A quality improvement programme to increase compliance with an anti-infective prescribing policy

• Published in: Journal of antimicrobial chemotherapy Vol. 66; no. 8; pp. 1916 - 1920
• Main Authors: Thakkar, Kandarp, Gilchrist, Mark, Dickinson, Edward, Benn, Jonathan, Franklin, Bryony Dean, Jacklin, Ann
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.08.2011; Oxford Publishing Limited (England)
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents - therapeutic use; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Compliance; Drug Utilization - standards; Female; Guideline Adherence - standards; Health care policy; Health Policy; Humans; Male; Medical sciences; Middle Aged; Original Research; Pharmacology. Drug treatments; Prescriptions; Quality Improvement; Quality of care; United Kingdom; Young Adult; United Kingdom > UK; QIP; prescribing; antibiotic stewardship; anti-infectives; Antibiotic; Health policy; Compliance; Medical prescription; Quality; Antiinfectious; Antibacterial agent; Public health
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkr207

Objectives The UK Department of Health has made recommendations on safe and appropriate prescribing of anti-infectives. In response, we reviewed our anti-infective policies to ensure they were in line with best practice. As a result, a new adult anti-infective policy was launched. To help facilitate its implementation, a quality improvement programme was established, with the aim of achieving >90% compliance with the new policy. Methods Patients under the care of the medical admissions teams who had been prescribed one or more systemic anti-infectives between January and November 2008 were included in the study. Study pharmacists collected data daily on all patients, including the anti-infective(s) prescribed and indication(s) documented on either the patient's drug prescription chart or health records. A definition of compliance was developed, which required documented indication(s) and associated anti-infectives to match the anti-infective policy. A baseline compliance level was established; we then implemented a series of interventions using the plan-do-study-act ('PDSA') approach to monitor and improve compliance. Three overlapping intervention phases were retrospectively identified: raising awareness; education; and weekly feedback of results in the form of run charts distributed to medical teams. Results Over the 11 month study period, compliance with the policy increased from 30% to 71%. Since 2008, we have seen the average compliance increase year-on-year to over 90% in 2010 using a sustainable once weekly data collection model. Conclusions This study shows that it is possible to use quality improvement methodology to support antimicrobial stewardship within existing resources and suggests that an improvement in policy compliance can be both achieved and sustained.