National Antimicrobial Prescribing Survey
The National Antimicrobial Prescribing Survey (NAPS) is a standardised auditing tool that is designed to assist healthcare facilities to assess the quantity and quality of local antimicrobial prescribing. The development and implementation of the NAPS has been undertaken through an ongoing collaborative partnership between the National Centre for Antimicrobial Stewardship and the Australian Commission on Safety and Quality in Health Care since 2013. The NAPS was developed and is administered by the Guidance Group at the Royal Melbourne Hospital, and is a program partner in the Antimicrobial Usage and Resistance in Australia (AURA) Surveillance System. The Hospital NAPS is the flagship survey and commenced in 2011. Since then, the NAPS program has grown and diversified to provide a suite of auditing tools that support the antimicrobial stewardship (AMS) workforce and meet the geographical challenges of Australian hospitals. There are several modules available: Hospital NAPS, Surgical NAPS, Hospital-in-the-Home NAPS and the Quality Improvement NAPS, which have been developed for hospitals; and the Aged Care NAPS (in partnership with the VICNISS Coordinating Centre at the Royal Melbourne Hospital), which has been developed for residential aged care facilities. A General Practice NAPS is being piloted, and a Veterinary NAPS is in development. The NAPS has become an important tool for the implementation of the objectives of Australia’s National Antimicrobial Resistance Strategy, and for supporting the appropriate and judicious use of antimicrobials.
Surgical antibiotic prophylaxis was identified as the most common reason for antibiotics to be prescribed in tertiary hospitals in Australia in the NAPS performed in November 2013, and in subsequent iterations of the survey. The administration of surgical antibiotic prophylaxis is an important strategy for the prevention of 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. The Surgical NAPS program provides a more granular assessment of the appropriateness of antimicrobial prophylaxis prescribing in the surgical setting. A project within this stream focuses on surgical antimicrobial prophylaxis prescribing, using a mixed-methods approach to conceptualise factors contributing to inappropriate surgical antimicrobial prophylaxis prescribing rates. It is anticipated that by gaining further insight as to why surgical antimicrobial prophylaxis is inappropriately prescribed, more specific antimicrobial stewardship measures can be developed and implemented to improve this. Another project within this stream examines antifungal use and antifungal stewardship in tertiary hospitals, with a focus on the liver transplant setting.
Antibiotics are among the most common medications prescribed in general practice, but there is very little information available regarding the indications for use and the appropriateness of the antibiotic prescriptions. Additionally, very little is known about how GPs learn about antibiotics, and the perceptions and attitudes that shape their prescribing behaviour. This project focuses on antimicrobial stewardship in general practice. The aims of this project are to: analyse current antibiotic prescribing by GPs; review international general practice antimicrobial stewardship frameworks; consider the views of stakeholders regarding the barriers and enablers to AMS in general practice and their potential contribution to such a framework. To gain an insight into the patterns of antibiotic use and adherence to guidelines in general practice, this project will utilise the MAGNET research platform to analyse clinical data that has been extracted from the clinical records of patients attending general practices in the inner eastern region of Melbourne. The researchers will also conduct qualitative interviews with GPs to understand their workflows and the barriers and enablers to evidence-based prescribing of antibiotics. The findings from both the quantitative and qualitative studies will be used to inform the development of novel interventions that can guide GPs' decision-making around antibiotic prescribing and address the education needs of GPs to support their decision-making. NCAS is implementing a pilot GP NAPS survey to assess prescribing practices in this setting.
Research suggests that residential aged care facilities may be acting as a ‘reservoir and gateway’ for multi-drug resistant organism transmission (into hospitals and other parts of the general community). Thus, there is an urgent need to optimise the use of antimicrobials in this setting, given that inappropriate use of antimicrobials increases selection pressure for multi-drug-resistant organisms. This stream is geared towards optimising antimicrobial use in the residential aged care facilities setting, with a focus on implementing the Aged Care NAPS, a survey of antimicrobial use and infections in aged care homes and facilities in Australia. Research undertaken within this stream investigates the best ways of measuring antibiotic consumption in aged care facilities; interventions to improve antimicrobial prescribing in aged care facilities; and outcomes associated with these interventions. Researchers aim to improve the care of older people with respiratory tract infections in Australian residential aged care facilities with antimicrobial stewardship, and investigate the roles of nurses, and residents and their families in determining antibiotic use at the end of life.
Regional and remote care
Australia is a country in which a significant proportion of the community live in rural and regional centres. Often dedicated experts are not available locally to guide antimicrobial stewardship programs in those settings. Attention is needed to establish sustainable models of care for antimicrobial stewardship in rural Australian hospitals. This group will examine available data to interrogate the quality of prescribing in rural-vs-urban hospital settings. Qualitative research will be conducted to examine models of care by interviewing key informants from sites where innovative models have been established. The aim is to describe a comprehensive model for antimicrobial stewardship in rural hospitals. The impact of the program will be evaluated using mixed methods along the following parameters: uptake/utilisation, staff acceptance, and changes in drug consumption patterns and appropriateness of antibiotic prescriptions. It is likely that this work will also inform strategies to build capacity in antimicrobial stewardship amongst local staff in rural hospitals. Training for auditing and feedback, and provision of resources as part of a package of interventions will also be a focus.
Veterinary medicine – companion animals
While there is greater microbiological monitoring of infectious disease in companion animals as compared to farm animals, and data available within veterinary diagnostic laboratories on resistance patterns in a number of important indicator species, including Staphylococcus aureus, Staphylococcus pseud-intermedius and Escherichia coli, there is limited data available about usage patterns or the rationales behind antimicrobial usage. Through our research, we have been identifying factors driving antimicrobial prescribing in companion animal and equine practices, and have identified and designed strategies for future interventions, including improved prescribing guidelines and suitable mechanisms to ensure appropriate use; educational programs through continuing education courses; and, potentially, the incorporation of responsible prescribing into veterinary hospital accreditation programs.
Veterinary medicine – livestock
In Australia, livestock production systems differ markedly from intensive livestock practices internationally. Usage in animal production is generally restricted to specific registered classes of antimicrobials and administration is generally for restricted periods of time in relatively isolated populations of animals. In contrast, antimicrobial usage in companion animals (dogs, cats and horses) is across a wider range of classes, within less isolated populations and in animals in near constant contact with humans. The aim of our studies has been to gain a clear understanding of the volumes of antimicrobials administered to different food animals, the specific antimicrobials used in typical herds and flocks, and the distribution of this usage over the lifetime of these animals. The indications that serve as signals to prescribers have been explored to identify those that are justifiable and those that are questionable, as well as to identify health problems that might be the focus of alternative solutions. In addition, the rationales for specific choices of drugs have been assessed and analysed in relation to the evidence available to support this use. This has assisted in identifying gaps in evidence for different prescribing patterns that can be addressed to guide improved behaviour.
Professor Karin Thursky
(03) 9342 9404 | [email protected]
- Director of NCAS; Director of the Guidance Group; Deputy Director of Infectious Diseases (Peter MacCallum Cancer Centre)
- Antimicrobial Resistance and Healthcare Associated Infections
- Epidemiology, Global Health, Public Health, Translational and Clinical Research
- Victorian Infectious Diseases Service (VIDS), Department of Medicine
- Lab Group(s):
- National Centre for Antimicrobial Stewardship
Professor Karin Thursky is the Director of the National Centre for Antimicrobial Stewardship, the Deputy Head of Infectious Diseases at the Peter MacCallum Cancer Centre, and the Director of the Guidance Group at the Royal Melbourne Hospital. The National Centre for Antimicrobial Stewardship (NCAS) is a health services Centre of Research Excellence under the National Health and Medical Research Council that is taking a ‘one health’ approach to the challenges of optimising antimicrobial usage across both human and animal health. NCAS has a key role in the implementation of the National Antimicrobial Resistance Strategy. Karin is an infectious diseases physician and clinician-researcher whose research spans paediatric and adult medicine, immunocompromised patients, primary and secondary healthcare, and veterinary antimicrobial stewardship. She leads the implementation stream of the Centre of Research Excellence - National Centre for Infections in Cancer based at Peter Mac, undertaking the implementation of clinical pathways for sepsis, neutropenic fever and antibiotic allergy management. She is a national leader and recognised international expert on the design and implementation of antimicrobial stewardship programs, with expertise in the use of information technology for antimicrobial stewardship and more broadly in healthcare. Karin has active roles with the Australian Commission of Safety and Quality in Healthcare as an expert advisor for the Antimicrobial Usage and Resistance in Australia program, and the antimicrobial stewardship advisory group.