Quality Use of Antimicrobials in Intensive Care
As part of a state-wide strategy to reduce the prevalence and burden of healthcare associated infections, the Clinical Excellence Commission (CEC) and the Intensive Care Coordination and Monitoring Unit (ICCMU) developed a project to support quality use of antimicrobials in the intensive care unit (QUAIC).
Antimicrobial use is linked to the development of multidrug-resistant organisms. These organisms cause infections with significant associated morbidity and mortality. In intensive care units, both antimicrobial usage rates and the prevalence of infection with multi-resistant organisms are higher than in other healthcare settings. The principles of QUAIC were developed to help clinicians working in intensive care units obtain the best possible results for patients while limiting the risk of contributing to the development of multi-resistant organisms.
An expert advisory group with representation from Intensive Care, Pharmacy, Infectious Diseases and Microbiology were convened by the CEC to progress a project plan. A position statement was developed by ICCMU and the expert advisory group, in consultation with stakeholders from the NSW health system. This position statement provides a set of seven evidence and expert opinion based recommendations for structures and processes that should be in place in all Intensive Care Units to support the quality use of antimicrobials. These recommendations are:
- That intensive care units have appropriate policies for first line treatment of sepsis, including policies for empiric antimicrobial management of suspected bacterial infection
- That intensive care units are provided with regular data on the prevalence of microorganisms and their susceptibility and local guidelines for empiric treatment are assessed against this information
- That intensive care units are provided with timely reports of laboratory results which may be used to guide antimicrobial therapy
- That intensive care units are provided with antimicrobial usage data on a monthly basis
- That intensive care units have access to standard materials for training medical officers in the quality use of antimicrobials
- That intensive care units have mechanisms to audit the quality use of antibiotics and to provide feedback on audit results to individual prescribers
- That intensive care units utilise local experts to provide patient focussed ward rounds reviewing all positive microbiology and antimicrobial prescriptions.
A toolkit containing antimicrobial guidelines, a learning package and an audit tool to support quality use of antimicrobials in intensive care units was developed. Additionally, an information sheet for setting up a multidisciplinary antimicrobial liaison round in intensive care units was developed. Four pilot sites in NSW have tested the audit tools developed to support antimicrobial prescribing review and feedback.
The lessons learned from the QUAIC project have been very useful in understanding and addressing the successes and challenges associated with broader antimicrobial stewardship initiatives. The QUAIC project has now been incorporated into the Quality Use of Antimicrobials in Health Care program, which aims to optimise antimicrobial use not only in intensive care units, but in all areas of NSW public health facilities.
- Survey of Structures and Processes to Support the Quality Use of Antimicrobials in NSW Intensive Care Units
- Status Report October 2010 - PDF ~357kb
- QUAIC ICCMU Position Statement
- November 2010 - PDF ~328kb
Setting up a multidisciplinary antimicrobial liaison round in the Intensive Care Unit
- Information sheet for setting up a multidisciplinary antimicrobial liaison round - PDF ~357kb
QUAIC Intensive Care Unit Empirical Antimicrobial Treatment Guidelines
The Intensive Care Unit Empirical Antimicrobial Treatment Guidelines are aimed at providing the clinicians of NSW intensive care units with recommendations to frame the development of policies and procedures related to empirical antimicrobial therapy. These were developed by the QUAIC Expert Advisory Group convened for this project in November 2010. They are based on the Therapeutic Guidelines: Antibiotic version 14, 2010.
- Intensive Care Unit Empirical Antimicrobial Treatment Guidelines - PDF ~437kb
QUAIC audit tools to measure appropriate antimicrobial prescribing
- QUAIC antimicrobial communication sheet and audit tool (Teleform®) - PDF ~65kb
- QUAIC online audit tool (designed in SurveyMonkey®) - version 5, 2012 - PDF ~293kb
- Definitions for data collection when using the online audit tool - PDF ~234kb