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Antibiotic Awareness Week: On the path to least resistance

This post below from Professor John Turnidge,  Senior Medical Advisor at the Australian Commission on Safety and Quality in Health Care, marks Antibiotic Awareness Week (Nov 17-23).

It outlines how the Commission’s release of the Antimicrobial Stewardship Clinical Care Standard is another significant step along the path to ‘least antibiotic resistance’, but reports also on the latest 2013 National Antimicrobial Prescribing Survey (NAPS) which shows there is still lots of room for improvement in the use of antimicrobials in many Australian hospitals.

***

Professor John Turnidge writes:

Antibiotic Awareness Week is upon us once again. This annual global event is increasing in importance in Australia and is now the major launch vehicle for a whole range of activities by government and non-government bodies aimed at controlling and preventing antimicrobial resistance.

The Australian Commission on Safety and Quality in Health Care has been very active over a number of years in promoting strategies to reduce unnecessary antibiotic prescribing in Australia’s hospitals. One crucial strategy, antimicrobial stewardship, is now incorporated into the National Safety and Quality Health Service Standards, against which hospitals are accredited. As a consequence, all hospitals have been guided to focus on rational and restrained antibiotic use within their ‘four walls’, using tools and tactics such as those developed by the Commission in 2011. This has laid the foundation for a systems approach to improving antibiotic prescribing. Larger hospitals have or will be developing formal stewardship teams with the express purpose of developing effective interventions on inappropriate and non-guideline-compliant prescribing.

The release of the Antimicrobial Stewardship Clinical Care Standard today by the Commission is another significant step along the path to ‘least antibiotic resistance’.  Focussed on individual clinicians and their patients, rather than the system, the Antimicrobial Stewardship Clinical Care Standard contains nine quality statements which describe what is expected of every prescriber of antimicrobials. Some of these statements have suggestions for clinical indicators which health services can use to monitor the quality of their prescribing. In simple terms, this is what care should be provided:

1.   If a patient has sepsis, they are provided antimicrobial treatment without delay.

2.   For non-life threatening bacterial infections, antimicrobial treatment is guided by the results of microbiology testing rather than continuing with the unnecessary use of broad spectrum antimicrobials.

3. Clinicians are expected tofollow the national Therapeutic Guidelines: Antibiotic and/or endorsed local antimicrobial guidelines.

4. Clinicians should discuss treatment options with the patient, which may or may not include antimicrobial treatment. This is to reinforce the message in the community that you do not need antimicrobials for viral infections such as colds or sore throats.

5. To improve continuity of care, clinicians must document the reason for the provision of a particular antibiotic treatment in the patient’s health record, including the dose, route of administration, duration and review plan, which is currently poorly documented.

Codifying a standard of care for antimicrobial prescribing nationally creates a huge opportunity for everyone to examine their own prescribing practices, an essential first step towards the safe and continuous effective use of antimicrobials.

Tomorrow the Commission, in conjunction with the Melbourne Health National Health and Medical Research Council Centre for Antimicrobial Stewardship, will release the 2013 National Antimicrobial Prescribing Survey (NAPS).

Under development for a number of years, the survey moved to an online format for the first time. This initiative aimed to take a snapshot of antimicrobial use in hospitals of all types, where participants reviewed antimicrobial prescriptions and judged them against set criteria for appropriateness and compliance with guidelines, either national or locally-endorsed.

Participants were able to get reports of their own survey results for local use, as well as benchmark themselves against similar hospitals in Australia.

The survey shows that across the 151 participating hospitals, the proportion of antimicrobial prescriptions that were deemed appropriate was 71 per cent, while compliance with guidelines was lower at 60 per cent. Only 71 per cent of prescriptions had the rationale and indication for the prescription documented in the medical records. More than 40 per cent of surgical prophylaxis prescriptions were administered for longer than 48 hours.

These findings show there is considerable room for improvement in the use of antimicrobials in many Australian hospitals. The survey will continue to be repeated annually, and potentially extended to residential aged care facilities in the future, where antimicrobial use is very common.

Professor John Turnidge is Senior Medical Advisor for the Australian Commission on Safety and Quality in Health Care. He is an Infectious Disease physician and microbiologist who has had a long career in Adelaide and Melbourne working with antibiotic resistance and appropriate antibiotic use.

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