Antimicrobial ward round Gabriella Booth Antimicrobial Pharmacist Cwm Taf University Health Board

Outline Introduction Ward round Interventions / advice given Did it improve antimicrobial stewardship – the audit results Further work / plan Questions

Introduction Audit results in 2013 highlighted a number of antimicrobials being prescribed and managed inappropriately. A multi-disciplinary team was set up to review patients with complex antimicrobial needs Intervention data was collected on each ward round Re-audit in summer 2014. on the respiratory ward in Prince Charles Hospital (PCH) consisting of a consultant microbiologist, consultant physician, respiratory doctor, and respiratory pharmacist – and now an antimicrobial pharmacist highlighted by the medical team

Ward round Takes place on the respiratory ward in Prince Charles Hospital (PCH) Weekly ward round Commenced on 25th June 2013 Data analysed for 29 ward rounds over a 14 month period Total of 118 reviews (30 were follow up reviews)

Reason for discussion Other included – conjunctivtis, infective endocarditis, throat infection

Interventions Total of 222 interventions made. Main intervention was specify duration: So could be abx already prescribed and the team wanted to know how long to keep going e.g. stop at 14 days rather than review IV to PO switch questions Micro just highlighting the duration they want Other: included Clinical e.g. specify monitoring requirements, refer for further investigation, complete care pathway Isolates e.g. await / chase samples +/- plan if positive, resistance/sensitivity information provided, likely to represent colonisation Treatment e.g. treatment not required, change agent due to recent admission,

Advice given Advice on the duration of treatment was given in most cases. E.g. needs at least 14 days or review at 14 days Review dates was to discuss with micro at XX date. The second most common advice given was regarding future treatment. E.g. stop treatment and if pt deteriorates send cultures and start XX antibiotic. OR prophylactic antibiotics were recommended this was for 9/38 cases of future treatment advice. Other included review date and serum levels.

Did this improve antimicrobial stewardship on the ward?

Re-audit results N/A = prophylactic antibiotics Unknown = indication not clear / indication not in guidelines Micro advice = micro approved choice

Duration documented? Also ….. Co-amoxiclav prescribing is high across Prince Charles Hospital but the audit has shown a decrease in co-amoxiclav prescriptions to 26% in 2014 from 34% in 2013

Further work Antimicrobial ward rounds have shown to improve antimicrobial prescribing across the ward. Role out ward rounds across the hospital with the introduction of an antimicrobial pharmacist. Antimicrobial stewardship group is in the process of being set up. Role out – identify areas of poor prescribing …. Set up rounds ….. Provide education to the ward staff to help improve prescribing from the antimicrobial team ASG – help to increase awareness of antimicrobial stewardship and raise its profile across the health board.

Thanks you for listening Any Questions?