P224 The impact of implementing a collaborative antimicrobial ward round model within the Respiratory Directorate of a large university teaching hospital

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Abstract

Introduction

Clostridium difficile Infection (CDI) remains a considerable source of healthcare associated infection. A Department of Health briefing recommends all Trusts establish an antimicrobial management team (AMT) to develop an antibiotic stewardship programme aiming to reduce CDI rates through appropriate antibiotic prescribing.1 As a result, collaborative antimicrobial ward rounds were initiated in the Trust in May 2009.

Aim

To study the impact of collaborative ward rounds on antibiotic prescribing within the Respiratory Directorate.

Method

A weekly collaborative ward round model comprising of a Consultant microbiologist, Respiratory pharmacist and the Consultant Infection Control lead for the Respiratory Directorate was implemented across three acute respiratory wards (comprising 90 beds) in March 2011. Data were collected prospectively over a 6-week period between March and May 2011 using a standardised pro-forma. Patients prescribed antibiotics were identified using the Trust's electronic prescribing system. During ward rounds, case notes and microbiology data including resistance patterns were reviewed. Treatment plans were discussed with respective clinical teams to facilitate the learning of junior medical staff. Each prescription was reviewed and recorded as appropriate if compliant with the following parameters; indication recorded, correct route, correct dose, course length documented, compliance with hospital formulary or microbiology results.

Results

A total of 156 antibiotic prescriptions were reviewed during the study period; 96 (62%) prescriptions were appropriate, 60 (38%) required intervention. Course lengths were documented for 29 (19%) prescriptions, 11 (7%) antibiotic prescriptions were discontinued, 9 (6%) antibiotic prescriptions were changed to more appropriate therapy and 6 (4%) intravenous antibiotics were switched to oral therapy and 5 (3%) antibiotic course lengths were extended. The defined daily doses (DDD) of antibiotics/1000 bed days over the two periods were 3544 in 2011 and 4335 in 2010 respectively (see Abstract P224 figure 1).

Conclusion

Implementation of a collaborative AMT was associated with an 18% reduction in antibiotic consumption (DDD/1000 bed days) between the two periods within the respiratory directorate of a large urban university teaching hospital.

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