1. ABMU Antibiotic Audits An Update
Siân Price
Antimicrobial Pharmacist

2. The Background Cardiff and Vale stickers introduced
Care bundle introduced and monthly care bundle audits started
Feb
July
Sept
April
2011
2012

3. The ABMU Antimicrobial Care Bundle
Applies to all antimicrobials prescribed on the regular side of
the medication chart:
Documentation of allergy status on medication chart
Clear indication for antimicrobial(s) on medication chart
Documentation of a stop or review date on medication chart
Consistency with Health Board guidelines
Use of antimicrobial sticker(s)

4. The Background Smaller stickers introduced
Infection Prevention Board established
First monthly audit report
Feb
July
Sept
April
2011
2012

5. Issues with original audit format
Labour intensive for ward pharmacists and AM pharmacists
Focus on documentation rather than clinical appropriateness
Relied on assessment of appropriateness by ward pharmacist – results consistently (falsely?) high
Lack of familiarity with guidelines?
Lack of confidence in clinically checking antimicrobial prescriptions?

6. Issues with original audit format
No patient/antibiotic details recorded
No quality check by AM pharmacist
No intervention into patient care

7. So…… Progress came to a standstill without achieving the targets and……
….there was a need to move forward and audit
more clinical and relevant aspects of
antimicrobial prescribing……
….and further engage with prescribers

8. Jan 2015 – new format audits Frequency reduced to two monthly
Data still collected by clinical pharmacists
All patients prescribed systemic antibiotics
All acute areas audited
Every audit quality checked by AM Pharmacist
Coding used to enable automation

9. Patient details
Day of therapy
Indication
Antibiotic
Route

12. Data Reported Care bundle data:
Clear indication for antimicrobial(s) on medication chart
Documentation of a stop or review date on medication chart
Use of antimicrobial sticker(s)
Documentation of allergy status no longer audited (duplication of All Wales patient safety thermometer data)

13. 4 Key Prescribing Indicators
Percentage of antimicrobial prescriptions assessed as appropriate in terms of choice of antimicrobial
Percentage of antimicrobial prescriptions over 7 days (excluding deep seated and high risk infections)
Percentage of prescriptions for surgical prophylaxis over 24 hours
Percentage of IV antimicrobial prescriptions over 72 hours (excluding deep seated and high risk infections)

14. Trigger Points
Prescribing Indicator
Trigger Point
Rationale for Trigger Point
Percentage of antibiotic prescriptions assessed as appropriate in terms of choice of antimicrobial
≤ 95%
Current target
Percentage of antibiotic prescriptions over 7 days (excluding deep seated and high risk infections)
≥ 20%
All Wales average = 19%
Percentage of antibiotic prescriptions for surgical prophylaxis over 24 hours
All Wales average = 30%, which also requires improvement
Percentage of IV antibiotic prescriptions over 72 hours (excluding deep seated and high risk infections)
≥ 30%
All Wales average = 48% (does not include deep seated and high risk infections)
Directorates reaching these trigger points highlighted to the C. difficile Improvement Group and asked to investigate further

15. Exclusions > 7 days IV > 72 hours Liver abscess Osteomyelitis
Septic arthritis
Empyema
Cavitating pneumonia
S. aureus bacteraemia
Severe necrotising soft tissue infections
Infected implants/prostheses
Meningitis
Encephalitis
Intracranial abscess
Mediastinitis
Endocarditis
Exacerbation bronchiectasis/CF
Medical prophylaxis
Neutropenic sepsis
Liver abscess
Osteomyelitis
Septic arthritis
Empyema
Cavitating pneumonia
S. aureus bacteraemia
Severe necrotising soft tissue infections
Infected implants/prostheses
Meningitis
Encephalitis
Intracranial abscess
Mediastinitis
Endocarditis
Exacerbation bronchiectasis/CF
Hospital-acquired pneumonia

16. Benefits of new format Information more relevant to prescribers
Identify poorly performing areas
Identify gaps in pharmacists’ knowledge
Intervene in individual cases to improve patient care
Reported to Clostridium difficile group for directorates to investigate
Enables directed, in-depth audits by clinicians (minimum 2 audits per year)

17. Feedback received from directorates – mostly positive/constructive
The First Report
Directorate
Feedback received from directorates – mostly positive/constructive

18. Teething Problems….
Approximately 20% prescriptions excluded from assessment of appropriateness as indication not featured in guidelines
Low numbers of surgical prophylaxis audited
Needed to change some exclusions e.g. HAP (IV>72 hours)
More codes/code changes needed
Help from PHW to simplify and ensure only necessary data collected
More education of pharmacists needed
Some prescribing indicators may not be applicable to some specialities

19. The Future
Interactive data (Tableau) down to speciality level via Public Health Wales
Care bundle data to be inputted automatically into FOC database
Continue to adapt based on feedback and amend/add to guidelines
Trend data
? Audit by consultant (anonymously)

20. Summary Major changes to ABMU audit format introduced Jan 2015
Modifications made after Jan and March data collections
Data appears to be more meaningful
Still a work in progress……

21. Thank you for listening
Any Questions?