Antimicrobial stewardship in Scotland: quality improvement agenda

Transcription

1 Antimicrobial stewardship in Scotland: quality improvement agenda Dr Jacqueline Sneddon Project Lead Scottish Antimicrobial Prescribing Group

2 Background Scottish Antimicrobial Prescribing Group (SAPG) is a national multidisciplinary clinical forum formed in 2008 Implement national improvement initiatives via a network of NHS board Antimicrobial Management Teams (AMTs) Drivers in Scotland ScotMARAP 2008 HAI Delivery Plans and HEAT targets for SAB and CDI The Quality Strategy 2010

3 Current SAPG workstreams Information national surveillance programme and development of research methodologies to utilise data Education ensuring all healthcare professionals receive training in antimicrobial stewardship Quality improvement initiatives spanning medicine, surgery, primary care and care homes.

4 This image cannot currently be displayed. Scottish Medicines Consortium Prescribing indicators for CDI SAPG asked to develop and report on national prescribing indicators for primary and secondary care that would: demonstrate quality improvement in antimicrobial prescribing practice contribute to reduction of CDI

5 CDI prescribing indicators 1 Seasonal variation in quinolone use is 5% calculated using the equation: (Oct-Mar total DDDs Apr-Sep total DDDs -1)x100% 2 Indication recorded in patient medical record and empirical antibiotic choice compliant with local Antimicrobial Prescribing Policy 3 Duration of surgical prophylaxis <24 hours and compliant with local Antimicrobial Prescribing Policy 5% Variation 95% Compliance 95% Compliance

6 Data management and reporting Institute of Healthcare Improvement (IHI) methodology and Extranet system used for hospital prescribing indictors SAPG produces reports on national compliance with the hospital indicators and AMTs can access their own real time data Primary care indicator developed as a standard report within the Prescribing Information System for Scotland

7 National Results Primary care indicator

8 National Results hospital empirical prescribing Indication Documented Policy Compliant Sample Size Median %Compliance Boards Achieving Target (>=95%) Sample Size Median %Compliance Boards Achieving Target (>=95%) % 10 of % 4 of 14 Compliance with empirical prescribing in Medical Admission Units April June 2011 Data on examples of deviation from policy collated and common themes identified Breakthrough collaborative approach to address these utilising local improvement advisers

9 Results national CDI rate Health Protection Scotland, October 2011

10 Have changes in antibiotic use contributed to CDI reduction? Medicine Surgery %Decrease %Decrease Cephalosporins 32% 90% Fluoroquinolones 57% 44% Clarithromycin 73% 64% Clindamycin 41% 56% Co amoxiclav 87% 70% Total CDI 54% 50% Hospital Acquired CDI 44% Community Acquired CDI 75% Using transfer function statistical model 59% of CDI reduction in Medicine and 42% of CDI reduction in Surgery explained by changes in antibiotic use NHS Tayside impact of a restricted antibiotic policy

11 Community acquired pneumonia Developed evidence based care bundle consisting of 4 must do measures SAPG Extranet for data management Breakthrough collaborative with 6 hospitals Improvement led by Acute physicians

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13 After 6 months CAP Breakthrough Collaborative Final Results % Compliance Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5 Hospital 6 Oxygen Assessed Oxygen Administered CURB65 Recorded *IV Antibiotics (CURB65>3) Target * No patients with CURB65 >3 in Hospital 5 (April 2011)

14 Neutropenic sepsis Scottish Government lead group developed Best Practice statement to prevent unnecessary deaths from neutropenic sepsis Covers recognition of symptoms, acute management and follow-up Measures to audit practice against the statement hosted on SAPG Extranet site

15 Staph. aureus bacteraemia Focus on prevention has reduced numbers Evidence of variation in management of SAB National consensus established and algorithm developed as a tool to guide management Next steps - implementation of algorithm and evaluation of outcomes in collaboration with key national stakeholders

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17 SAB algorithm audit measures 1. Source of SAB confirmed or likely source documented and clearly documented plan of investigation 2. Appropriate intravenous antibiotic therapy started 3. Documentation of IV medical device removal or documentation of reason for device retention 4. Patient reviewed by an Infection Specialist

18 Sepsis new priority in Scotland Breakthrough collaborative in Acute Medicine focusing on patients with severe sepsis Sepsis six care bundle oxygen, fluids, blood cultures, IV antibiotics, measure lactate, urinary catheter Sepsis in admission areas and downstream wards will be target area for Scottish Patient Safety Programme in 2012

19 Why sepsis? Major cause of preventable mortality Kills more patients each year than myocardial infarctions and lung + breast + colon cancer STAG audit 1 of management in first 48 hours defect rate was 18-74% Study in NHS Tayside 2 showed only 38% patients with sepsis got IV antibiotics within 4 hours 1. Sepsis Management in Scotland, Scottish Trauma Audit Group, November C. Marwick et al, 2011

20 Conclusions SAPG and our network of Antimicrobial Management Teams have delivered quality improvement with positive outcomes for patients. Ongoing collaboration at national and local level with other stakeholders working on HAI and patient safety is essential to achieve reliable and sustainable improvements in patient care.