PERFORMING AUDIT ON THE USAGE OF RESTRICTED DRUGS IN ANTIBIOTIC POLICY WITH HELP OF RAPID CYCLE ANALYSIS AND SUGGESTING CORRECTIVE AND PREVENTIVE ACTIONS
SUBMITTED BY – DIVYA DIKSHIT (TISS –M2017HO052 )
UNDER GUIDANCE OF?
Mr. Abhishek Sawant (Manager Quality Management )
Dr. Rahul S Kamble (Infection control officer)
LITRATURE REVIEW- 2
STATEMENT OF PROBLEM- 4
OBJECTIVE – 4
1. Overview of the department functions 4
2. Procedures – 4
RAPID CYCLE ANALYSIS 5
SPECE- FACTORS 6
1.GAP Analysis 7
2. Analysis of the data – 7
ANALYSING THE COMPLIANCES – 9
COMPLIANCE WITH THE SECTIONS OF ANTIBIOTIC POLICY- 12
The DDD utilisation Data 14
CORRECTIVE AND PREVENTIVE ACTION- 17
ANNEXURE – 1 22
Antibiotic resistance is matter of concern to healthcare service providers .Antibiotics are essential for serious infections and an important discovery for medical science. However administration of antibiotics may lead to antibiotics resistant organisms leading to increased morbidity and mortality. Hence the benchmarking guidelines e.g. NABH always emphasis on the review of the antibiotic policies over period of time . This is to minimize the risk of health-associated infections. To achieve an effective result of audit of the antibiotic policy, approach was adopted to study “restricted antibiotics” . A retrospective study was done with samples collection which was guided by ICD codes. A total of 120 samples were assessed which was 20% of total data of 699 cases with probability of using restricted antibiotic. A three way approach adoption was suggested with Rapid cycle analysis of clinical case data from Medical Records Department, DDD utilization data from pharmacy department, and third, which was not implemented due to permission issues , sending out Google forms to clinical staff to get understanding of clarity of policy to staff .The purpose of this study is to understand the factors acting in the implementation of an antibiotic policy , create a method to conduct antibiotic audit of current antibiotic policy and suggesting the changes required. The current antibiotic policy of Lilavati Hospital emphasizes describing procedures to encourage the use of antibiotic guidelines and to ensure that antibiotics are not prescribed in a way which is likely to lead to health associated in infections. The policy deals with processes by which recommendations for specific antibiotic treatment are made and procedures to support these recommendations.
What is antibiotic policy-
The basic purpose of antibiotic policy is to provide guidelines on usage of antibiotic as to which antibiotics may be frequently used, or occasionally used depending upon the clinical guidelines
One of the aim of antibiotic policy is to investigate the influence of “reserve antibiotic” on antimicrobial utilization. Antibiotic formulary restrictions are among the most popular methods to control anti- biotic utilization in hospitals. Restriction of usage of some antibacterial agents is a successful method to decrease antibiotic consumption and a way to bring cost savings and helps prevent emergence of resistant microorganisms in hospitals. 2 Antibiotic policy limits the emergence of resistant microorganisms. Antibiotic policy guides on the effectiveness of the newly produced antibiotics and broad spectrum antibiotics too The antibiotic policy making should include microbiologist, pharmacist , pathologists, Doctors, Nursing staff , and infection committee members from administration7
Methods of antibiotic policy audits-
1.The resistance and antibiotic policy may be recorded by predictor variable .These may be recorded to monitor the various factors influencing resistance prevalence .The amount of different microbial drugs used by period must be measured. (DDD) daily defined dose OR Average local daily administration(DDD)PER 100 Patient days may be monitored1
2.Segmented regression analysis of pharmacy stock data is a simple, practical and robust method for measuring the impact of interventions to change prescribing. The Alert Antibiotic Monitoring intervention was associated with significant decreases in total use and cost in the 2 years after the program was implemented. In our hospital, the value of the data far exceeded the cost of processing and analysis.13
3.Design of the Alert Antibiotic Intervention to monitor the changing professional behavior in the EPOC (Effective Practice and Organization of Care) 13
4. As per following guidelines should be used 1. Use standards 2.Generate reliable numerator 3.Express resistance as incidence rate
whys it needed- The monitoring of hospital antibiotic resistance may be judged by antibiogram. The effects of an antibiotic policy is shown in the wards of the hospitals by reduced antibiotic resistance . 1
Antibiotic policy – India-Antibiotic resistance, a global concern, is particularly pressing in developing nations, including India, where the burden of infectious disease is high and healthcare spending is low.
Their are research papers showing long and short term action plans which are documented in antibiotic policy 8.
Internationally-?In studies conducted in Ireland ,the evaluation objectives were to determine the effect of the policy on the annual antibiotic use and expenditure, the prescribing patterns for anti- biotic drugs, the total number of different antimicrobial agents used within the hospital, and to examine prescribers’ attitudes to the use of the antibiotic policy within their wards . There were studies done over a long period of time of 11 years. It was shown with years that reduction in unnecessary prescription was reduced with time ,if there was an antibiotic policy in place11.
Dutch association of chest observed and promoted the test supported , specific microorganism empirical treatment which was supported by antibiotic policy.4In Europe there have been studies done to audit antibiotic usage by European Surveillance of Antimicrobial Consumption (ESAC-tool)10
Hospital level guidelines-
– A committee should be maintained to make , monitor and improvise the antibiotic policy.
– Also a guideline of flowchart and graphical depictions if supported brings better implementations
– To establish Antimicrobial stewardship which refers to the multifaceted approach (including policies, guidelines, surveillance, prevalence reports, education and audit of practice) that healthcare organizations have adopted to optimize prescribing9
To achieve Goals of antibiotic policy should be clear-
-.Policy should be reviewed by experienced peers who are not the members of the policy development group. Policy is not static. It is a living document. Hospital versus national antibiotic policy comparisons should be made. To make prudent antibiotic management an integral part of the behavior of all healthcare professionals and to bring about quality improvement it is necessary to adopt a whole-system approach. To do this it is necessary first to understand the factors that influence antibiotic management and prescribing. this may be done through Antibiotic stewardship which may give a Whole-system approach to optimizing antibiotic use 9.
STATEMENT OF PROBLEM-
The antibiotic policy has been implemented in Lilavati as per rules and requirements, which has been continued without changes requirement felt in years 2013 ; 2014 . There were some review and changes implemented in 2015 ;2016 . The compliance of restricted drugs is critical and effective method to check effective compliance of antibiotic policy. The audit would be hence performed on the restricted drugs compliance with antibiotic policy.
1. To explore factors that determine requirement of antibiotic policy and regulation.
2. To assess the compliance of the restricted drugs usage with the existing antibiotic policy.
3. To understand and establish corrective changes that are required in the policy.
The Methodology was based on the literature review mentioned in the references . The audit was performed on perceived GAPS found , by a multi approach of Rapid cycle analysis , Utilization DDD Indicator ,. The personalized questionnaire were a suggestion made but were not utilized due to permission constraints.
1. Overview of the department functions
– The antibiotic policy overviews all the clinical departmental guidelines for medicine prescriptions .The key departments for formulating the Antibiotic policy is with the-
– Clinical departments – Patient flow and Medication prescribed in guidance with Cumulative antibiogram .
– Infection control committee
– Pathology department – for understanding of antibiogram.
– Pharmacy department – for estimates on dispatch of restricted medicines.
2. Procedures –
– The Quality Improvement department provided a briefing on policy.
– The infection control officer gave guidelines and other data available on dispatch of restricted medicines.
– Selection of sample on grounds of ICD 10 coding was adopted by guidance.
– The data was retrieved from the Medical records department.
– Data collection
• The purposive random sampling was conducted, with samples selected on grounds of ICD 10 coding
• Every 5th sample was collected
• 120 Samples were assessed (20% of total sample size attained from ICD CODE samples collected.
– Analysis of compliance of data with antibiotic policy done with help of ICD code samples + case data detailed analysis + drugs prescribed and its empirical relation.
– cases graded as compliant or non compliant.