Poster Session HRT11420 Innovation Awards November 2014 Melbourne Antimicrobial Stewardship In Residential Aged Care Facilities Elizabeth Orr: Monash Health:
Elevator Pitch- A pilot project was conducted to look at antimicrobial use in RACF s. In the pre intervention phase, data was collected on type and dose of antibiotic, reason why commenced, collection of specimens and result and total duration of antibiotics. Education was provided to the GP s and nursing staff during the intervention stage and the identical data was collected in the post intervention phase. This proved to be effective in decreasing total number of courses of antibiotics prescribed and days of therapy.
Presenters Summary Inappropriate antibiotic prescribing in RACF increases multiresistant organisms spread and development To decrease overall antibiotic use and decrease length of therapy according to therapeutic guidelines 3 phase study, pre intervention (data collection), intervention (education) and post intervention (data collection) Overall decrease in courses of antibiotics prescribed Overall decrease in days of therapy (P <0.0001)
KEY PROBLEM Antimicrobial prescribing in RACF s has significant implications for health services with the development and spread of multi-resistant organisms (MRO) Routine surveillance of common infections revealed high numbers of antibiotics prescribed, especially those not meeting McGeer definition for surveillance in RACF s
AIM OF THIS INNOVATION The aim of our research was to implement, monitor and evaluate an antimicrobial stewardship program driven by an Infection Control CNC together with an ID physician and GP
BASELINE DATA - Pre intervention data collection phase involved baseline data collection including type and dose of antibiotics prescribed, reason why commenced, whether specimens were collected prior to antibiotics prescribed and results of these, were these results seen by the GP, total duration of antibiotics and patient outcomes Total number of courses prescribed over the 3 month data collection period was 102, with days of therapy 723
KEY CHANGES IMPLEMENTED The infection control CNC took on an intermediary role between the GP s and the ID physician and was involved in education of nursing staff and GP s, data collection and monitoring of pathology results Education took the form of small lectures, posters on the wards, letters to GP s detailing findings of the baseline audit and reminders of appropriate prescribing Twice weekly rounds occurred whereby current pathology results were evaluated and discussed with the GP where possible and data collection was undertaken
OUTCOMES SO FAR Patient details Pre-AMS Post-AMS P-value Total OBDs 11 661 11 518 Total no: courses 102 83 Total specimens sent 23/102 22/93 0.53 Meets McGeer criteria 37/102 29/83 0.85 Therapy Days of therapy (per 1000 OBD) 723 (62.0) 571 (49.6) <0.0001 Mean +/- s.d. duration 7.08 +/- 1.97 6.92 +/- 2.44 0.11 Range of duration 2-14 1-16 Medial duration +/- (IQR) 7 (6-7) 7 (6-8)
LESSONS LEARNT Education to all key stakeholders is very important Provide information on antimicrobial prescribing guidelines Establish factors that influence antimicrobial prescribing to guide education Important to focus on not treating asymptomatic bacteriuria and decreasing the duration of prescribed antibiotics for urinary sepsis
Who can provide information on this innovation from your service? Elizabeth Orr liz.orr@monashhealth.org Dr Rhonda Stuart rhonda.stuart@monashhealth.org