Point prevalence surveys (PPS) can demonstrate
strengths and areas for improvement within antimicrobial steward-
ship (ASP) programmes but are inherently labour-intensive. Imperial
College Healthcare NHS Trust has undertaken PPS since 2002. In
2015/16 electronic prescribing (e-prescribing) was introduced, pro-
viding an opportunity to reassess delivery of PPS.
We aimed to evaluate how the introduction of
e-prescribing affected PPS in terms of ease of data collection and
All inpatients scheduled to receive anti-infectives on the
day of data collection were included in the February 2016 study.
Antimicrobial pharmacists noted time taken to audit each clinical
area and any significant ASP interventions made before analysis of
Of 84 wards (1267 patients) reviewed, 36 retained paper-
based systems, 4 utilised specialist intensive care prescribing pro-
grammes and 44 had moved to e-prescribing. Whilst overall
antimicrobial prescribing indicators remained similar to previous
years, the average PPS time taken per ward (hh:mm) was reduced
from 1:07 for paper-based areas to 00:24 for e-prescribing locations
(00:32 in intensive care areas). On paper-based wards, interventions
identified were around dose optimisationwhereas those identified via
electronic systems mainly concerned course duration.
Discussion and/or Conclusion(s):
Electronic record and prescription
systems have dramatically reduced the time taken to undertake
PPS. Even greater efficiency improvements are anticipated in future,
following Trust-wide adoption of electronic prescribing.
Interventions identified on paper systems involved dose optimisation
whereas these were not seen within e-prescribing areas. It is hypo-
thesized that in-built e-prescribing user support influenced the
Progress towards achieving antimicrobial prescribing standards in
medical wards at Aberdeen Royal Infirmary
Fiona McDonald, Gillian Macartney, Rashmi Subbarao-Sharma.
In NHS Grampian the Antimicrobial Management Team
co-ordinate annual antibiotic point prevalence audits across all acute
hospitals, as recommended by the Scottish Antimicrobial Prescribing
To monitor compliance with local antimicrobial
guidelines, against agreed audit standards.
Data was collected by pharmacists using a standard
data collection form over 2 days in November/December each year.
The Antibiotic Pharmacists, in liaison with Medical Microbiologists,
assessed whether antibiotic prescribing was
against audit standards was calculated. A report summarising
the results for all medical wards was disseminated to clinical staff
each year and individualised reports sent to wards with the lowest
rates of compliance with the audit standards.
Percentage of indications documented inmedical notes/drug chart
improved from 88% in 2010 to 98% in 2015. (Audit Standard (AS)
Percentage of antibiotic prescriptions with duration/stop/review
date documented in medical notes/drug chart improved from 30%
in 2010 to 65% in 2015. (AS
Percentage of indications where review of antibiotics was
documented within last 48 hours in medical notes improved
from 80% in 2013 to 94% in 2015. (AS
80%) (Datawas not collected
Percentage of indications where prescribing was appropriate
improved from 87% in 2010 to 92% in 2015. (AS
Percentage of doses administered improved from 93% in 2014 to
96% in 2015. (Data not collected in 2010 or 2013.) (AS
Discussion and/or Conclusion(s):
Between 2010 and 2015 there have
been improvements across all of the audit standards, with a significant
improvement for documentation of duration/stop/review dates and
Antimicrobial Stewardship (AMS) activities in English Community
Health Services (CHS) Trusts
, Sejal Hansraj
, Mary Akpan
, Nada Atef Shebl
, Susan Hopkins
Public Health England,
Imperial College London
The implementation of the national toolkits TARGETand
SSTF, led by PHE is listed as one of strategic actions for implementing
the UK 5 year Antimicrobial Resistance (AMR) Strategy. The imple-
mentation of these toolkits has previously been assessed in CCGs and
To gain an understanding of current AMS
activities in CHS Trusts.
In February 2016, an online survey was distributed to the
26 English CHS Trusts. This was a voluntary service evaluation by
healthcare professionals; ethics approval was not required.
77% of CHS Trusts responded to the survey; of these, 25% (5%
in CCGs and 94% in Acute Trusts) had a substantive pharmacy post
focussed on AMS. 50% of responding CHS Trusts had an AMS
committee (18% in CCGs; 94% in Acute Trusts).
85% of responding CHS Trusts had an antimicrobial formulary (99% in
CCGs; 93% in Acute Trusts), while 55% had empirical antibiotic
guidelines in place (73% in CCGs; 83% in Acute Trusts).
Other key findings include that 70% of responding CHS Trusts had an
antimicrobial policy in place (99% in CCGs; 93% in Acute Trusts), while
90% indicated that they were aware of TARGET, and of these, 11 had
formally reviewed it. With SSTF, 75% of CHS Trusts reported being
aware of SSTF and of these, 10 had formally reviewed it.
Discussion and/or Conclusion(s):
Study results demonstrate that
AMS guidance has been focused on initiatives to improve its imple-
mentation in primary and secondary care. Further work is required to
promote AMS delivery in CHS Trusts.
Protected antibiotic use at the Central Manchester NHS Foundation
Trust: findings from a prospective antibiotic stewardship
Giorgio Calisti, Rob Shorten, Louise Sweeney, Mihaela Petric,
Catherine Child, Benjamin Farrington, Caroline Templeton,
Kelly Alexander, Ahmed Qamruddin.
Central Manchester University
Hospitals NHS Foundation Trust
As part of our Antimicrobial Stewardship strategy, we
reviewed daily all pharmacy requests for protected antibiotics (i.e.,
meropenem, ertapenem and linezolid) in our Trust. We reviewed the
case notes, drug chart and laboratory information system to evaluate
the rationale for starting the protected antibiotic and whether the
prescription was appropriate or not.
The appropriateness of the prescription was discussed in a daily
clinical meeting attended by Medical Microbiology Doctors and
Antibiotic Pharmacists. The possible outcomes of the multi-disciplin-
ary discussion were:
Stop the protected antibiotic without starting a new antibiotic in
Switch the protected antibiotic to a non-protected alternative
Continue the protected antibiotic.
The most commonly used protected antibiotic was merope-
nem, followed by linezolid and ertapenem. The protected antibiotic
was started as an escalation in most patients and a discussion with
Microbiology was documented in half of the cases.
The most common indication for starting the protected antibiotic
was the recent isolation of a MDR organism not covered by the
Abstracts of FIS/HIS 2016
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24