1. ANTIMICROBIAL PLAN STICKER Improving Antimicrobial documentation with the use of an Antimicrobial Plan sticker Evonne Fong, Pharmacy Department AHS, ICU AHS

2. Background  Australian Commission on Safety and Quality in Health Care Consultation Draft: Clinical Care Standard for antimicrobial stewardship (Dec 2013 )  Quality Statement 6 Clinical reason Drug name Dose Route of administration Intended duration Review plan

3. Baseline  NAPS audit November 2013 One day “snap shot” 85 antimicrobial orders Documentation of indication = 67.1% –Med chart, patient’s notes, anaesthetic/surgical/other procedural records –Excludes nursing hand over notes or other non-official records  NIMC audit 2012 Regular orders with indication documented on NIMC = 7.93%

4. Aim  To improve documentation of antimicrobial treatment Best practice: >95%  To have effective communication between clinicians  To ensure there is a system in place at AHS to support documentation and communication

5. Methodology Trial 1:  Pilot of new sticker in consultation with ICU director  Sticker covers documenting requirements  Promoted in Pharmacy Newsletter  ICU doctors emailed; discussed with doctors on floor

6. Methodology RESULTS: After 2 weeks:  Documentation of indication = 86% (n = 29) compared to 67.1% at baseline Good sticker use with initial doctors  rotation/shift change  poor compliance Stickers used for 41% of antimicrobial orders Stickers disappearing Drs unaware/unsure intention

7. Methodology  RE-LAUNCH : Discussion with doctors and nurses New sticker designed to use in med chart instead

8. Methodology  Drs emailed  Registrars spoken to individually (handover time and registrar “champion”)  Discussed at ICU management meeting with consultant and CNS  Ward clerk enlisted to assist

9. Results 10 days auditing post re-launch:  96% compliance with documenting indication (n = 24)  Sticker used for 83% of antimicrobial orders Other results: Drug name, dose, route = 100% Intended duration/review plan: 71%

10. Work in progress…  Addressing issues as they arise  New doctors soon  Re-educate and remind

11. Conclusion  Reached indication target of 95%. Regular re-auditing  Look to improve documentation of intended duration and review plan  Roll out to other wards ICU transfers to other wards  launch officially on other wards Dr education