From intermittent antibiotic point prevalence surveys to quality improvement: experience in Scottish hospitals

Abstract

BackgroundIn 2008, the Scottish Antimicrobial Prescribing Group (SAPG) was established to coordinate a national antimicrobial stewardship programme. In 2009 SAPG led participation in a European point prevalence survey (PPS) of hospital antibiotic use. We describe how SAPG used this baseline PPS as the foundation for implementation of measures for improvement in antibiotic prescribing.MethodsIn 2009 data for the baseline PPS were collected in accordance with the European Surveillance of Antimicrobial Consumption [ESAC] protocol. This informed the development of two quality prescribing indicators: compliance with antibiotic policy in acute admission units and duration of surgical prophylaxis. From December 2009 clinicians collected these data on a monthly basis. The prescribing indicators were reviewed and further modified in March 2011. Data for the follow up PPS in September 2011 were collected as part of a national PPS of healthcare associated infection and antimicrobial use developed using ECDC protocols.ResultsIn the baseline PPS data were collected in 22 (56%) acute hospitals. The frequency of recording the reason for treatment in medical notes was similar in Scotland (75.9%) and Europe (75.7%). Compliance with policy (81.0%) was also similar to Europe (82.5%) but duration of surgical prophylaxis <24hr (68.6%), was higher than in Europe (48.1%, OR: 0.41, p<0.001). Following the development and implementation of the prescribing indicators monthly measurement and data feedback in admission units illustrated improvement in indication documented of ≥90% and compliance with antibiotic prescribing policy increasing from 76% to 90%. The initial prescribing indicator in surgical prophylaxis was less successful in providing consistent national data as there was local discretion on which procedures to include. Following a review and a focus on colorectal surgery the mean proportion receiving single dose prophylaxis exceeded the target of 95% and the mean proportion compliant with policy was 83%. In the follow up PPS of 2011 indication documented (86.8%) and policy compliant (82.8%) were higher than in baseline PPS.ConclusionsThe baseline PPS identified priorities for quality improvement. SAPG has demonstrated that implementation of regularly reviewed national prescribing indicators, acceptable to clinicians, implemented through regular systematic measurement can drive improvement in quality of antibiotic use in key clinical areas. However, our data also show that the ESAC PPS method may underestimate the proportion of surgical prophylaxis with duration <24hr.

Antimicrobial usage among hospitalized children in Latvia: A neonatal and pediatric antimicrobial point prevalence survey

“…There are well-established surveillance methodologies developed by The European Surveillance of Antimicrobial Consumption (ESAC) Project but these PPSs have focused mainly on adults [9]. PPSs have been used in hospitals not only at the European level but also undertaken at the national and individual hospital level [10,11]. There are some studies on antibiotic use in pediatric population using PPSs [12] but methodology was adopted from adult PPSs and it was not specifically designed for children.…”

A comparison of antibiotic use in three specialist paediatric hospitals in France, Latvia and the UK

“…PPSs can be a successful method to monitor trends in antibiotic prescribing and identify targets for quality improvement 9. PPSs are an important tool for a quality control exercise because they provide useful data for targeted interventions and further study 22.…”

“…Well-established surveillance methodologies were developed by the European Surveillance of Antimicrobial Consumption (ESAC) Project, but these have focused mainly on adults7 with only some studies carried out in the paediatric population 8. PPSs have been undertaken in hospitals at the individual, national and European level 9 10…”

Drug Resistance in Bacteria, Fungi, Malaria, and Cancer

“…The collection of prevalence data in 2009 led to the development of two quality prescribing indicators: (1) the extent of compliance with antibiotic policies among acute admission units and (2) surgical prophylaxis duration (Malcolm et al 2013). The collection of prevalence data in 2009 led to the development of two quality prescribing indicators: (1) the extent of compliance with antibiotic policies among acute admission units and (2) surgical prophylaxis duration (Malcolm et al 2013).…”

“…The collection of prevalence data in 2009 led to the development of two quality prescribing indicators: (1) the extent of compliance with antibiotic policies among acute admission units and (2) surgical prophylaxis duration (Malcolm et al 2013). Overall, SAPG has shown that the implementation of national prescribing indicators, which are acceptable to clinicians and regularly audited, can improve subsequent antibiotic utilisation (Malcolm et al 2013). Following the implementation of prescribing indicators, there was an improvement in the indication noted in the patient records of 90 %.…”