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ID: 4772
NHS Greater Glasgowand Clyde (GG&C): antibiotic point prevalence
studies 2009 to 2015
Ysobel Gourlay
1
, Michael Da Silva Neto
2
, Karen Downie
2
,
Janice Maguire
2
, Fiona Robb
2
, Rachael Rodger
2
, Lee Stewart
2
,
Brian Jones
3
, Andrew Seaton
4
.
1
Greater Glasgow & Clyde,
2
Pharmacy
GG&C,
3
Microbiology GG&C,
4
Infectious Diseases GG&C
Background:
NHS GG&C provides healthcare to 1.2 million people
with acute care delivered through 6 (previously 9) adult hospitals.
Following the 2008 introduction of a cephalosporin, co-amoxiclav,
quinolone and clindamycin restrictive antimicrobial guideline the
antimicrobial management team (AMT) have conducted annual
antibiotic point prevalence surveys (PPS) in each acute hospital.
Aim(s)/Objective(s):
To annually monitor antibiotic use in all acute
adult hospitals in GG&C.
Method(s):
>3000 patients including >900 antibiotic-treated patients
have been surveyed annually across medical and surgical units
(excluding adults in critical care and children).
Results:
The proportion on antibiotics has increased from27.7% (2009)
to 35.9% (2015) with an increasing proportion receiving IV therapy
(from 36.1% to 42.7%) whilst median IV antibiotic duration has
remained 3 days. Recording of antibiotic indication and appropriate-
ness of agent have improved from 81.7% to 90.3% and 86.9% to 90.4%
respectively. Improvements in dosing and frequency of gentamicin and
vancomycin have also been observed and have followed quality
improvement initiatives.
Discussion and/or Conclusion(s):
The annual PPS has provided
useful qualitative, longitudinal prescribing data which has comple-
mented routinely collected usage data. The data has enabled the
AMT to highlight clinical areas and clinical scenarios where antibiotic
use may be sub-optimal and has informed healthcare worker
education and allowed the AMT to appropriately target prescribing
interventions.
ID: 4777
Dose banding gentamicin by patient height improves initial dose
accuracy
Neil Powell.
Royal Cornwall Hospital Trust
Background:
A review of gentamicin found suboptimal initial dosing.
An evaluation of dose banding by height was conducted to determine
whether it improved accuracy.
Aim(s)/Objective(s):
To determine whether dose banding gentamicin
by patient height, coupled eGFR improves dosing accuracy.
Method(s):
95 consecutive patients were included; actual body
weight, height, eGFR and gentamicin dose at initiation. Actual doses
administered were compared to calculated doses using ideal body
weight and eGFR.
A table dosing gentamicin by patient height and eGFR was developed.
Gentamicin dose banding was then introduced with protocols set up
on the electronic prescribing system. Fifty gentamicin prescriptions
were reviewed two months later.
Results:
31 of 95 (33%) administered gentamicin doses were within
10% of the calculated dose. Of the remaining 64 doses, 35 were more
than 10% above (range up to 80% above calculated dose) and 29 doses
were 10% or more below the calculated dose (range up to 50% below
the calculated dose).
Dose banding by height and eGFR was introduced. A review of 50
patients revealed 33 had gentamicin prescribed according to the dose
banding chart, of these 23/33 (70%) were within 10% of the calculated
dose. 8/33 were above this (by up to 30%) and one patient 40% below
the calculated dose. Of the 17 initial doses not prescribed according to
the dose banding chart 5/17 (30%) received a correct dose were within
range, 12 doses were between +70% and
−
50% of target dose.
Discussion and/or Conclusion(s):
Dose banding gentamicin by
patient height resulted in more patients receiving the correct initial
gentamicin dose.
ID: 4823
Measuring potential unintended consequences of interventions to
reduce primary care antibiotic use: an exemplar of NHS Scotland
Infection Intelligence Platform
William Malcolm
1
, Guy Mcgivern
2
, Charis Marwick
3
, Kim Kavanagh
4
,
Jacqui Sneddon
5
, Nicholas Reid
6
, Alison Macdonald
7
, Jean Sneddon
8
,
Marion Bennie
8
.
1
NHS National Services Scotland: Health Protection
Scotland,
2
Information Services Division, NHS National Services Scotland,
3
Population Health Sciences Division, School of Medicine, University of
Dundee,
4
Department of Mathematics and Statistics, University of
Strathclyde,
5
Scottish Antimicrobial Prescribing Group, Scottish Medicines
Consortium, Glasgow,
6
Pharmacy Department, NHS Ayrshire & Arran,
7
Area Antimicrobial Pharmacist, NHS Highland,
8
Information Services
Division, NHS National Services Scotland
Background:
Reducing unnecessary antibiotic use is a priority for
theScottish Antimicrobial Prescribing Group (SAPG). Clinicians are
concerned that initiatives to reduce antibiotic use could result in some
patients with serious infections not being treated.
Aim(s)/Objective(s):
Using individual level linked data to assess
whether reductions in total antibiotic use in primary care have been
associated with specific unintended harm.
Method(s):
Patients admitted to hospital with peritonsillar abscess,
mastoiditis or community acquired pneumonia (potential markers
for under-treatment in community) were identified from national
hospital activity data. Using the NHS Scotland Infection Intelligence
Platform cases were linked to patient-level community prescribing
data to measure antibiotic exposure in the 30 days prior to admission.
Results:
Between April 2010 and March 2014 there were 73,981
patients admitted with indicator infections.
In patients admitted with indicator conditions there was a 1.9%
increase in the proportion that received antibiotics in the 30 days
prior to admission over the study period, despite a 0.8% decrease in
the proportion of the whole population who received antibiotics in
primary care.
Discussion and/or Conclusion(s):
There is no evidence SAPG inter-
ventions to reduce unnecessary antibiotic use have resulted in patients
with serious infections respiratory tract infections not receiving
antibiotics. This study found increased antibiotic use in patients with
indicator infections.
This should provide reassurance to clinicians and support further
improvements in prescribing in primary care. Regular repetition can be
conducted to monitor the impact of changes in prescribing to reassure
clinicians and allow early identification of any emerging unintended
harm.
ID: 4824
Investigating orthopaedic surgical prophylaxis changes and post-
op acute kidney injury in NHS Grampian
–
using NHS Scotland
Infection Intelligence Platform
Eilidh Fletcher
1
, WilliamMalcolm
2
, Charis Marwick
3
, Jacqui Sneddon
4
,
Gwen Bayne
1
, Andrea Patton
4
, Jean Sneddon
1
, Marion Bennie
1
.
1
Information Services Division, NHS National Services Scotland,
2
Health Protection Scotland, NHS National Services Scotland,
3
Population Health Sciences, School of Medicine, University of Dundee,
4
Scottish Antimicrobial Prescribing Group, Scottish Medicines
Consortium, Glasgow
Background:
To support reduction of
Clostridium difficile
infection
(CDI) the Scottish Antimicrobial Prescribing Group recommended that
NHS boards in Scotland restrict antibiotics associated with a high risk
of CDI. In June 2010 NHS Grampian changed its policy for antibiotic
prophylaxis in orthopaedic surgery to include flucloxacillin and
gentamicin. Recent studies found increased post-operative acute
kidney injury (AKI) following similar changes.
Aim(s)/Objective(s):
Using individual level linked data to examine
rates of post-operative AKI before and after policy change in NHS
Grampian.
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S40