Abstract
Introduction
National surveillance shows an estimated 58,224 people in England had antibiotic-resistant infections in 2022, a rise of 4% since 2021 (ESPAUR report). Between 2022-23, our Trust had 2nd highest C.difficile rates in the country. Geriatric population is particularly vulnerable of inappropriate antimicrobial prescribing, leading to prolonged hospital stays As part of anti-microbial stewardship (AMS), a Quality improvement project was carried out between February-May 2024.
Methods
Six geriatric wards (n=168) were audited between 14-16th February 2024. Indication, route, duration, choice of antibiotic and compliance to Microguide was measured. Interventions included introducing weekly microbiology consultant led ward rounds, junior doctor, nurse and consultant education (individual and group) and streamlining IT access to Microguide were implemented. AMS meetings were introduced, which included lead microbiology consultants, chair of medicines safety group, lead antimicrobial pharmacist, geriatric consultants and incorporating prescribing into simulation sessions were sought. Plan-do-study-act (PDSA) cycle was carried out, with repeat cycle carried out in June 2024.
Results
In total, 99 patients were on antibiotics with compliance to Microguide ranging from 39- 65% (mean = 53%) in 1st cycle. Co-amoxiclav (n=45) and Tazocin (n=14) were the most used antibiotics. After the PDSA cycle with interventions implemented, compliance increased from range 70 to 90 % (mean = 83%m n=71). Areas such as prescribing of co-amoxiclav for UTI, Tazocin use without micro approval were targeted. There was increase in the indications and duration mentioned on drug charts (89 to 95%).
Conclusion
Local drivers of change with existing resources can significantly improve AMS. This ultimately leads to less C.difficle infections, improved patient safety. Junior doctor education and weekly ward rounds can be implemented in other areas of our trust to improve AMS.