Antimicrobial stewardship activities: a survey of Queensland hospitals.
OBJECTIVE
In 2011, the Australian Commission on Safety and Quality in Health Care (ACSQHC) recommended that all hospitals in Australia must have an Antimicrobial Stewardship (AMS) program by 2013. Nevertheless, little is known about current AMS activities. This study aimed to determine the AMS activities currently undertaken, and to identify gaps, barriers to implementation and opportunities for improvement in Queensland hospitals.


METHODS
The AMS activities of 26 facilities from 15 hospital and health services in Queensland were surveyed during June 2012 to address strategies for effective AMS: implementing clinical guidelines, formulary restriction, reviewing antimicrobial prescribing, auditing antimicrobial use and selective reporting of susceptibility results.


RESULTS
The response rate was 62%. Nineteen percent had an AMS team (a dedicated multidisciplinary team consisting of a medically trained staff member and a pharmacist). All facilities had access to an electronic version of Therapeutic Guidelines: Antibiotic, with a further 50% developing local guidelines for antimicrobials. One-third of facilities had additional restrictions. Eighty-eight percent had advice for restricted antimicrobials from in-house infectious disease physicians or clinical microbiologists. Antimicrobials were monitored with feedback given to prescribers at point of care by 76% of facilities. Deficiencies reported as barriers to establishing AMS programs included: pharmacy resources, financial support by hospital management, and training and education in antimicrobial use.


CONCLUSIONS
Several areas for improvement were identified: reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use. There also appears to be a lack of resources to support AMS programs in some facilities. WHAT IS KNOWN ABOUT THE TOPIC?: The ACSQHC has recommended that all hospitals implement an AMS program by 2013 as a requirement of Standard 3 (Preventing and Controlling Healthcare-Associated Infections) of the National Safety and Quality Health Service Standards. The intent of AMS is to ensure appropriate prescribing of antimicrobials as part of the broader systems within a health service organisation to prevent and manage healthcare-associated infections, and improve patient safety and quality of care. This criterion also aligns closely with Standard 4: Medication Safety. Despite this recommendation, little is known about what AMS activities are undertaken in these facilities and what additional resources would be required in order to meet these national standards. WHAT DOES THE PAPER ADD?: This is the first survey that has been conducted of public hospital and health services in Queensland, a large decentralised state in Australia. This paper describes what AMS activities are currently being undertaken, identifies practice gaps, barriers to implementation and opportunities for improvement in Queensland hospitals. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Several areas for improvement such as reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use have been identified. In addition, there appears to be a lack of resources to support AMS programs in some facilities.
Infection and Immunity Theme, UQ Centre for Clinical Research (UQCCR), Level 8, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Qld 4006, Australia. Email:
Minyon L
ML
Avent
Centre for Healthcare Related Infection Surveillance and Prevention, Communicable Diseases Unit, Queensland Health, Herston, Qld 4006, Australia. Email: ;
Lisa
L
Hall
Centre for Healthcare Related Infection Surveillance and Prevention, Communicable Diseases Unit, Queensland Health, Herston, Qld 4006, Australia. Email: ;
Louise
L
Davis
Centre for Healthcare Related Infection Surveillance and Prevention, Communicable Diseases Unit, Queensland Health, Herston, Qld 4006, Australia. Email: ;
Michelle
M
Allen
Burns Trauma and Critical Care Research Centre, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Qld 4029, Australia. Email:
Jason A
JA
Roberts
Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia. Email:
Sean
S
Unwin
Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000. Email:
Kylie A
KA
McIntosh
Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Melbourne, Vic. 3000, Australia. Email: ;
Karin
K
Thursky
Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Melbourne, Vic. 3000, Australia. Email: ;
Kirsty
K
Buising
Infection and Immunity Theme, UQ Centre for Clinical Research (UQCCR), Level 8, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Qld 4006, Australia. Email:
David L
DL
Paterson
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019538:Health Care Surveys; D006779:Hospitals, Public; D006801:Humans; D016134:Organizational Policy; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D016730:Program Development; D011787:Quality of Health Care; D011793:Queensland
D000890:Anti-Infective Agents