ANTIMICROBIAL PLAN STICKER Improving Antimicrobial documentation with the use of an Antimicrobial Plan sticker Evonne Fong, Pharmacy Department AHS, ICU.
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ANTIMICROBIAL PLAN STICKER
Improving Antimicrobial documentation with the use of an Antimicrobial Plan sticker
Evonne Fong, Pharmacy Department AHS, ICU AHS
Background
Australian Commission on Safety and Quality in Health Care• Consultation Draft: Clinical Care Standard for antimicrobial
stewardship (Dec 2013)
Quality Statement 6• Clinical reason• Drug name• Dose• Route of administration• Intended duration• Review plan
Baseline
NAPS audit November 2013• One day “snap shot”
• 85 antimicrobial orders• Documentation of indication = 67.1%
– Med chart, patient’s notes, anaesthetic/surgical/other procedural records
– Excludes nursing hand over notes or other non-official records
NIMC audit 2012• Regular orders with indication
documented on NIMC = 7.93%
Aim
To improve documentation of antimicrobial treatment• Best practice: >95%
To have effective communication between clinicians
To ensure there is a system in place at AHS to support documentation and communication
Methodology
Trial 1: Pilot of new sticker in consultation
with ICU director
Sticker covers documenting requirements
Promoted in Pharmacy Newsletter ICU doctors emailed; discussed with
doctors on floor
Methodology
RESULTS: After 2 weeks: Documentation of indication = 86%
(n = 29) • compared to 67.1% at baseline
• Good sticker use with initial doctors rotation/shift change poor compliance
• Stickers used for 41% of antimicrobial orders
• Stickers disappearing• Drs unaware/unsure intention
Methodology
RE-LAUNCH :• Discussion with doctors and nurses• New sticker designed to use in med chart instead
Methodology
Drs emailed Registrars spoken to
individually (handover time and registrar “champion”)
Discussed at ICU management meeting with consultant and CNS
Ward clerk enlisted to assist
Results
10 days auditing post re-launch: 96% compliance with documenting indication (n = 24) Sticker used for 83% of antimicrobial orders
Other results:• Drug name, dose, route = 100%• Intended duration/review plan: 71%
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