Adherence to International Antimicrobial Prophylaxis Guidelines in Cardiac Surgery: A Jordanian Study Demonstrates Need for Quality Improvement

Abstract

BACKGROUND: Antimicrobial prophylaxis in cardiac surgery has been demonstrated to lower the incidence of surgical site infection (SSI). Inappropriate antimicrobial prophylaxis, such as inappropriate selection of the antimicrobial agent or inappropriate dosing regimen, can increase the prevalence of antibiotic resistant strains, prolong hospital stay, cause adverse reactions, and negatively affect an institution's pharmacy budget for antibiotics. In developing countries such as Jordan, where the role of clinical pharmacists is still in its primary stages, the first step in establishing an organized clinical pharmacy service is the evaluation of current practice to determine the need for improvement.

the impact of antimicrobial stewardship strategies on antibiotic appropriateness and prescribing behaviours in selected countries in the Middle East: a systematic review

“…All studies provided recommendations for successful programme development and/ or implementation. Table 1 summarizes the studies in regard to the adoption by institutions of interventional strategies in order to assess and enhance antimicrobial use and prescribing behaviours by physicians (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

“…Eleven (61.1%) of these reported unwarranted and inappropriate use (typically overuse) of antimicrobials. The majority of the studies concluded that prescribing habits were to blame for the discrepancies observed, and that physicians were not prescribing according to local policies and guidelines (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Conversely, 6 (33.3%) studies reported adherence to guidelines and local institutional policies (27)(28)(29)(30)(31)(32).…”

“…All the studies we examined provided recommendations that are considered to be crucial for further enhancement of antimicrobial usage through implementation of successful antimicrobial stewardship programmes. Eight studies mentioned the importance of implementing local guidelines and policies (13,16,18,21,24,(25)(26)(27). It was also suggested that these should be supported…”

“…Others highlighted the importance of the role of the clinical pharmacist in monitoring prescriptions (i.e. dosage and frequency adjustments), intervening when appropriate, and the implementation of such interventions if deemed reasonable (17,18,21,23,29,30,32). Lastly, some studies reflected upon the need for continuous use of guidelines (13,28,31) and the increased need for drug utilization reviews, audits, or strategies that include restriction policies, order forms, pharmacodynamics dose optimization and antimicrobial cycling and rotating (13)(14)(15)17,21,23,24).…”

Improvement in Adherence to Surgical Antimicrobial Prophylaxis Guidelines after Implementation of a Multidisciplinary Quality Improvement Project

“…6 However, despite the presence of evidence-based guidelines, poor adherence to guidelines has been reported internationally. [7][8][9][10][11][12][13] The King Hussein Cancer Centre (KHCC) in Amman, Jordan, is a 170-bed comprehensive teaching cancer centre with a surgical service consisting of nine teams with various specialties. Among these teams, an average of 25 patients are seen and five major elective surgeries are performed per day.…”