Sticking to minimum standards: implementing antibiotic stewardship in intensive care

Area of Science:

• Medical Quality Improvement
• Infectious Disease Management
• Hospital Pharmacy Practice

Background:

• Antimicrobial stewardship programmes are mandatory for hospital accreditation in Australia.
• Effective documentation of antimicrobial prescribing is crucial for communication and improving practices among healthcare professionals.
• Poor documentation can lead to suboptimal antimicrobial use in complex care settings.

Purpose of the Study:

• To develop and implement an intervention aimed at enhancing antimicrobial prescribing practices within a hospital intensive care unit.
• To address barriers and enablers of good antimicrobial prescribing through a targeted quality improvement project.
• To improve the documentation of key prescribing details for antimicrobial agents.

Main Methods:

• A prospective, collaborative, before-and-after quality improvement study was conducted in four phases.
• A customized intervention was implemented, comprising a medication record sticker, educational sessions, and unit-specific guidelines.
• Antimicrobial prescribing practices were audited before and for one year after the intervention to assess outcomes.

Main Results:

• Significant improvements were observed in documenting the antimicrobial start date, planned stop/review date, and indication.
• Overall adherence to minimum documentation standards (start date, stop date, indication) increased from 13% to 63%.
• The intervention, particularly the sticker, became integrated into daily practice one year post-implementation.

Conclusions:

• A systematic quality improvement approach, coupled with a tailored, multi-faceted intervention, effectively enhances antimicrobial prescribing.
• Improved documentation of antimicrobial prescriptions contributes to better stewardship and patient care.
• The study demonstrates the successful implementation and sustained impact of targeted interventions in critical care settings.