Assessing the impact of antimicrobial

stewardship ward rounds

using an app-based data collection tool

Francis Collett-White1, Ya-Ying Wang2,3, Sarisha Singh2,3, Andy Parrish4,7, David Stead6,7

1.

Presenter: Dr. David Stead

Background

• Multi-disciplinary antimicrobial stewardship ward rounds are a useful collaborative strategy for ‘point-of-care’ in stewardship in hospitals

• Audit of this activity is an opportunity to assess the AMS compliance of the responsible ward clinicians & nurses

Context

Frere hospital

Cecilia Makiwane hospital

Aim

• To develop a hand-held electronic AMS data collection platform that is:

– Free

– Easily accessible

– Quick to enter on rounds

– Modifiable

Methods

• Antimicrobial stewardship (AMS) ward rounds were held monthly in each of 4 medical inpatient wards at Frere and Cecilia Makiwane Hospitals, East London, from February to July 2017

• Each patient was reviewed to determine the appropriateness of currently prescribed antibiotics and the need for infection prevention control (IPC) measures (unnecessary IV cannula, urinary catheter, or isolation of an infective patient).

• Antibiotics for tuberculosis and prophylaxis were not included.

Data collection tool• A free iOS and android app was used to

develop a data collection tool• Data collection form designed on website• Data collected using smartphone app• Data was stored securely online and

downloaded to Microsoft Excel for data analysis.

Results

25%

75%

22%

78%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yes No

Pe

rce

nta

ge

Percentage of patients prescribed an antibiotic

CMH

FH

(Sample sizes: CMH=101; FH=172)

0%

5%

10%

15%

20%

25%

30%

35%

40%

Perc

enta

ge

Frequency of antibiotic prescriptions

CMH FH

FH

84%

16%

73%

27%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yes No

Pe

rce

nta

gePercentage prescribed antibiotic according to ID

opinion/guidelines

CMH

FH

60%

24%

16%

12%

0% 0%

51%

0%

5%

24%

8%

14%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

No change Durationchanged/reduced

Antibioticchanged

Antibioticstopped

IVOS/ Routechanged

Dose changed

Pe

rce

nta

ge

Impact of the ward round on antibiotic prescription

CMH

FH

92%

3% 2% 2%

83%

10%

3%6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

No infection controlmeasures

Removal of IV Cannula Removal of urinaryCatheter

Isolate infectivepatient

Pe

rce

nta

ge

Impact of the ward round on infection control

CMH

FH

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

February March April May June July

Perc

enta

ge

Antibiotic prescribed according to EML clinical guidelines or ID opinion trends

FH

CMH

Strengths

• Hawthorn effect with scheduled rounds

• Reliance on correct data entering

• ID opinion subjective as to compliance

• Free to use app

• Feedback an educational tool

• Data collection during ward round

Limitations

Conclusion

• An app-based data collection tool enables efficient auditing of AMS ward rounds

• Antibiotic prescribing compliance was lower at FH compared to CMH, whilst the need for IPC interventions were higher

• Feedback of this data can be motivational for clinical teams and used to target educational resources more effectively

Acknowledgements

• Dr F Collett-White & colleagues• Improving Global Health Fellowship, Thames Valley and

Wessex Leadership Academy, United Kingdom• Clinical pharmacists (Y Wang, S Singh)• Medicine department clinicians• Infection Prevention Control dept. (L Tshaka & N Hangana)

Contact: dfstead@gmail.com