ANTIMICROBIAL PLAN STICKER

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, patients notes, anaesthetic/surgical/o
  ther 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 gt95
• 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