The 5x5 Antimicrobial Audit
The 5x5 Antimicrobial Audit is a sustainable model of audit, intervention and feedback designed to improve the quality of antimicrobial prescribing in targeted areas of clinical practice.
The methodology of the 5x5 Antimicrobial Audit involves ongoing data collection of small sample sizes, with trained auditors required to answer up to 5 questions in 5 or more patients per week. Two process measures for the audit are based on a prescribing indicator developed by the Scottish Antimicrobial Prescribing Group, and are defined as:
- Documentation of an indication for antimicrobial therapy
- Concordance with guidelines (or non-concordance with a documented reason).
Implementation of the 5x5 Antimicrobial Audit may contribute to meeting the Standard 3.14 of the National Safety and Quality Health Service Standards, as evidence of monitoring antimicrobial usage and taking action to improve the effectiveness of an AMS program. If you have implemented, or are considering implementation of the 5x5 Antimicrobial Audit at your facility, the QUAH program team is available to provide advice. Please send us an email at CEC-AMS@health.nsw.gov.au.
The 5x5 Antimicrobial Audit Resource Package contains the following core items to direct and support implementation:
- 5x5 Antimicrobial Audit - Audit User Guide PDF ~449KB
- 5x5 Antimicrobial Audit - Frequently Asked Questions PDF ~203KB
- 5x5 Antimicrobial Audit - Community Acquired Pneumonia Cheat Sheet PDF ~337KB
- 5x5 Antimicrobial Audit - Guide to Data Entry and Review System PDF ~534KB
- 5x5 Antimicrobial Audit - Data Entry and Review System (with sample data) XLS ~1.1MB
- 5x5 Antimicrobial Audit - Data Entry and Review System (blank - no sample data) XLS ~1.1MB
- 5x5 Antimicrobial Audit - Challenging Cases Tutorial PPT ~8.0MB
This resource package also includes the following clinician engagement tools:
- Template Letter to Prescribers (Modifiable) DOC ~20KB
- Basic Presentation for Prescribers (Modifiable) PPT ~139KB
- Audit Information Flyer for Prescribers (Modifiable) DOC ~3.6MB
- Ward Poster - Message 1 PDF ~396KB
- Ward Poster - Message 2 PDF ~399KB
- Generic Monthly Report Template for 5x5 Antimicrobial Audit DOC ~48KB
- 5x5 Antimicrobial Audit Interventions in Practice Slides DOC ~1.4MB
In February 2016, the CEC offered webinar training to support implementation of the 5x5 Antimicrobial Audit across NSW local health districts and specialty networks. Recordings of these webinars have been provided below, and it is strongly recommended that all three sessions are reviewed before preparing and launching this audit activity.
Session 1: Audit Basics
Session 2: Determining Concordance & Challenging Cases
Session 3: Interventions & Feedback
Pilot Project Evaluation
Across 2014/15, fifteen facilities from NSW local health districts and networks were involved in a 12 month pilot project for the 5x5 Antimicrobial Audit. This project provided cumulative data from over 4600 audit records and prompted over 1000 point-of-care interventions. Results of the pilot provide strong evidence that implementation of this initiative contributes to improvements in the quality of antimicrobial prescribing in wide variety of hospital inpatient settings.
The 5x5 Antimicrobial Audit pilot project was evaluated in July 2015 and the 5x5 Antimicrobial Audit resource package has been updated based on the project’s key learnings.