Using National Antimicrobial Usage Surveillance Program (NAUSP) data to monitor improvements in surgical antimicrobial prophylaxis prescribing: Determining a quality improvement target for local interventions.

Dr  Kathryn Daveson1, Ms Alexandra Marmor1

1The Canberra Hospital, Garran, Australia

Background:

Surgical antimicrobial prophylaxis (SAP) is a focus for quality improvement for Australian healthcare.  Available tools for SAP surveillance include the labour-intensive Surgical National Antimicrobial Prescribing Survey (SNAPS).  Most cefazolin use is for SAP and is captured by the National Antimicrobial Usage Surveillance Program (NAUSP). We aimed to determine if NAUSP data could be used to monitor appropriate ward cephazolin prescribing.

Methods:

We conducted a four-week audit of ward prescribing data extracted from the electronic medication management (EMM) system to estimate the proportion of cefazolin used for SAP and compliance with the current Therapeutic Guidelines. We calculated the Pearson’s correlation coefficient for the monthly defined daily doses (DDD) administered (calculated from EMM prescription data) and dispensed (from non-ICU NAUSP surveillance data).  A quality improvement target was modelled based on a 50% improvement in the guideline compliance of cephazolin used for postoperative SAP.

Results:

Fifty-five percent of cephazolin administered was for SAP, and none of this was compliant with guidelines. There was a strong correlation between monthly DDDs of cephazolin measured by NAUSP and EMM (r=0.68, p=0.03).  As an estimated 38% of NAUSP usage was for postoperative SAP, an effective quality improvement intervention to improve guideline compliance by 50% would lead to a 19% reduction in NAUSP DDDs.

Conclusion:

NAUSP data may be useful for monitoring SAP quality improvement interventions, in conjunction with less frequent SNAPS or EMM audits.  We set a quality improvement target of a 10% (average 235 DDD/month) reduction in total hospital use within 6 months.


Biography:

Kathryn Daveson is an infectious diseases physician practicing in two Australian jurisdictions, ACT and Qld Health. She is the current acting Director of the Queensland Statewide Antimicrobial Stewardship Program, a program overseeing the use of antibiotics across the state, servicing from the tip of the Cape to the Southern Qld border, and works locally in the ACT as a infectious diseases clinician in a 750 bed principal referral hospital including running the local antimicrobial stewardship program.

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