The Univeristy of Melbourne The Royal Melbourne Hopspital

A joint venture between The University of Melbourne and The Royal Melbourne Hospital

Celebrating Five Years of the Doherty Institute

Antimicrobial Resistance and Healthcare Associated Infections

Auditing antibiotic prescribing practices

2016 marked a turning point for surgical prophylaxis – the use of antibiotics prior to surgery to prevent infection – in Australia. Through the Hospital National Antimicrobial Prescribing Survey (NAPS), this practice was found to not only be the highest use of antibiotics in the country, but also consistently the most inappropriate every year since data collection started in 2013.

“It sparked the Australian Commission of Quality and Safety in Healthcare and Federal Department of Health to help fund a deep dive into surgical practices and the subsequent development of the Surgical NAPS - a dedicated surgical prophylaxis audit,” explains Dr Rod James, Director of Clinical Services for the Royal Melbourne Hospital’s Guidance Group.

The NAPS program is an annual survey that uses standardised auditing tools to assess the quality of antimicrobial prescribing practices and appropriateness across a variety of health care settings, including public and private hospitals and aged care facilities. It is also able to provide data on the quantity of prescriptions for antimicrobials for specific indications and by specialist admission type.

The NAPS program is a collaborative project between the National Centre for Antimicrobial Stewardship (NCAS) and the Guidance Group (Royal Melbourne Hospital), partnering with Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre and located at the Doherty Institute. The Australian Commission on Safety and Quality in Health Care (the Commission) and the Australian Government Department of Health provides funding for the NAPS program to contribute to the Antimicrobial Use and Resistance in Australia (AURA) Surveillance System.

To date, over half of all Australian hospitals have participated in the Hospital NAPS .

“It’s not just about hospitals providing data; as soon as they’ve entered the data, they have meaningful reports they can use to effect changes locally,” says Dr James.

“As more and more hospitals are coming on board, the data set is becoming larger and larger. With this big data, we’ll be able to see if the interventions we put in place are actually working.”

In 2016, a specific Aged Care NAPS survey was developed, which has been transformational in the aged care setting with almost a third of all Australian aged care homes having contributed data.

“Lots of people in aged care were being prescribed antibiotics in hospitals, or by their local general practitioner, but once they moved into an aged care facility, no one was monitoring their use or stopping them. Some were on antibiotics for years without providers knowing what they were being used for,” explains Dr James.

“The process of performing the audit allowed directed feedback to the prescribers and a reason to review these prescriptions, with the majority being ceased.”

In addition, NAPS has seen significant changes made to the Therapeutic Guidelines: Antibiotic, the recommended national guidelines.

Pilot NAPS are now underway for general practices and veterinary practices, and in the future, will possibly be rolled out in agriculture and dental settings. There are also plans underway to expand NAPS overseas, with New Zealand, Malaysia, Fiji, Bhutan and Canada in the process.

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