The feasibility and generalizability of assessing the appropriateness of antimicrobial prescribing in hospitals: a review of the Australian National Antimicrobial Prescribing Survey

Abstract

The National Antimicrobial Prescribing Survey (NAPS) is a web-based qualitative auditing platform that provides a standardized and validated tool to assist hospitals in assessing the appropriateness of antimicrobial prescribing practices. Since its release in 2013, the NAPS has been adopted by all hospital types within Australia, including public and private facilities, and supports them in meeting the national standards for accreditation. Hospitals can generate real-time reports to assist with local antimicrobial stewardship (AMS) activities and interventions. De-identified aggregate data from the NAPS are also submitted to the Antimicrobial Use and Resistance in Australia surveillance system, for national reporting purposes, and to strengthen national AMS strategies. With the successful implementation of the programme within Australia, the NAPS has now been adopted by countries with both well-resourced and resource-limited healthcare systems. We provide here a narrative review describing the experience of users utilizing the NAPS programme in Canada, Malaysia and Bhutan. We highlight the key barriers and facilitators to implementation and demonstrate that the NAPS methodology is feasible, generalizable and translatable to various settings and able to assist in initiatives to optimize the use of antimicrobials.

Auditing tools for antimicrobial prescribing in solid organ transplant recipients: The why, the how, and an assessment of current options

“…30 Quality parameters are categorized into appropriate prescribing, which is further sub-categorized into optimal or adequate use, and inappropriate prescribing, which is sub-categorized into suboptimal or inadequate use. 30 Thus, NAPS is an instrument to assess, report, and monitor antimicrobial use, as well as a behavioral change intervention to optimize prescribing practices. Beyond Australia, it has been piloted in Canada, Malaysia, Bhutan, New Zealand, Fiji, Timor-Leste, and the UK.…”

“…(1) able to capture valid data elements that are well defined and convenient to identify; (2) has an intuitive user-interface for data entry; (3) applies an a priori adjudication framework that incorporates applicable local consensus guidelines, yet maintains flexibility to accommodate clinical scenarios where guidelines do not exist or are not applicable. [27][28][29][30][31][32] (4) Crucially, retrieval of data for reporting the quality and quantity of antimicrobial prescribing should be efficient, timely, and transportable. 22,30,33 (5) To encourage widespread use in hospitals in both resource-rich and resource-limited jurisdictions, cost of the auditing tool should be sufficiently low.…”

“…NAPS is a web‐based tool (printable forms available) to adjudicate antimicrobial regimens, with standardized definitions of appropriateness centered around consensus guidelines, and in the absence of guidelines, the principles of AMS are applied 30,35 . Variables included in the auditing tool are standardized, validated, and frequently updated to meet the needs of end‐users 30 . In addition to access to the raw data, a distinctive feature of NAPS is its dashboard and benchmarking report which is automated and offers a real‐time, at‐a‐glance summary of the pertinent metrics on the quantity and quality of antimicrobial prescribing 30 .…”

“…Variables included in the auditing tool are standardized, validated, and frequently updated to meet the needs of end‐users 30 . In addition to access to the raw data, a distinctive feature of NAPS is its dashboard and benchmarking report which is automated and offers a real‐time, at‐a‐glance summary of the pertinent metrics on the quantity and quality of antimicrobial prescribing 30 . Quality parameters are categorized into appropriate prescribing, which is further sub‐categorized into optimal or adequate use, and inappropriate prescribing, which is sub‐categorized into suboptimal or inadequate use 30 .…”

“…30 In addition to access to the raw data, a distinctive feature of NAPS is its dashboard and benchmarking report which is automated and offers a real-time, at-a-glance summary of the pertinent metrics on the quantity and quality of antimicrobial prescribing. 30 Quality parameters are categorized into appropriate prescribing, which is further sub-categorized into optimal or adequate use, and inappropriate prescribing, which is sub-categorized into suboptimal or inadequate use. 30 Thus, NAPS is an instrument to assess, report, and monitor antimicrobial use, as well as a behavioral change intervention to optimize prescribing practices.…”