web-based antimicrobial guidelines – a 2 year review

Medicines Management & Pharmacy Services

Web-based Antimicrobial

Guidelines – a 2 year review

Philip Howard, Jonathan Sandoe, KatieWarburton, Jason Dunne, Abimbola Olusoga

Winner of EuropeanAssociation of HospitalPharmacy Poster & OralCommunication Award 2011


Leeds Teaching Hospitals NHSTrust (North of England)

• Serves population 900k plus 2.5mfor tertiary services

• ~ 2300 inpatient beds

• 2 teaching hospitals: LGI & SJUH

• 3 peripheral sites

• £93m drug budget (£20m AB)

• 430 staff incl ~125 pharmacists, 8Microbiologists & 3 Infectiousdisease consultants


LTH Antimicrobial Consultant Pharmacist

• 2008 - worstacute teachinghospital in UK forMRSA and Cdifficile

CDI Acute Teaching

0

200

400

600

800

1000

0 50000 100000 150000 200000 250000

Admissions

Cases

Trusts

Best Rate

MRSA Acute Teaching

0

20

40

60

80

100

120

140

0 50000 100000 150000 200000 250000

Admissions

Cases

Trusts

Best Rate

We received “help” from aturn around team who madethings change quicker

Update guidelines; stopusing “C”drugs; do audit,education.


Antimicrobial Stewardship teams

Team

• Jon Sandoe (CMM)

• Philip Howard (CP)

• Abimbola Olusoga (8a Ph)

• Helen Smith (Sec 3)

LHP team

• Web designers

• Guidelines lead

Improving AntimicrobialPrescribing Group (DTCSub-committee

• 3 Con Med Micro

• 1 ID Con

• Primary Care Pharmacist

• 2 AB pharmacists

• Anaesthetist

• Deputy Chief Nurse

• Medical Director


Purpose of project

• single on-line antimicrobial resource

• evidence-based, peer-reviewed guidelines

• educational resource for all staff

• audit resources with results

• decision support including calculators


Current home of guidelines

http://nww.lhp.leedsth.nhs.uk/


The Database


Example Database Table


Dreamweaver


Resource Page ‘Heat’


Antimicrobial Guidelines Home Page


Guidelines development

Draft guideline for peer review

Specialtydoctor

Specialtydoctor

PharmacistPharmacist MicrobiologistMicrobiologist

• Template• Review evidence• Draft document• Peer review (4/52)• Address comments• Approval• Publication ontoLeeds HealthPathways on NHSspine


Peer review of draft antimicrobial guidelines

3 options• Approve• Not approve with minor amendments• Not approve & needs major amendments = another draft


Status of guidelines: Paed treatment


Divisional status of guidelines


Adult Guidelines


Guideline template


Comment on guidelines in use


Number and location of hits


Hits by time of day


Treatmentalgorithms

• severity based• treat sickest patientfirst


Links to eBNF and EMC


Prophylaxis on posters in theatres / wards


Results• 104 guidelines developed

• 72 adult & 32 children and neonatal

• 77 treatment & 27 prophylaxis

• average 73 draft views (20 – 962)

• Average 7 comments per draft (1-92)

• 3 had second peer-review


Hits per month: >7000 (now 8000)

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Antimicrobials Non Antimicrobials


Impact on HCAI and Antimicrobial usage

• Antimicrobial prevalence from ~35% to ~25%

• Clostridium difficile infection decreased from~80 to ~20 cases/month


Summary• On line, evidenced-based, peer-reviewed antimicrobial

guidelines are an effective method to support prescribersin their diagnosis, investigation and treatment ofinfection.

• Links to eBNF, eMC and calculators improve safety.

• Feedback and regular update ensure that guidelines arealways up-to-date.

• Consensus based guidelines combined with otherelements of antimicrobial stewardship is associated witha decrease in the prevalence of antimicrobial usage andreductions in some HCAIs.

web-based antimicrobial guidelines – a 2 year review

Documents