title: A quality improvement programme to increase compliance with an anti-infective prescribing policy.
abstract: OBJECTIVE
  The UK Department of Health has made recommendations on safe and appropriate prescribing of anti-infectives. In response, we reviewed our anti-infective policies to ensure they were in line with best practice. As a result, a new adult anti-infective policy was launched. To help facilitate its implementation, a quality improvement programme was established, with the aim of achieving >90% compliance with the new policy.
  
  
  METHODS
  Patients under the care of the medical admissions teams who had been prescribed one or more systemic anti-infectives between January and November 2008 were included in the study. Study pharmacists collected data daily on all patients, including the anti-infective(s) prescribed and indication(s) documented on either the patient's drug prescription chart or health records. A definition of compliance was developed, which required documented indication(s) and associated anti-infectives to match the anti-infective policy. A baseline compliance level was established; we then implemented a series of interventions using the plan-do-study-act ('PDSA') approach to monitor and improve compliance. Three overlapping intervention phases were retrospectively identified: raising awareness; education; and weekly feedback of results in the form of run charts distributed to medical teams.
  
  
  RESULTS
  Over the 11 month study period, compliance with the policy increased from 30% to 71%. Since 2008, we have seen the average compliance increase year-on-year to over 90% in 2010 using a sustainable once weekly data collection model.
  
  
  CONCLUSIONS
  This study shows that it is possible to use quality improvement methodology to support antimicrobial stewardship within existing resources and suggests that an improvement in policy compliance can be both achieved and sustained.
authors.affiliation: Pharmacy Department, Imperial College Healthcare NHS Trust, London W12 0HS, UK. kandarp.thakkar@imperial.nhs.uk
authors.forename: Kandarp
authors.initials: K
authors.lastname: Thakkar
authors.forename: Mark
authors.initials: M
authors.lastname: Gilchrist
authors.forename: Edward
authors.initials: E
authors.lastname: Dickinson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Benn
authors.forename: Bryony Dean
authors.initials: BD
authors.lastname: Franklin
authors.forename: Ann
authors.initials: A
authors.lastname: Jacklin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents