ANTIMICROBIAL PLAN STICKER

Improving Antimicrobial documentation with the use of an Antimicrobial Plan sticker

Evonne Fong, Pharmacy Department AHS, ICU AHS

Background

Australian Commission on Safety and Quality in Health Care• Consultation Draft: Clinical Care Standard for antimicrobial

stewardship (Dec 2013)

Quality Statement 6• Clinical reason• Drug name• Dose• Route of administration• Intended duration• Review plan

Baseline

NAPS audit November 2013• One day “snap shot”

• 85 antimicrobial orders• Documentation of indication = 67.1%

– Med chart, patient’s notes, anaesthetic/surgical/other procedural records

– Excludes nursing hand over notes or other non-official records

NIMC audit 2012• Regular orders with indication

documented on NIMC = 7.93%

Aim

To improve documentation of antimicrobial treatment• Best practice: >95%

To have effective communication between clinicians

To ensure there is a system in place at AHS to support documentation and communication

Methodology

Trial 1: Pilot of new sticker in consultation

with ICU director

Sticker covers documenting requirements

Promoted in Pharmacy Newsletter ICU doctors emailed; discussed with

doctors on floor

Methodology

RESULTS: After 2 weeks: Documentation of indication = 86%

(n = 29) • compared to 67.1% at baseline

• Good sticker use with initial doctors rotation/shift change poor compliance

• Stickers used for 41% of antimicrobial orders

• Stickers disappearing• Drs unaware/unsure intention

Methodology

RE-LAUNCH :• Discussion with doctors and nurses• New sticker designed to use in med chart instead

Methodology

Drs emailed Registrars spoken to

individually (handover time and registrar “champion”)

Discussed at ICU management meeting with consultant and CNS

Ward clerk enlisted to assist

Results

10 days auditing post re-launch: 96% compliance with documenting indication (n = 24) Sticker used for 83% of antimicrobial orders

Other results:• Drug name, dose, route = 100%• Intended duration/review plan: 71%

Work in progress…

Addressing issues as they arise

New doctors soon

Re-educate and remind

Conclusion

Reached indication target of 95%. • Regular re-auditing

Look to improve documentation of intended duration and review plan

Roll out to other wards• ICU transfers to other wards launch officially on other wards• Dr education