Epworth: National Antimicrobial Prescribing Survey (NAPS) 2015.

Abstract

The Epworth Antimicrobial Stewardship (AMS) team participated in the National Antimicrobial prescribing Survey (NAPS) during November 2015. 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 informs the design and evaluation of local AMS interventions. The progress notes of 629 overnight patients, across 35 wards at all divisions, were reviewed to identify antimicrobial prescriptions . All prescriptions valid at 8:00 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, recognising that guidelines may not apply in all clinical scenarios. 36% patients were prescribed ≥ antimicrobial. 331 prescriptions were assessed. The most common agents were: cephazolin (54), ceftriaxone (35) and metronidazole (24). The most common indications were: SAP (70), community-acquired pneumonia (30), and medical prophylaxis (22). 54.4% prescriptions were compliant with guidelines, or microbiology directed therapy. 10.6% could not be assessed, and 35.0% were non-compliant with guideline recommendations. Compliance with guidelines was below the national benchmark. 71.3% prescriptions were appropriate, 7.6% could not be assessed, and 21.1% were inappropriate. Appropriateness matched the national benchmark, and out performed the private hospital result. SAP represented 21.1% of all prescriptions, but 41.4% of inappropriate prescriptions. The most frequent reasons for SAP to be inappropriate were: incorrect duration, and spectrum too broad. These data are limited by the point-prevalence design of the survey, and number of patients reviewed. Epworth AMS has worked with NCAS to design and pilot a targeted surgical NPAS to provide more robust data to evaluate SAP prescribing.