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Assessing the impact of antimicrobial
stewardship ward rounds
using an app-based data collection tool
Francis Collett-White1, Ya-Ying Wang2,3, Sarisha Singh2,3, Andy Parrish4,7, David Stead6,7
1.
Presenter: Dr. David Stead
Background
• Multi-disciplinary antimicrobial stewardship ward rounds are a useful collaborative strategy for ‘point-of-care’ in stewardship in hospitals
• Audit of this activity is an opportunity to assess the AMS compliance of the responsible ward clinicians & nurses
Context
Frere hospital
Cecilia Makiwane hospital
Aim
• To develop a hand-held electronic AMS data collection platform that is:
– Free
– Easily accessible
– Quick to enter on rounds
– Modifiable
Methods
• Antimicrobial stewardship (AMS) ward rounds were held monthly in each of 4 medical inpatient wards at Frere and Cecilia Makiwane Hospitals, East London, from February to July 2017
• Each patient was reviewed to determine the appropriateness of currently prescribed antibiotics and the need for infection prevention control (IPC) measures (unnecessary IV cannula, urinary catheter, or isolation of an infective patient).
• Antibiotics for tuberculosis and prophylaxis were not included.
Data collection tool• A free iOS and android app was used to
develop a data collection tool• Data collection form designed on website• Data collected using smartphone app• Data was stored securely online and
downloaded to Microsoft Excel for data analysis.
Results
25%
75%
22%
78%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yes No
Pe
rce
nta
ge
Percentage of patients prescribed an antibiotic
CMH
FH
(Sample sizes: CMH=101; FH=172)
0%
5%
10%
15%
20%
25%
30%
35%
40%
Perc
enta
ge
Frequency of antibiotic prescriptions
CMH FH
FH
84%
16%
73%
27%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yes No
Pe
rce
nta
gePercentage prescribed antibiotic according to ID
opinion/guidelines
CMH
FH
60%
24%
16%
12%
0% 0%
51%
0%
5%
24%
8%
14%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
No change Durationchanged/reduced
Antibioticchanged
Antibioticstopped
IVOS/ Routechanged
Dose changed
Pe
rce
nta
ge
Impact of the ward round on antibiotic prescription
CMH
FH
92%
3% 2% 2%
83%
10%
3%6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
No infection controlmeasures
Removal of IV Cannula Removal of urinaryCatheter
Isolate infectivepatient
Pe
rce
nta
ge
Impact of the ward round on infection control
CMH
FH
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
February March April May June July
Perc
enta
ge
Antibiotic prescribed according to EML clinical guidelines or ID opinion trends
FH
CMH
Strengths
• Hawthorn effect with scheduled rounds
• Reliance on correct data entering
• ID opinion subjective as to compliance
• Free to use app
• Feedback an educational tool
• Data collection during ward round
Limitations
Conclusion
• An app-based data collection tool enables efficient auditing of AMS ward rounds
• Antibiotic prescribing compliance was lower at FH compared to CMH, whilst the need for IPC interventions were higher
• Feedback of this data can be motivational for clinical teams and used to target educational resources more effectively
Acknowledgements
• Dr F Collett-White & colleagues• Improving Global Health Fellowship, Thames Valley and
Wessex Leadership Academy, United Kingdom• Clinical pharmacists (Y Wang, S Singh)• Medicine department clinicians• Infection Prevention Control dept. (L Tshaka & N Hangana)
Contact: [email protected]