The work described here was presented at the Pharmacy Together 2019 conference.
The NICE guideline on the systems and processes for effective antimicrobial medicine use recommends the development of antimicrobial stewardship (AMS) programmes which should include a clinical microbiologist and a pharmacist as core members.
Failure to treat neurosurgical infections can lead to further surgical intervention, posing additional risks to the patient. It is therefore imperative to prescribe and administer antibiotics correctly to combat the infection. Nevertheless, inconsistent documentation of treatment plans (incorrect indication, duration) and inappropriate cessation were identified. This was amplified by an inconsistent approach to reviewing antimicrobial therapy by various clinicians depending on degree of experience.
Our aim was to improve antimicrobial stewardship by implementing a simple but highly effective intervention, incorporating accurate documentation and communication. The objectives were to:
- Establish a pharmacist led weekly multidisciplinary AMS round
- Ensure microbiology review of all the patients on antimicrobials, documenting original start date and planned duration (stopping inappropriate antimicrobials or avoiding inappropriate cessation) and reviewing laboratory results
- Set an effective documentation and communication strategy with teams.
Set location and time was agreed and various members of the multidisciplinary team were invited to participate to promote stewardship. Pharmacists were provided with additional training for data collection and Excel was used to collate and analyse the information. Patients were reviewed with the microbiologist at the round and the recommendations recorded on the spreadsheet. An email was sent to clinical teams which contained concise information from the Excel document and additional advice. A record of the AMS round review was documented in the patient’s notes.
Impact was measured eight weeks after implementation:
- Between April 2018 and May 2019, a total of 50 AMS rounds were led
- We reviewed 959 antimicrobials, resulting in 100 percent of the microbiology results reviewed with original start date and stop date documented. A retrospective eight-week audit (170 antimicrobial regimes) found that an intervention was made to one in three of every antimicrobial reviewed. Duration was updated in almost half, inappropriate cessation was avoided in eight percent, and five percent of the regimes were ceased as inadequate.
- Nine out of 10 recommendations were actioned, with 83 percent being actioned within 24 hours of the email being sent.
We have successfully implemented a sustainable AMS programme with limited resource and received positive feedback by the wider multidisciplinary team. Pharmacists have gained greater confidence in challenging inappropriate prescriptions as well as being a recognised valued member of the AMS team.
We could further reduce patient risk, side effects, cost and resistance of antimicrobials by achieving 100 percent of the recommendations actioned without delay. The plan to take this further includes developing the skills of pharmacists to enable them to be independent prescribers and increasing the rounds to twice weekly.
S Sumaria and C Curtis: The National Hospital for Neurology and Neurosurgery, London
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Competing interest statement:
The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.