QUAH - Quality Use of Antimicrobials in Healthcare

Other Antimicrobial Stewardship Resources

Hospital-Level Cumulative Antibiograms

Antibiograms are summary antimicrobial susceptibility tables, used by clinicians to inform empirical antimicrobial choice, develop local antimicrobial guidelines and guide formulary management.

The National Safety and Quality Health Service Standard 3.14.3 requires hospitals to monitor antimicrobial resistance. As a guide, the Australian Commission on Safety and Quality in Health Care developed a Specification for Hospital Cumulative Antibiograms which details both the clinical and technical elements of cumulative antibiograms that will support antimicrobial prescribing and antimicrobial stewardship in general. This specification is an essential step toward achieving detailed, accurate, efficient, national antimicrobial resistance surveillance.

To read more about antibiograms, and to see an example of a hospital-level cumulative antibiogram, go to Hunter New England Local Health District’s AIMED - Let’s Talk About Antibiotics Blog.

E-learning

Antimicrobial resistance: Turn the Tide

This e-Learning module is an innovative video for medical officers, nurses, nurse practitioners and pharmacists employed by NSW Health working in hospital and community settings. The video focuses on the health care worker’s role in improving appropriate use of antimicrobials and emphasises a team approach to antimicrobial stewardship.

It includes a moving patient story illustrating the impact of antimicrobial resistance on a patient’s quality of life. It also includes interviews with a range of hospital staff members who share their experience, answer questions about what antimicrobial stewardship is and why it is so important, and they describe how all staff can help improve the way antibiotics are used in hospitals.

Available on My Health Learning (course code: 137891572).

Indicators for Quality Use of Medicines
in Australian Hospitals

The NSW Therapeutic Advisory Group has produced a manual containing a wide range of targeted process indicators to inform and support quality use of medicines practices. The set of indicators which are specific to antibiotic therapy include:

Indicator 2.1

Percentage of patients undergoing specified surgical procedures that receive an appropriate prophylactic antibiotic regimen

Indicator 2.2

Percentage of prescriptions for restricted antibiotics that are concordant with Drug and Therapeutics Committee approved criteria

Indicator 2.3

Percentage of patients with a toxic or sub-therapeutic aminoglycoside concentration whose dosage has been adjusted or reviewed prior to the next aminoglycoside dose (currently under review)

Indicator 2.4

Percentage of adult patients with community acquired pneumonia that are assessed using an appropriate validated objective measure of pneumonia severity

Indicator 2.5

Percentage of patients presenting with community acquired pneumonia that are prescribed guideline concordant antibiotic therapy.

Details on the antibiotic therapy indicator set are available from the NSW Therapeutic Advisory Group website.

Mobile Applications to Support AMS

The usefulness and prevalence of mobile device applications (‘apps’) to support best practice in healthcare is increasing across a range of clinical areas. Apps to support appropriate antimicrobial prescribing generally do so by improving the accessibility and/or understanding of locally-endorsed guidelines, and some also provide a level of decision-support at the point of care.

The following list of AMS-related mobile apps has been provided for information purposes only, as examples of the types of applications which have been developed within NSW local health districts or by external commercial entities.

To find out more about these applications, we ask that you please contact the developers directly.

Please note that the inclusion of a product within this list does not constitute an endorsement by the CEC.

eASYapp
(developed by the eASY Team, based within Northern Sydney Local Health District)

A downloadable app described as an all-in-one decision-support and AMS auditing tool. Antimicrobial prescribing advice is provided according to the selection of either an antibiotic or the infectious indication/location, with capacity to customise content based on local restrictions or guideline recommendations. Auditing capacity includes capturing data on AMS interventions and IV-to-oral switch.

Westmead Acute Surgery
(developed by Westmead Hospital, in association with Sydney University)

A downloadable app providing algorithm-based advice for the management of the acute surgical patient, including empirical antibiotic advice for relevant infections. Protocols and recommendations are specific to Westmead Hospital only, and development was supported financially via the HETI Medical Education Support Fund.

MicroGuide™
(developed by University Hospital Southampton NHS Foundation Trust and Horizon Strategic Partners UK)

A downloadable, highly-modifiable guideline and information repository app, the core content of which is controlled by individual health service organisations. Used widely across a range of NHS trusts within the UK, with commercial capacity for international clients.

HNE Quality Use of Medicines
(developed by Hunter New England LHD)

A web-based mobile app providing point-of-care access to a selection of medication-related Hunter New England LHD guidelines, including management of common infectious conditions and local IV-to-oral switch protocols. Content is developed and maintained via the HNE Quality Use of Medicines Committee.

Educational Vancomycin Interactive
(developed by Illawarra Shoalhaven Local Health District)

A web-based (but mobile-device accessible) interactive education module designed to improve the dosing, administration and monitoring of IV vancomycin in adults. This interactive is highly engaging, free to use and is targeted towards doctors, nurses and pharmacists. Available at www.vancomycin.com.au.

Antimicrobial Prescribing Behaviours

HARC Scholarship Research Project

In 2015, a member of the QUAH program team received a Hospitals Alliance for Research Collaboration (HARC) Scholarship to pursue a research project titled Modifying antibiotic prescribing behaviours: exploring innovative antimicrobial stewardship interventions and the science behind their success.

This scholarship provided financial support to attend an international conference and meet with experts at various centres of excellence throughout the UK. A final report has been provided below, including a literature review and discussion of key learnings and recommendations.

Quality Use of Antimicrobials in Intensive Care (QUAIC)

The QUAIC project was created a number of years ago to develop and support the role of antimicrobial stewardship in intensive care settings. In 2012, the QUAIC project was superseded by the establishment of the broader Quality Use of Antimicrobials in Healthcare (QUAH) program. While the QUAIC project is no longer current, links to the original QUAIC resources are available below.

Audit tool to measure appropriate prescribing: