Compliance with antimicrobial guidelines in a regional referral centre

Shruti Krishnan, Sarah Ritchie, Sarah Myers, Julia Fattore

Introduction

Antibiotic resistance is a growing phenomenon in Australia where traditionally, there was unrestrained use of broad spectrum antibiotics across the fields of both human and veterinary medicine. Antimicrobial stewardship was subsequently developed to promote appropriate prescribing patterns, aiming to overall reduce resistance, morbidity, mortality and health costs within our nation. In conjunction, therapeutic guidelines were also developed to advise prescribers on recommended first line agents for certain illnesses warranting antibiotic therapy. We aim to investigate the compliance rate of our regional referral hospital in adhering to these national guidelines, in order to inform and guide our future practice in antimicrobial prescribing.

Methodology

A retrospective audit was conducted on a single day of all inpatients >18 years of age admitted to acute services at Wagga Wagga Rural Referral Hospital. All medical records were surveyed to determine current antibiotic prescription. Medical records and medication charts were reviewed for a documented indication, plan for cessation or a planned review date. Compliance was assessed as either optimal, adequate, suboptimal, inadequate or not assessable. Further assessment determined whether antimicrobial use was compliant with current therapeutic guidelines, locally endorsed guidelines, directed therapy or if they were non-compliant/non-assessable.

Results

179 case records were audited. Of these, 99 patients were prescribed antimicrobial therapy. Of the 99 patient cases analysed, 58.3% were found to be compliant with therapeutic guidelines, 11.8% compliant with locally endorsed guidelines, 13.2% directed therapy, 12.5% non-compliant with guidelines, 2.1% had no guidelines available and 2.1% of cases was not assessable. Overall, 78.5% were deemed appropriate use with 18.7% inappropriate, and 2.8% unassessable. Other important results included documentation of indication in 87.5% of cases and a review/stop date documented in 31.9% of cases.

Conclusion

This audit demonstrated that at our regional referral hospital, 70.1% of current antibiotic prescriptions were compliant with national or local therapeutic guidelines, 13.2% prescriptions were directed therapy. Overall antibiotics were appropriate in 78.5% of prescriptions. This is of utmost importance in an acute healthcare setting as higher rates of compliance invariably contribute to reduced levels of antimicrobial resistance and subsequently decreased mortality, morbidity and cost to our health care system.