CQUIN audit for prescription of antibiotics for urinary tract infections in an acute medical assessment unit

Abstract

Urinary tract infections (UTI) are a common presentation in a medical assessment unit, and we wanted to check compliance with hospital guidelines for antibiotic prescribing in patients presenting to hospital with urinary tract infection. The guidelines are based on local organisms and sensitivities. A retrospective audit of 40 patient records with positive urine cultures from July to August 2013 showed that 20% of patients with culture confirmed UTI were not given antibiotics at all. Of those prescribed antibiotics, 25% were non-compliant with local policy, and nearly one in two patients received more than one antibiotic. Furthermore, stop dates were not stated on 77% of the drug charts and duration of treatment ranged from one to 11 days.Interventions were then introduced in the form of group teaching sessions, proactive checks by Trust pharmacists and widely distributed posters, and the same data sets collected for April to March 2014 to assess for efficacy of the interventions. On re-auditing, 35% patients were not prescribed any antibiotics. However, compliance with local policy was 100%, including 100% drug charts having a stop/review date stated. The overall duration of treatment now ranged from one to seven days, and fewer than one in four patients had more than one antibiotic.Our results showed that improvement was needed in antibiotic stewardship, in particular with regards to compliance with the local guidelines and documentation of prescription. We have demonstrated that it is possible to improve compliance through teaching, by displaying information prominently, and vigilance by the clinical team. The outcome of this is a decreased number and duration of antibiotics prescribed, which has benefits for the patients, the hospital, and the community as a whole. Further work would include interventions to improve the number of patients who are missing antibiotic prescriptions altogether.

Effectiveness of implementing a locally-developed guideline for antibiotic treatment of lower urinary tract infection in adults in Thailand

“…Our locally-developed CPG for antibiotic treatment of lower UTI in adults was implemented at Siriraj Hospital using multifaceted interventions because this type of implementation was reported to be effective measure for guideline implementation 9 , 16 – 19 . Although the CPG compliance rate was significantly increased from 17.3% during the CPG development phase to 43.0% during CPG implementation phase ( p = 0.001), and the rate of inappropriate choice (fluoroquinolones) of antibiotic treatment during the CPG implementation phase was significantly lower than the rate during the CPG development phase, the rate of CPG compliance of 43% is still too low, and fluoroquinolones were still the most commonly prescribed agents to treat lower UTI during the CPG implementation phase.…”

A prospective, follow up study to assess guidelines compliance in uncomplicated urinary tract infection

“…A similar prescription audit conducted in UK showed an initial compliance of 75% with the local policy, which was successfully raised to 100% after an intervening teaching session of medical staff, widespread awareness via means of posters and active checking by pharmacists. [ 17 ] The data shows that antibiotic stewardship programs, group teaching sessions and awareness of the medical fraternity regarding the changing antibiotic sensitivity trends is essential to curb the threat of emerging antimicrobial resistance among pathogenic bacteria.…”

How Can Multi-Professional Education Support Better Stewardship?

“…For example, whilst an emphasis has been placed on volumes of prescribed antimicrobials 72 and such indicator is clearly essential, the appropriateness of all decisions along the clinical management path may be reflected on the education support to be provided. 73 For example, appropriate diagnosing would lead to fewer antibiotics used empirically, or at all.…”

“…Ideally, antimicrobial education programs should consider the impact of different education interventions on the variety of antimicrobial prescription quality indicators available and that may be relevant or suitable to each local organisation. For example, whilst an emphasis has been placed on volumes of prescribed antimicrobials 72 and such indicator is clearly essential, the appropriateness of all decisions along the clinical management path may be reflected on the education support to be provided. 73 For example, appropriate diagnosing would lead to fewer antibiotics used empirically, or at all.…”