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Optimizing carbapenem use through a national quality improvement programme.

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A quality improvement program successfully reduced the use of carbapenems and piperacillin/tazobactam in Scotland. This initiative demonstrated effective antimicrobial stewardship, leading to decreased prescribing of these critical antibiotics.

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Area of Science:

  • Infectious Diseases
  • Antimicrobial Stewardship
  • Public Health

Background:

  • Rising use of carbapenems and piperacillin/tazobactam prompted national guidance development.
  • The Scottish Antimicrobial Prescribing Group (SAPG) initiated a quality improvement program to monitor guidance impact.

Purpose of the Study:

  • Evaluate SAPG guidance implementation across health boards.
  • Assess translation of guidance into clinical practice.
  • Investigate clinician perspectives on prescribing carbapenems and alternatives.

Main Methods:

  • Online surveys for local guidance implementation assessment.
  • Point prevalence surveys for prescribing evaluation.
  • Semi-structured interviews for clinician experiences.
  • Analysis of national prescribing data.

Main Results:

  • Greater local restrictions for carbapenems than piperacillin/tazobactam.
  • Inconsistent laboratory result suppression and limited availability of carbapenem-sparing agents.
  • Good compliance with meropenem guidelines, lower for piperacillin/tazobactam.
  • Well-documented indications but poor review/stop dates for both antibiotics.
  • Clinician confidence in de-escalation was a limiting factor.
  • Overall decrease in the use of both antibiotics during the program.

Conclusions:

  • A multifaceted quality improvement program effectively reduced carbapenem and piperacillin/tazobactam use.
  • This reduction contrasts with trends in Europe, highlighting program success.
  • The program's methodology is adaptable for other antimicrobial stewardship initiatives.