Antimicrobial stewardship in Australian emergency departments

The present study aims to determine and describe the involvement of Australian EDs in antimicrobial stewardship (AMS) and the role of Emergency Medicine Pharmacists (EMPs).

A Surveymonkey® questionnaire was devised, piloted and distributed to all members of the Society of Hospital Pharmacists of Australia Committee of Specialty Practice EM via the online discussion forum and email distribution list.

There were 41 respondents, 35 (85%) of which had an EMP at their hospital. Of respondents, 30 (73%) were EMP, nine were involved in ED and wanted to contribute to the survey and two were neither. Thirty-four (83%) had a hospital AMS programme. All other questions had 29 respondents. Twenty-three of 29 (79%) had an AMS committee, and 14/23 (61%) had an ED representation. Twenty-eight of 29 (97%) had a restricted antimicrobial policy. Twenty-one of 29 (72%) had a specialist AMS pharmacist, and 12/21 (57%) were involved in the ED. Eleven of 29 (37%) had ED-specific antimicrobial guidelines. A variety of electronic AMS support is available in EDs. EDs had access to a hospital antibiogram (6) and used it to inform AMS. Point prevalence surveys often involved the ED. EMPs were involved with antimicrobial education via ward rounds (6) and didactic sessions (7), guideline development (4), and monitoring of ED antimicrobial prescribing, 21/29 (72%). Multiple ways of controlling ED antimicrobials were used including: providing a limited range of after-hours antimicrobials, predetermined trauma packs, review of ED stock and follow up of restricted antimicrobials. Fourteen of 29 (48%) had conducted ED antimicrobial drug use evaluations.

The ED can be a focus for AMS and is at many sites surveyed. The EMP can provide an important role in this programme.