51 / 150
non-protected option, whilst allergy to penicillin was a contributing
factor in choosing a carbapenem in around 20% of patients.
The prescription was judged as appropriate in approximately 3/4 of all
cases. Treatment de-escalation or stopping the whole antibiotic
therapy was recommended for all patients receiving an inappropriate
prescription and in some of the patients receiving an appropriate
prescription.
Discussion and/or Conclusion(s):
Our study shows that a proactive
and multi-disciplinary strategy of reviewing every prescription of
protected antibiotic can lead to marked reduction in the use of these
precious options.
ID: 5048
Stewardship opportunities in the treatment of urinary tract
infection using oral fosfomycin. Much more to be learnt
Helmi Sulaiman, Aqtab Mazhar Alias, Shu Jiun Khoo,
Saufi Irzat Che Yusoff.
University of Malaya
Background:
Fosfomycin (FM) was first introduced following the
fermentation of Streptomyces strain in 1969. Following its unique
position for uncomplicated UTI, its appropriate use is of paramount
importance to mitigate the emergence of resistance.
Aim(s)/Objective(s):
We aim to look at the current practice of
prescription in our large outpatient clinic.
Method(s):
This is a retrospective study carried fromApril 2015 toMay
2016 in primary care clinics affiliated to University Malaya Medical
Centre, Malaysia. We recruited any patients above 12 years old who
received single dose oral FM. We divided the patients into guideline
compliant (GC) and non-guideline compliant (NGC) groups based on
available consensus.
Results:
100 patients were recruited from a list of 139. The median age
was 54.6 (IQR 15
–
88) and female predominates (81%). 57 of the
subjects had at least one co-morbidity and hypertension predominates
(40%). There were 91 NGC occurrences. Reasons for NGC were
asymptomatic bacteriuria/ABU (18, 19.7%), acute pyelonephritis (13,
14.2%), complicated UTI (16, 17.6%) and inappropriate investigations
(urine culture (21, 23.1%) and ultrasound of kidney (4, 4.3%)). Urine
analysis was the commonest test performed (87, 97%). FMT was
prescribed wrongly in 66 subjects (wrong indications).
Discussion and/or Conclusion(s):
The data above illustrates the dire
need for education in term of UTI management by the primary care
physicians. The misuse of FM was common and not in accordance to
the guideline. The additional investigations may be reflective of
“
non-
uncomplicated
”
nature of UTI. In addition, the lack of susceptibility
data on FM against the local contemporary urinary isolates should be
addressed.
ID: 5053
QASI-2: Measuring the quality of Antimicrobial Stewardship
Andrew Berrington
1
, Rachel Bruce
2
, Amy Penni
2
.
1
City Hospitals
Sunderland NHS FT,
2
City Hospitals Sunderland NHSFT
Background:
It is not straightforward to measure how good we are
at antimicrobial stewardship. Real outcome measures like
‘
infections
cured
’
or
‘
resistance pressure
’
are elusive. Surrogate outcome
measures like antibiotic consumption metrics are tendentious and
confounded by other factors. So usually we measure process, typically
by audit of antimicrobial prescribing.
But audit is easy to do badly and difficult to do well: decisions are
spread out in time and place as new information emerges, objective
standards are difficult to set and we need to be careful that we are
auditing stewardship specifically rather than medical practice more
generally. The typical
‘
compliance audit
’
is unlikely to capture these
complexities.
We have developed an audit tool that assigns a score out of 10 to the
decisions made at initiation (
‘
start Smart
′
) and a score out of 5 to the
decisions made as treatment continues. We have refined this over
several years and have now piloted its use in a systematic programme
of audit and feedback on our Integrated Assessment Unit and back-of-
house medical wards.
Aim(s)/Objective(s):
To describe deployment of our QASI-2 tool in a
pilot systematic audit programme designed to assess the feasibility of
the QASI-2 approach and to measure the quality of antimicrobial
prescribing in our medical unit.
Method(s):
QASI-2: key aspects of the tool
Results:
Summary charts describing 322 initiation audits and 369 continuation
audits
Data on time taken to perform QASI-2 audits
Discussion and/or Conclusion(s):
Useful and feasible approach though time consuming
Acceptable to clinical teams
–
good engagement
Importance of defining what constitutes a course.
ID: 5081
Development of a Clinical Decision Support (CDS) mobile app for
antimicrobial prescribing
Jacqueline Sneddon
1
, Ann Wales
2
, Dilip Nathwani
3
.
1
Healthcare
Improvement Scotland,
2
NHS Education for Scotland,
3
NHS Tayside
Background:
Development of clinical decision support (CDS) is a
priority for Scottish Government to give clinicians easy access to
decision support tools and relevant guidance at the point of care.
Antimicrobial prescribing was identified as a
‘
quick win
’
to demon-
strate CDS as national evidence-based guidance, treatment algorithms
and a robust clinical networks were already available.
Aim(s)/Objective(s):
To develop a national antimicrobial app through
collaboration between the Scottish Antimicrobial Prescribing Group
and NHS Education for Scotland.
Method(s):
A proposal was developed, funding secured from Scottish
Government, a developer appointed via a tendering process and a
multi-professional clinical reference group established.
Results:
The app was launched in August 2016 available to download
free via app stores for use on any mobile device.
The app includes:
•
Dosage calculators for gentamicin and vancomycin (registered
with the Medicines and Healthcare Products Regulatory Agency)
•
Antibiotic guidance for primary care and hospitals customised by
each health board
•
A decision aid to support management of urinary tract infection in
older people
•
An audit tool to support data gathering and reporting for local and
national improvement work
Discussion and/or Conclusion(s):
This bespoke national app provides
customised local guidance and CDS tools to enable clinicians to use
antibiotics safely and effectively across all care settings. The unique
audit component will support improved practice through timely audit
and feedback of key prescribing measures. An evaluation of its impact
is underway using an outcomes chain model and contribution
analysis.
ID: 5113
Thinking beyond tazocin: improving antibiotic prescribing in
cancer care
Anastasia Theodosiou, Kieran Hand, Tat Shing Yam, Hayley Wickens.
University Hospital Southampton
Background:
Excessive broad-spectrum antibiotic use is associated
with adverse outcomes, including
Clostridium difficile
and antibiotic-
resistant infection. Oncology inpatients are susceptible to infection
due to cancer and chemotherapy-associated immunocompromise,
but use of broad-spectrum antibiotics is not always warranted.
Aim(s)/Objective(s):
This project aims to identify and tackle barriers
to appropriate antibiotic prescribing in oncology inpatients at
Abstracts of FIS/HIS 2016
–
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24
–
S134
S46