Transcript Slide 1

ANTIMICROBIAL PLAN STICKER
Improving Antimicrobial documentation with the
use of an Antimicrobial Plan sticker
Evonne Fong, Pharmacy Department AHS, ICU
AHS
Background
 Australian Commission on Safety and Quality in Health Care
• Consultation Draft: Clinical Care Standard for antimicrobial
stewardship (Dec 2013)
 Quality Statement 6
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Clinical reason
Drug name
Dose
Route of administration
Intended duration
Review plan
Baseline
 NAPS audit November 2013
• One day “snap shot”
• 85 antimicrobial orders
• Documentation of indication = 67.1%
– Med chart, patient’s notes, anaesthetic/surgical/other
procedural records
– Excludes nursing hand over notes or other non-official
records
 NIMC audit 2012
• Regular orders with indication
documented on NIMC = 7.93%
Aim
 To improve documentation of antimicrobial treatment
• Best practice: >95%
 To have effective communication between clinicians
 To ensure there is a system in place at AHS to support
documentation and communication
Methodology
Trial 1:
 Pilot of new sticker in consultation
with ICU director
 Sticker covers documenting
requirements
 Promoted in Pharmacy Newsletter
 ICU doctors emailed; discussed with
doctors on floor
Methodology
RESULTS:
After 2 weeks:
 Documentation of indication = 86%
(n = 29)
• compared to 67.1% at baseline
• Good sticker use with initial doctors
 rotation/shift change  poor
compliance
• Stickers used for 41% of
antimicrobial orders
• Stickers disappearing
• Drs unaware/unsure intention
Methodology
 RE-LAUNCH :
• Discussion with doctors and nurses
• New sticker designed to use in med chart instead
Methodology
 Drs emailed
 Registrars spoken to
individually (handover
time and registrar
“champion”)
 Discussed at ICU
management meeting
with consultant and
CNS
 Ward clerk enlisted to
assist
Results
10 days auditing post re-launch:
 96% compliance with documenting indication (n = 24)
 Sticker used for 83% of antimicrobial orders
Other results:
• Drug name, dose, route = 100%
• Intended duration/review plan: 71%
Work in progress…
 Addressing issues
as they arise
 New doctors
soon
 Re-educate and
remind
Conclusion
 Reached indication target of 95%.
• Regular re-auditing
 Look to improve documentation of intended duration and
review plan
 Roll out to other wards
• ICU transfers to other wards  launch officially on other wards
• Dr education