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Antibiotic prescribing practices within a Scottish acute medical admissions unit
Abstracts These data together with patient specific easy audit tools can provide a more reliable set of indicators in drug use.
P 080 ANTIBIOTIC PRESCRIBING PRACTICES WITHIN A SCOTTISH ACUTE MEDICAL ADMISSIONS UNIT Dawson SC 1, Kumarasamy Y 1, McGoldrick C 2, Laing RBS 2 1
School of Pharmacy, The Robert Gordon University, Schoolhill, Aberdeen 2 Infection Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen Background and objective: Appropriate empirical antibiotic prescribing is considered important, in order to treat patients effectively, and to decrease risks of antimicrobial resistance. Where clinically appropriate, the oral route of administration should be employed, in order to minimise costs, durations of hospital stay, and risks of soft tissue infections related to cannulation. The objective of the audit was to examine antibiotic prescribing practices within the acute medical admissions unit of a large Scottish teaching hospital. Methods: A five-week prospective audit was performed within our acute medical admissions unit. All patients receiving intravenous (IV) or oral antibiotic therapy, present during the hours of data collection, were included. The British National Formulary, the hospital formulary and the admissions unit protocol were used as audit standards. Results: 124 patients were included, of whom 52.4% (65/ 124) were initially treated with IV antibiotics. Oral therapy was the initial choice in 43.5% (54/124), and 4% (5/124) received a combination of the two routes. Of those empirically treated solely by the IV route, this was deemed appropriate in 73.8% (48/65). 63.1% (41/65) with such treatment, continued to receive IV antibiotics until the end of therapy. The mean time for IV to oral switching was 53.8 hours. For all patients, initial antibiotic choice was deemed appropriate in 85.5% (106/124). Microbiological cultures were performed in 76.6% (95/124), and 56.8% (54/95) of them had positive cultures. After antibiotic sensitivity testing, previously chosen empiric therapy was deemed appropriate in 44.4% (24/ 54). A resultant change in antimicrobial therapy was made in 26.7% (8/30) of those whose empirical treatment was deemed inadequate by sensitivity testing. Conclusion: Within our cohort, greater consideration needs to be given to empirical antibiotic choices, initial routes of antibiotic administration, timings of IV to oral switching and antibiotic sensitivity results. The results should also serve as a reminder to all doctors treating patients with infections, of the importance of adhering to appropriate antibiotic prescribing practices.
e81 Dept of Microbiology & Pharmacy, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston PR2 9HT While the prudent use of antimicrobials is accepted as a key issue in reducing healthcare associated infections and the emergence of multi-resistant microorganisms, the optimal way of achieving this remains uncertain. At Lancashire Teaching Hospitals (LTH) a joint ward round with a Medical Microbiologist and Antibiotic Pharmacist attending was initiated in 2004. Objective: Analyse the impact of weekly ward rounds across LTH a large acute trust on two sites, with 1200 beds. Methodology: A prospective study from June 2005 to May 2006. The Antibiotic Pharmacist identified prospective patients by referrals from ward pharmacists using rapidly assessed simple screeing criteria, and insecption of pharmacy IV additive service records. The Microbiologist identified patients from direct referrals and laboratory data. Relevant data was collected prospectively from prescrition charts, case records, laboratory data and discussion with junior medical staff. Results: A total of 244 patients were reviewed of which 18 (76%) were on medical wards and 54(22%) on surgical wards. Reasons for referral were: inappropriate choice/combination of antibiotic, 200 (82%), unnecessary IV route, 20 (8%), inappropriate duration, 23 (9.5 %), therapeutic drug monitoring issues, 17 (7%) and inappropriate dose, 28 (12%). A restricted antibiotic without prior approval was prescribed in 47 (19%). Additional investigations were recommended in 76 patients (15%) and undertaken in 36. Antibiotics were omitted in (18%) and switched to oral in (39%) and in 25(10%) were advised to continue current treatment. The advice was accepted in 165 (67%) & not accepted in 28 (12%). Outcome was not known in 26 (11%). The mean antibiotic cost per day per patient pre-review was £36 and £26 post review. No detrimental effects on mortality or morbidity were identified. Conclusion: Ward rounds were successful in identifying inappropriate antimicrobial prescriptions and offering advice that was generally accepted. An impressive cost reduction was achieved. They provide an important opportunity to educate junior staff about prescribing, which is immediately relevant to their practice.
P 082 ANTIBIOTIC REVIEW ROUND: RESULTS OF A PILOT PHASE Gilchrist MJ, Lawson W, Newsholme W Hammersmith Hospitals NHS Trust, Du Cane Road, London W12 OHS
P 081 CAN ‘‘ANTIMICROBIAL WARD ROUNDS’’ IMPROVE PRESCRIBING? Gnanarajah DP, Jones D, Cheesbrough J
Background: Following the successful business case for a new Infectious Diseases Consultant a cross-site, multidisciplinary antibiotic review service has been developed at Hammersmith Hospitals NHS Trust (comprising four hospitals on three sites). The service is run jointly by Pharmacy
P 080 ANTIBIOTIC PRESCRIBING PRACTICES WITHIN A SCOTTISH ACUTE MEDICAL ADMISSIONS UNIT Dawson SC 1, Kumarasamy Y 1, McGoldrick C 2, Laing RBS 2 1
School of Pharmacy, The Robert Gordon University, Schoolhill, Aberdeen 2 Infection Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen Background and objective: Appropriate empirical antibiotic prescribing is considered important, in order to treat patients effectively, and to decrease risks of antimicrobial resistance. Where clinically appropriate, the oral route of administration should be employed, in order to minimise costs, durations of hospital stay, and risks of soft tissue infections related to cannulation. The objective of the audit was to examine antibiotic prescribing practices within the acute medical admissions unit of a large Scottish teaching hospital. Methods: A five-week prospective audit was performed within our acute medical admissions unit. All patients receiving intravenous (IV) or oral antibiotic therapy, present during the hours of data collection, were included. The British National Formulary, the hospital formulary and the admissions unit protocol were used as audit standards. Results: 124 patients were included, of whom 52.4% (65/ 124) were initially treated with IV antibiotics. Oral therapy was the initial choice in 43.5% (54/124), and 4% (5/124) received a combination of the two routes. Of those empirically treated solely by the IV route, this was deemed appropriate in 73.8% (48/65). 63.1% (41/65) with such treatment, continued to receive IV antibiotics until the end of therapy. The mean time for IV to oral switching was 53.8 hours. For all patients, initial antibiotic choice was deemed appropriate in 85.5% (106/124). Microbiological cultures were performed in 76.6% (95/124), and 56.8% (54/95) of them had positive cultures. After antibiotic sensitivity testing, previously chosen empiric therapy was deemed appropriate in 44.4% (24/ 54). A resultant change in antimicrobial therapy was made in 26.7% (8/30) of those whose empirical treatment was deemed inadequate by sensitivity testing. Conclusion: Within our cohort, greater consideration needs to be given to empirical antibiotic choices, initial routes of antibiotic administration, timings of IV to oral switching and antibiotic sensitivity results. The results should also serve as a reminder to all doctors treating patients with infections, of the importance of adhering to appropriate antibiotic prescribing practices.
e81 Dept of Microbiology & Pharmacy, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston PR2 9HT While the prudent use of antimicrobials is accepted as a key issue in reducing healthcare associated infections and the emergence of multi-resistant microorganisms, the optimal way of achieving this remains uncertain. At Lancashire Teaching Hospitals (LTH) a joint ward round with a Medical Microbiologist and Antibiotic Pharmacist attending was initiated in 2004. Objective: Analyse the impact of weekly ward rounds across LTH a large acute trust on two sites, with 1200 beds. Methodology: A prospective study from June 2005 to May 2006. The Antibiotic Pharmacist identified prospective patients by referrals from ward pharmacists using rapidly assessed simple screeing criteria, and insecption of pharmacy IV additive service records. The Microbiologist identified patients from direct referrals and laboratory data. Relevant data was collected prospectively from prescrition charts, case records, laboratory data and discussion with junior medical staff. Results: A total of 244 patients were reviewed of which 18 (76%) were on medical wards and 54(22%) on surgical wards. Reasons for referral were: inappropriate choice/combination of antibiotic, 200 (82%), unnecessary IV route, 20 (8%), inappropriate duration, 23 (9.5 %), therapeutic drug monitoring issues, 17 (7%) and inappropriate dose, 28 (12%). A restricted antibiotic without prior approval was prescribed in 47 (19%). Additional investigations were recommended in 76 patients (15%) and undertaken in 36. Antibiotics were omitted in (18%) and switched to oral in (39%) and in 25(10%) were advised to continue current treatment. The advice was accepted in 165 (67%) & not accepted in 28 (12%). Outcome was not known in 26 (11%). The mean antibiotic cost per day per patient pre-review was £36 and £26 post review. No detrimental effects on mortality or morbidity were identified. Conclusion: Ward rounds were successful in identifying inappropriate antimicrobial prescriptions and offering advice that was generally accepted. An impressive cost reduction was achieved. They provide an important opportunity to educate junior staff about prescribing, which is immediately relevant to their practice.
P 082 ANTIBIOTIC REVIEW ROUND: RESULTS OF A PILOT PHASE Gilchrist MJ, Lawson W, Newsholme W Hammersmith Hospitals NHS Trust, Du Cane Road, London W12 OHS
P 081 CAN ‘‘ANTIMICROBIAL WARD ROUNDS’’ IMPROVE PRESCRIBING? Gnanarajah DP, Jones D, Cheesbrough J
Background: Following the successful business case for a new Infectious Diseases Consultant a cross-site, multidisciplinary antibiotic review service has been developed at Hammersmith Hospitals NHS Trust (comprising four hospitals on three sites). The service is run jointly by Pharmacy