Tertiary Hospitals stream

Surgical antibiotic prophylaxis was identified as the most common reason for antibiotics to be prescribed in tertiary hospitals in Australia during the National Antimicrobial Prescribing Survey (NAPS) performed in November 2013 (Unpublished data NAPS 2013). Surgical antibiotic prophylaxis is an important strategy to prevent surgical site infections however, in the 2013 NAPS survey, ~50% of surgical antibiotic prophylaxis use was inappropriate, particularly because of prolonged duration or inappropriate agent selection.

National and international surgical antibiotic prophylaxis guidelines may not reflect the local ecology of organisms associated with surgical site infections. Currently, there is a national strategy for the development of a national AMR surveillance in Australia being led by the Australian Commission on Safety and Quality in Health Care. We plan to use data coming from this program, linking data on antimicrobial resistance with antimicrobial consumption, which will improve the understanding of the local epidemiology of antimicrobial resistance and inform guideline development.

At the end of this project we expect to have empowered hospitals to critically assess the use of antibiotics for the most common surgical conditions. We will have identified and tested generalisable strategies to improve prescribing in the identified high volume and high-risk problem surgical areas.

Regional & Remote Hospitals stream

Regional and remote based hospitals face major challenges with developing and implementing antimicrobial stewardship because of differences in patient mix, workforce and existing service delivery structures. Antimicrobial stewardship in smaller Australian hospitals is in its infancy. The institutions rely on affiliations with larger metropolitan hospitals for antimicrobial prescribing advice.

As part of the NCAS CRE, the investigators will test models for antimicrobial stewardship in regional and remote hospitals. The models will be adapted to suit the sites but it is intended that Telehealth links to a tertiary hospital will be used to provide regular contact for individualised post prescription review, in addition to a computerised approval system for nominated restricted medicines, structured education and regular audit and feedback. New modules of Guidance have been developed to further improve documentation and communication of advice, and these are likely to assist in Telehealth consultations. The activity of the antimicrobial stewardship service will be measured in addition to nature of their interventions. The impact on prescribing behaviour will be measured using the National Antimicrobial Prescribing Survey tool and the acceptability of the service will be evaluated.

At the conclusion of the projects proposed, we will have identified and tested interventions to improve antimicrobial prescribing that are feasible and translatable from large hospitals to rural and regional sites with limited resources.

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