Prospective audit and feedback

Hello, my name is Adrian Brink. I’m a clinical microbiologist from Johannesburg, and I’d like to share with you a specific antimicrobial stewardship programme that we’ve been involved in.

In South Africa, we don’t have enough infectious disease resources, neither microbiologists in all hospitals. We also don’t have IV pharms or clinical pharmacists in every hospital, so we had to use existing resources to embed a initial basic stewardship programme – a sustainable one – in all of the hospitals that participated in this programme.

So we chose a prospective audit pharmacist – a non-specialised pharmacist – to have an audit and feedback strategy, to implement across 47 rural and urban hospitals. The interventions that the pharmacist chose or that we chose for the pharmacist were so-called ‘low-hanging fruit’, implying that they are easy, obtainable interventions without IV resources. They were, for example, duration of therapy longer than seven days, duration of therapy longer than 14 days, redundant cover – many doctors don’t know overlapping spectra between Gram-negative and Gram-positive antibiotics. We also did with them an intervention to make sure that cultures were taken prior to empirical therapy, for example.

The target was these five low-hanging fruit, and every pharmacist then were allocated stewardship time from their daily activities to go to the wards and ICUs, and to measure patients more than seven days of therapy, 14 days, et cetera, intervene, and discuss that with the doctor to reduce overall consumption, which was the aim of the study.

The model that we used for improvement amongst the non-IV forms was the Breakthrough Series Collaborative, which you’re going to learn about later. It involved six-weekly or two-monthly teleconferences with all the pharmacists in the so-called PDSA cycles, which you’re also going to learn of. Overall, the five interventions over a two-year period led to a 12.5% reduction in overall consumption in these 47 hospitals.