Antimicrobial Stewardship
Conditions
Keywords
Critical care, Antimicrobial Stewardship, Implementation, Quality improvement, Low or Middle Income Country (LMIC)
Brief summary
The goal of this observational study is to learn about the implementation of a process to review antimicrobial prescriptions for adult patients in Intensive Care Unit (ICU). The main question it aims to answer is: can a structured antimicrobial review can be implemented in ICUs? Implementation will be supported by the use of local protocols, audit and feedback, and education. It will be evaluated by daily data collection of clinical processes and interviews with local champions. Resources to conduct the study are provided by the Wellcome Flagship Innovations award. (Collaboration for Research, Implementation and Training in Critical Care in Asia and Africa, reference 224048/Z/21/Z).
Interventions
BEHAVIORALStructured antimicrobial review
The appropriateness of the documented indication, route of administration, expected duration and stop date of all antimicrobials will be reviewed within 48 hours of their prescription.
Sponsors
Nat Intensive Care Surveillence-MORU
University of Oxford
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* All adult ICUs within CCAA-affiliated Care Quality Registries * ICUs must appoint a named Champion to facilitate implementation * All antimicrobial prescriptions for adult patients within the ICUs described above
Exclusion criteria
• ICU's which demonstrate adoption and reach of 80% or greater (median over 2 months) of a pre-existing structured antimicrobial review
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Fidelity | Evaluated over calendar month periods during months 4-6 (i.e. the three months immediately following implementation) | The proportion of prescriptions reviewed as intended (reviewed within 48hours with documentation of all 4 review components: indication, route, duration, stop date). Reported as a proportion of the number of possible reviews. |
| Reach | Evaluated over calendar month periods during months 4-6 (i.e. the three months immediately following implementation) | Proportion of eligible patients who receive a review |
| Adoption | Evaluated over the calendar month period of month 7 | Proportion of prescriptions reviewed as intended once implementation support has been withdrawn |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Antimicrobial resistance rate | Evaluated over calendar month periods during months 1-7 of the study | Number of multidrug-resistant pathogens (as specified by WHO priority list) / number of patients |
| Antimicrobial Density (AD) | Evaluated over calendar month periods during months 1-7 of the study. | Defined Daily Dose / 1000 patient-days. This measure of antimicrobial consumption will compare prescribed daily doses of antimicrobials to those specified by the World Health Organization (WHO) (Anatomical Therapeutic Classification (ATC) J01 Defined Daily Doses). To correct for ICU unit size the investigators will standardise by number of admitted patient-days during that month in that ICU. |
| Antimicrobial prescribing rate | Evaluated over calendar month periods during months 1-7 of the study | Number of patients receiving at least 1 antimicrobial / number of patients admitted to ICU in the same period |
| Duration of Therapy | Evaluated over calendar month periods during months 1-7 of the study | Number of Days of antimicrobial Therapy / 1000 patient-days Analysed at the ICU level |
| Antimicrobial Redundancy Rate | Evaluated over calendar month periods during months 1-7 of the study | Days of Therapy of prespecified redundant combinations of antimicrobials. Analysed at the ICU level. |
Contacts
Primary ContactDuncan Wagstaff, PhD
Backup ContactArjen Dondorp, Prof
Outcome results
None listed