Drug Utilization and Evaluation of Restricted Anti-Microbials at CWM Hospital

Transcription

1 Drug Utilization and Evaluation of Restricted Anti-Microbials at CWM Hospital BY PHARMACY INTERNS 2007: ANNA ROSE PAVIHI MAKELESI COLATI VEEBHA CHAUHAN ANSHIL CHAND RAIJELI KAUYACA NAMRATA SINGH

2 INTRODUCTION v Use of Restricted Antimicrobials is rapidly increasing worldwide. v Inappropriate use results in: v increasing antimicrobial resistance v increasing health costs v To reduce such setbacks, regular monitoring and control of Restricted Antimicrobials is required.

3 The following are the Restricted Antimicrobials available at CWM hospital: ü Aciclovir 250mg IV ü Ceftriaxone 250mg & 1g IV ü Ciprofloxacin 500mg Tab. & 100mg/ 50ml IV ü Erythromycin 1g IV ü Metronidazole 500mg IV ü Piperacillin 2g IV ü Vancomycin 500mg IV

4 AIM v To review the current usage of Restricted Antimicrobials and to evaluate whether current prescribing corresponds with the Antibiotic Guidelines 2003/2004.

5 OBJECTIVES 1.To review the current usage of Restricted Antimicrobials at CWM Hospital as indicated in the Fiji Antibiotic Guidelines 2003/ To find out whether Prescribers are adhering to the Standard Operating Procedure for acquiring Restricted Antimicrobials. 3.To determine the Consumption Rate and Estimated Cost per annum of Restricted Antimicrobials over the past 5 year period ( ) at CWM Hospital.

6 METHOD Quantitative Retrospective and Prospective Review: v 6 month Retrospective (Aug Jan. 2008) review was carried out for Ceftriaxone IV, Metronidazole IV, Vancomycin IV, Ciprofloxacin IV/ Tabs. v Exception : Erythromycin IV, Piperacillin IV & Aciclovir IV (previous 2 years). v 2 month Prospective (May June 2008) for all except Piperacillin. (no pts) Collection Tools and Reference Source: v Audit Sheets v Patients Information System (PATIS) v Restricted Antimicrobial Form (SOP) v Antibiotic Guidelines nd Edition.

7 RESULTS and DISCUSSION OBJECTIVE 1 (a): Prescribing According To Antibiotic Guideline Retrospective Percentage of Indications According to Antibiotic Guideline Vancomycin Piperacillin Antimicrobial Erythromycin Metronidazole Aciclovir Ciprofloxacin Ceftriaxone Percentage (%) Within Outside

8 Prospective No. of Requests According to Guideline Erythromycin IV 2 Aciclovir IV 4 Antimicrobial Vancomycin IV Metronidazole IV Ceftriaxone IV 250 mg & 1 g 91 7 Ciprofloxacin IV/oral No. of patients Within Outside

9 Objective 1(a) : Majority are prescribed according to Indications in the Antibiotic Guideline: Retrospective (84%) and Prospective (93%). Outside Indication pertain to the following reasons: No indication on the request form Unclear indications Writing of microbe name with no specific indication New indications

10 OBJECTIVE 1 (b) : Completion of Therapy Retrospective Percentage of Completed Treatment Antimicrobials Ceftriaxone IV 250mg & 1g Piperacillin IV Metronidazole IV Ciprofloxacin IV/Oral Erythromycin IV Vancomycin IV Aciclovir IV 79% 43% 61% 32% 75% 50% 95% 21% 57% 39% 68% 25% 50% 5% 0% 20% 40% 60% 80% 100% 120% Percentage (%) TX Complete TX Incomplete

11 Prospective Completion of Therapy Erythrom ycin IV 2 Antimicrobials Aciclovir IV Vancomycin IV Metronidazole IV Ceftriaxone IV 250 mg & 1 g Ciprofloxacin IV/oral No. of Patients Tx Complete Tx Incomplete

12 Objective 1 (b): Completion of therapy: Treatment Incomplete Retrospective - 38% Prospective 33% The following applies to the Prospective data only Pt. Deceased (18) Pt. Discharged (15) Pt Switched to another Antimicrobial (8) Out of Stock (2) Others (23) * n=203

13 Objective 2 Not Adhering 21% Retrospective Adhering 79%

14 Objective 2: Adherence to Protocol Non Adherence: v Retrospective 21% v Prospective 26% v Reasons: - Patient details not specific e.g. NHN, age & weight for Peadiatrics - No justification given for Indications when outside the Antimicrobial Guidelline - Indication's not specified - Consultant did not sign - No sensitivity report - No pharmacy report

15 Objective 3: Consumption Rate Per Annum ( ) Consumption Rate Per Annum For Piperacillin & Ciprofloxacillin IV/Oral No. of Units Year Piperacillin IV Ciprof loxacin IV Ciprof loxacin Oral

16 Consumption Rate per Annum of Vancomycin IV/Metronidazole IV No. of Units Year Vancomycin IV Metronidazole IV

17 Consumption Rate per Annum of Erythromycin IV/Aciclovr IV No. of Units Year Erythromycin IV Acyclovir IV

18 Consumption Rate of Ceftriaxone 1g and 250mg per Annum No. of vials Ceftriaxone 1g Ceftriaxone 250mg Year

19 Cost Per Annum Consumption Rate of IV Piperacillin, Erythromycin, Aciclovir ($) 8000 Cost per Annum Year Piperacillin 2g Erythromycin 1g Aciclovir 250mg

20 Cost Per Annum Consumption rate of Vancomycin and Metronidazole ($) Cost per Annum Year Vancomycin IV (500mg) Metronidazole IV (500mg)

21 Cost Per Annum Consumption Rate of Ceftriaxone 250mg & 1g ($) Cost per Annum ($) Ceftriaxone 250mg Ceftriaxone 1G Year

22 Cost per Annum Consumption rate of Ciprofloxacillin Oral and IV ($) Cost per Annum Year Ciprofloxacillin 500mg Tablets Ciprofloxacillin IV 200mg

23 DISCUSSION: Objective 3 v Drastic increase in consumption and cost/annum in the period of for : v Ceftriaxone 250mg and 1g IV v Metronidazole IV v Ciprofloxacin IV v Vancomycin IV

24 Patients per Discipline Erythromycin IV 2 Aciclovir IV 13 Antimicobials Vancomycin IV Metronidazole IV Ceftriaxone IV 250mg & 1g Ciprofloxacin IV/ Oral Medical Surgical Paediatrics No. of patients

25 RECOMMENDATIONS - R - Clarify -- Delegate a clinical pharmacist to monitor all pts. on restricted antimicrobials - Additional intervention is required to improve communication between the microbiology and pharmacy department. - Continuing education for all health professionals.

26 LIMITATIONS Time Constraints Unavailability of Sensitivity Report. Incomplete Pharmacy Reports. Limited Time frame for Prospective Study (2months)

27 CONCLUSIONS The principal aim of restricted antimicrobial protocols is to improve the quality of prescribing, which should lead to a reduction of resistance, decreased cost and improved patient care. he approach to appropriate prescribing and utilization of restricted antimicrobials should include: Adherence to Antimicrobial Guidelines and prescribing protocols. The overall results of the study was found to be inconclusive due to significant limitations mainly the lack of patient numbers and inadequate time frame in the prospective part.

28