Restricted Antimicrobial Use at Transitions of Care at an Australian Hospital

Abstract

Background: The emergence of antimicrobial resistance reinforces the need for antimicrobial stewardship to promote the appropriate and judicious use of antimicrobials. Aim: To quantify restricted antimicrobial use among intensive care unit (ICU) discharges to general wards, and to review appropriateness of antimicrobial use. Method: A prospective clinical audit was conducted over a 2-week period. Medical records for ICU discharges were reviewed, with relevant data extracted (patient characteristics, antimicrobial therapy prescribed, treatment instructions). Appropriateness of restricted antimicrobials used was gauged in accordance with hospital policies and the Therapeutic Guidelines: Antibiotic. Results: 98 patients were discharged from the ICU -74 (76%) discharged to general wards were on antimicrobials, 15 discharged to general wards were not on antimicrobials and 9 discharged out of the hospital. Of these 74 patients, 31 (42%) were prescribed a total of 57 restricted antimicrobials; only 11 of these 31 (36%) patients had documented approval (from microbiology/infectious diseases teams) for use of restricted antimicrobials. 46 restricted antimicrobials (n = 57; 81%) were deemed clinically appropriate and the remaining 11 were prescribed outside guideline-recommended indications. Conclusion: While most restricted antimicrobials were prescribed according to national guidelines, in only one-third of patients were the restricted antimicrobials 'approved' for use according to hospital policies. Better clinical documentation on treatment plans and review processes for restricted antimicrobial use is needed during the transition from ICU to general wards. J Pharm Pract Res 2011; 41: 283-7.

The protected antimicrobial process in a University Teaching Hospital: a qualitative interview study exploring the knowledge, attitudes, and experiences of healthcare professionals

“…The antimicrobials which are restricted vary between hospitals, but typically include meropenem, linezolid, caspofungin and amphotericin B and several others. Formulary restriction/protection curtails the overuse of broad spectrum, costly and new antimicrobials [ 1 , 2 ]. It establishes the requirement for local approval from an Infectious Disease physician, microbiologist, or other member of the AMS Team to sanction those antimicrobials [ 2 ].…”

“…Formulary restriction/protection curtails the overuse of broad spectrum, costly and new antimicrobials [ 1 , 2 ]. It establishes the requirement for local approval from an Infectious Disease physician, microbiologist, or other member of the AMS Team to sanction those antimicrobials [ 2 ]. The latter strategy may involve approval numbers or codes displayed in patient records, or charts, which illustrate approval being granted [ 2 ].…”

“…It establishes the requirement for local approval from an Infectious Disease physician, microbiologist, or other member of the AMS Team to sanction those antimicrobials [ 2 ]. The latter strategy may involve approval numbers or codes displayed in patient records, or charts, which illustrate approval being granted [ 2 ]. Ideally, a treatment plan is also included in the patient’s notes, outlining parameters such as duration of therapy [ 2 ].…”

“…The latter strategy may involve approval numbers or codes displayed in patient records, or charts, which illustrate approval being granted [ 2 ]. Ideally, a treatment plan is also included in the patient’s notes, outlining parameters such as duration of therapy [ 2 ]. Notably, these mechanisms are in addition to standard procedures, including the performance of culture tests to confirm causative pathogens and determine antimicrobial sensitivity profiles [ 2 ].…”