Siân E Robson1, Alison Cockburn1,2, Jacqueline Sneddon1, Abdulrhman Mohana3, Marion Bennie3,4, Alexander B Mullen3, William Malcolm5, Jennifer Armstrong4, Andrea Patton1, Ronald Andrew Seaton1,6. 1. Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow, Scotland. 2. Regional Infectious Diseases Unit, Western General Hospital, Crewe Road, Edinburgh, Scotland. 3. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, Scotland. 4. Public Health and Intelligence, National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland. 5. Health Protection Scotland, National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland. 6. Infectious Diseases Unit, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, Scotland.
Abstract
Background: Concern about increasing carbapenem and piperacillin/tazobactam use led the Scottish Antimicrobial Prescribing Group (SAPG) to develop national guidance on optimal use of these agents, and to implement a quality improvement programme to assess the impact of guidance on practice. Objectives: To evaluate how SAPG guidance had been implemented by health boards, assess how this translated into clinical practice, and investigate clinicians' views and behaviours about prescribing carbapenems and alternative agents. Methods: Local implementation of SAPG guidance was assessed using an online survey. A bespoke point prevalence survey was used to evaluate prescribing. Clinicians' experience of using carbapenems and alternatives was examined through semi-structured interviews. National prescribing data were analysed to assess the impact of the programme. Results: There were greater local restrictions for carbapenems than for piperacillin/tazobactam. Laboratory result suppression was inconsistent between boards and carbapenem-sparing antibiotics were not widely available. Compliance with local guidelines was good for meropenem but lower for piperacillin/tazobactam. Indication for use was well documented but review/stop dates were poorly documented for both antibiotics. Decisions to prescribe a carbapenem were influenced by local guidelines and specialist advice. Many clinicians lacked confidence to de-escalate treatment. Use of both antibiotics decreased during the course of the programme. Conclusions: A multifaceted quality improvement programme was used to gather intelligence, promote behaviour change, and focus interventions on the use of carbapenems and piperacillin/tazobactam. Use of these antimicrobials decreased during the programme-a trend not seen elsewhere in Europe. The programme could be generalized to other antimicrobials.
Background: Concern about increasing carbapenem and piperacillin/tazobactam use led the Scottish Antimicrobial Prescribing Group (SAPG) to develop national guidance on optimal use of these agents, and to implement a quality improvement programme to assess the impact of guidance on practice. Objectives: To evaluate how SAPG guidance had been implemented by health boards, assess how this translated into clinical practice, and investigate clinicians' views and behaviours about prescribing carbapenems and alternative agents. Methods: Local implementation of SAPG guidance was assessed using an online survey. A bespoke point prevalence survey was used to evaluate prescribing. Clinicians' experience of using carbapenems and alternatives was examined through semi-structured interviews. National prescribing data were analysed to assess the impact of the programme. Results: There were greater local restrictions for carbapenems than for piperacillin/tazobactam. Laboratory result suppression was inconsistent between boards and carbapenem-sparing antibiotics were not widely available. Compliance with local guidelines was good for meropenem but lower for piperacillin/tazobactam. Indication for use was well documented but review/stop dates were poorly documented for both antibiotics. Decisions to prescribe a carbapenem were influenced by local guidelines and specialist advice. Many clinicians lacked confidence to de-escalate treatment. Use of both antibiotics decreased during the course of the programme. Conclusions: A multifaceted quality improvement programme was used to gather intelligence, promote behaviour change, and focus interventions on the use of carbapenems and piperacillin/tazobactam. Use of these antimicrobials decreased during the programme-a trend not seen elsewhere in Europe. The programme could be generalized to other antimicrobials.
Authors: J F García-Rodríguez; B Bardán-García; M F Peña-Rodríguez; H Álvarez-Díaz; A Mariño-Callejo Journal: Eur J Clin Microbiol Infect Dis Date: 2018-10-26 Impact factor: 3.267
Authors: Thomas Edwards; Eva Heinz; Jon van Aartsen; Alex Howard; Paul Roberts; Caroline Corless; Alice J Fraser; Christopher T Williams; Issra Bulgasim; Luis E Cuevas; Christopher M Parry; Adam P Roberts; Emily R Adams; Jenifer Mason; Alasdair T M Hubbard Journal: Microb Genom Date: 2022-04