Doukas Fiona F, Cheong Elaine, McKew Genevieve, Gray Timothy J, McLachlan Andrew J, Gottlieb Thomas
Pharmacy Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia.
Intern Med J. 2021 Nov;51(11):1876-1883. doi: 10.1111/imj.14979. Epub 2021 Oct 23.
Current methods of antimicrobial usage surveillance have limited efficacy in changing practice due to delayed reporting to clinicians and the inability to stratify by medical specialty. This study was undertaken in a tertiary teaching hospital with a well established antimicrobial stewardship (AMS) programme and electronic medicines management (eMM) system in Sydney, Australia.
To describe and analyse the implementation of a novel AMS audit and feedback method, in the context of an eMM system.
The AMS team conducted the audit weekly, and the study design was a prospective, observational study. All acute, adult inpatients were included in this intervention. All active systemic antimicrobial prescriptions on the day of the rounds were included.
The prevalence of patients on antimicrobial therapy was 37%. The median time taken per round was 44 min for eMM compared to 58 min for paper. All key performance indicators improved over the study period. Appropriateness compared to guidelines increased from 55% to 71%, and documentation of an indication increased from 75% to 98%. There were 1413 recommendations made, with the most common being to cease an antimicrobial agent. The recommendation uptake rate was 47% at 24 h post-round.
AMS rounds are an effective tool for auditing and providing feedback on antimicrobial use and should include all antimicrobials rather than solely 'restricted' agents. These rounds had a high uptake rate, improvements in the appropriateness of antimicrobial use, and a planned duration or review date. A benefit of eMM was improvement in the documentation of indication for antimicrobial agents, and reduced time taken to audit.
目前的抗菌药物使用监测方法在改变临床实践方面效果有限，原因是向临床医生的报告延迟，且无法按医学专科进行分层。本研究在澳大利亚悉尼一家拥有完善抗菌药物管理（AMS）项目和电子药品管理（eMM）系统的三级教学医院开展。
在eMM系统背景下描述和分析一种新型AMS审核与反馈方法的实施情况。
AMS团队每周进行审核，研究设计为前瞻性观察性研究。所有急性成年住院患者均纳入本干预措施。查房当日所有正在使用的全身抗菌药物处方均纳入研究。
接受抗菌治疗的患者比例为37%。eMM查房每轮的中位时间为44分钟，纸质查房为58分钟。在研究期间，所有关键绩效指标均有所改善。与指南相比，适宜性从55%提高到71%，用药指征记录从75%提高到98%。共提出1413条建议，最常见的是停用抗菌药物。查房后24小时建议采纳率为47%。
AMS查房是审核抗菌药物使用并提供反馈的有效工具，应涵盖所有抗菌药物，而非仅针对“限制使用”药物。这些查房的采纳率高，抗菌药物使用适宜性得到改善，且有计划的持续时间或复查日期。eMM的一个优点是改善了抗菌药物用药指征的记录，并减少了审核时间。
