National Antimicrobial Prescribing Survey [NAPS] 2016.

Abstract

BACKGROUND: Epworth Antimicrobial Stewardship (AMS) participated in the National Antimicrobial Prescribing Survey (NAPS) in late 2016. This point-prevalence survey, administered by the National Centre for Antimicrobial Stewardship (NCAS), assesses the prevalence and appropriateness of antimicrobial prescribing in public and private hospitals across Australia. This enables benchmarking, and evaluation of local AMS interventions. OUTCOMES: The progress notes of 627 overnight patients, across 38 wards at all divisions (excluding Geelong), were reviewed to identify antimicrobial prescriptions. All prescriptions valid at 08:00, or surgical antibiotic prophylaxis (SAP) administered within the preceding 24 hours were recorded. The drug, dose, route, duration, and indication for therapy, plus relevant microbiology or biochemistry results were recorded. The team assessed prescriptions for compliance with Therapeutic Guidelines: Antibiotic, or Epworth SAP Guidelines. Prescriptions were also assessed for appropriateness, recognizing that guidelines may not apply in all clinical scenarios. 42.9% patients were prescribed ≥1 antimicrobial. 406 prescriptions were assessed. 74.6% prescriptions were assessed as appropriate, 20.7% as inappropriate, and 4.7% could not be assessed. Appropriateness matched the national benchmark, and improved on the 2015 Epworth result (71.3%). Prescribing appropriateness at Epworth has improved compared to pre-implementation of the AMS program (52% in 2012). SAP represented 31.2% of all prescriptions, but 80.9% of inappropriate prescriptions. 46.5% of SAP prescriptions were assessed as appropriate, down from 58.6% in 2015. The most frequent reasons for SAP to be inappropriate were: incorrect duration (29%0, and incorrect dose or frequency (20%). SAP was continued for greater than 24 hours post-operatively for 31.5% of prescriptions. CONCLUSION: Antimicrobial prescribing compares well with comparators and continues to improve. These data are limited by the point-prevalence design of the survey, and number of patients reviewed. A SAP-specific NAPS conducted at Epworth in 2016, capturing day cases in addition to overnight stays, found higher rates of prescribing appropriateness peri-operatively (60%), and post-operatively (81%).