Workplan on Antibiotic Usage Management

Transcription

1 IMPACT Forum: Antibiotic Guideline in Perspective Workplan on Antibiotic Usage Management Dr. Raymond Yung Consultant Microbiologist PYNEH 20 April 2002 May 2002 Dr. Raymond Yung 1 Objective 1. Heighten awareness of antibiotic resistance pattern and utilization trend 2. Facilitate antibiotic usage management 3. Build the necessary infrastructure to implement the management programmes through multi-discipline collaboration May 2002 Dr. Raymond Yung 2 1

2 Workplan 1. Set up a HA antibiotic resistance surveillance system 2. Report of surveillance data to clinical department 3. Tracking antibiotic utilization trend May 2002 Dr. Raymond Yung 3 Identify utilization trend of different hospitals Step 1 Hospital A Total consumption on drug X (gm) Step 2 Hospital A Total consumption on drug X (gm) by Dept A Step 3 X (gm) = Y (no. of DDD consumed by Dept A) Defined daily dose (DDD) on drug X Step 4 Y x 1000 = Z (no. of DDD per 1000 patient days) Patient days in Dept A Step 5 Compare the median rate of Z between comparable dept / patient service area May 2002 Dr. Raymond Yung 4 2

3 Workplan (cont d) 4. Conduct regular education seminar 5. Facilitate hospital to set up antibiotic utilization review team 6. Work with CPO to enhance MOE system May 2002 Dr. Raymond Yung 5 Patient gum label Drug requested Dosage Route Date started Piperacillin-Tazobactam (Tazocin) Vancomycin Cefoperazone-sulbactam (Sulperazone) Ceftazidime (Fortum) Ciprofloxacin / Levofloxacin Meropenem / Imipenem Amoxacillin-clavulanate (Augmentin) IV Indications: 1. Confirmed MRSA 4. Uncomplicated community acquired pneumonia 8. Acinetobacter 2. Recurrent pseudomembranous colitis 5. Hospital acquired pneumonia 9. Confirmed pseudomonas 3. Severe PRSP (pen-r pneumococcal) e.g meningitis 12. Others (please specify) 6. Complicated urinary tract ± pyelonephritis 7. Empirical treatment for neutropenic fever 10. Confirmed ESBL positive E. coli or klebsiella 11. History of hypersensitivity to β lactam drugs reaction Medical Officer s signature and chop May 2002 Dr. Raymond Yung 6 3

4 The antimicrobial team in action (an example of a successful model in a hospital) To facilitate the process, all prescription of antibiotics should be accompanied by the following documentation: (I) Prophylactic or therapeutic. (ii) Empirical or known-pathogen therapy. (iii) Type of : community- or hospitalacquired. (iv) Site of : Respiratory, bloodstream, intra-abdominal, urinary. May 2002 Dr. Raymond Yung 7 On a daily basis: TIME ACTIVITY PARTICIPANTS AM Computer printout of all patients on vancomycin/teicoplanin Ward visit: Review and photocopy case notes / filling in pre-designed proforma Names of I/C MO FU of adherence to recommendations or feedback from I/C clinicians Noon Noon meeting (12 noon to 1pm) Lasts about minutes Daily recommendations: Appropriate/not advised; letter to prescribing doctor Pharmacist Antibiotic nurse or pharmacist Clinical microbiologist; antibiotic nurse, pharmacist linked clinician from participating departments of medicine, surgery, etc. PM Return recommendation sheet to patient Antibiotic nurse or pharmacist record or clinical microbiologist May 2002 Dr. Raymond Yung 8 4

5 Every three monthly (I) Record office Sends summary statistics of patient admission, bed-day occupied to clinical microbiologist. (ii) Pharmacist Sends summary statistics (DDD and HK$) of antibiotic consumption to clinical microbiologist. (iii) Clinical microbiologist Analyzes statistics from record office and pharmacist Summarizes adherence / not advise information; streamline data Presents data to all members of the antimicrobial May 2002 team Dr. Raymond Yung 9 Workplan (cont d) 7. Cross link Pharmacy System with LIS to facilitate on line review of antibiotic prescription when preparing microbiology report May 2002 Dr. Raymond Yung 10 5

6 Key performance indicators 1. Compliance to guideline 2. Antibiotic utilization trend 3. % ESBL producing E. coli and klebsiella spp May 2002 Dr. Raymond Yung 11 Thank you! May 2002 Dr. Raymond Yung 12 6