Antibiotic Stewardship Within A General Surgery Department - A Quality Improvement Project

ABSTRACT

Background: Antimicrobial stewardship involves a coherent set of actions geared towards responsible use of antimicrobials. NICE antimicrobial stewardship guidance forms the basis for trust wide standards;the surgical department inconsistently complies to these standards. Aims: Use of PDSA framework to improve departmental antibiotic prescribing practices. Methods: Data collection via MeditechTM prescribing records and documentation. 'Snapshots' of antibiotic prescriptions for surgical inpatients taken collecting the following data •Correct antibiotic prescribed as per guidelines or positive culture results •Antibiotic prescription reviewed within 72 hours •Samples sent for culture and sensitivity •IV prescriptions reviewed if longer than 72 hours Cycle 1 data collection in August/September 2020, followed by a presentation distributed to junior doctors detailing importance of accurate prescribing. Cycle 2 data collection in October/November 2020 was followed by a summary of documentation/prescribing guidelines being circulated to surgical juniors. The final data collection period took place in November 2020. Analysis via Chi-Squared test. Results: Interventions improved prescribing of correct antibiotics (75 to 89.3%), and documentation of IV antibiotic prescriptions with courses longer than 72 hours (p<0.05). Similar insigificant improvements observed with reviewing prescriptions within 72 hours and samples sent to microbiology. Discussion: Low frequency of samples sent to microbiology as antibiotics often used for surgical prophylaxis and continued post-operatively without prior cultures. Brief documentation on the ward round, accentuated by constraints enforced by Covid-19 pandemic. Conclusion: Positive changes can be achieved from simple interventions. Sustainable changes in prescribing practices require engagement of entire clinical team and amendments to electronic prescribing.