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

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

3. 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

4. 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)

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

6. 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,

7. 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.

8. Did this improve antimicrobial stewardship on the ward?

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

10. 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

11. 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.

12. Thanks you for listening Any Questions?