotic consumption
–1% Reduction in carbapenem consumption
–1% Reduction in piperacillin/tazobactam consumption
What are the trends in antibiotic use in primary care and acute hospitals?
Primary care - decreasing
Hospitals - increasing
What are NHS grampian strategies?
- Policies & guidelines
- Audits and feedback
- Surveillance data
- Education
Give examples of policies and guidelines within NHS grampian?
- Empirical guidelines
- Documentation & review/stop date (drug Kardex documentation)
- IVOST policy (IV to oral switch therapy) - IV antibiotics moved to IV administration if certain criteria are met
- Penicillin allergy
- Alert Antimicrobials - under authorisation of microbiologist or infectious disease specialist, and/or according to approved indications within local guidelines / policies
- Gentamicin
- Vancomycin
What are the criteria needed for the IV to oral switch therapy?
Patient is improving clinically
Patient is able to tolerate an oral formulation
All the criterion below are met:
Able to swallow and tolerate fluids
Temp. 36-38°C for at least 48 hours
Heart rate < 100bpm for previous 12 hours
WCC between 4 and 12x109L
NOT SWITCH:
- Oral route compromised, continuiing sepsis, special indication (endocarditis, meningitis, staph aureus), febrile neutropenia, hypotension/shock
What are the audits and feedback?
- Large point prevalence audits annually
- SAPG quality improvement audits
- Smaller ad-hoc audits
Give examples of survillance data
- Antimicrobial trends using DDDs and bed days for comparison across hospitals
- Antimicrobial resistance – on demand
- Hospital-acquired infections – IPCT
- National systems include HMUD, Antibiotic use in Humans 2012-2016 Database and HPS
