Antimicrobial Stewardship - No Action Today! No Cure Tomorrow!!

Introduction
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobial (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multi-drug-resistant organisms.

• The team members were identified from the various departments that practices and regulates antibiotics and its use such as clinicians, microbiologist, clinical pharmacist, infection control nurse and director – quality.
• The team members were identified from the various departments that practices and regulates antibiotics and its use such as clinicians, microbiologist, clinical pharmacist, infection control nurse and director – quality.

Problem Definition
Antibiotic resistance is one of the major threats to human health, especially because some bacteria have developed resistance to all known classes of antibiotics. Diseases caused by these bacteria are increasing in long term care facilities and contributing to higher rates of because some bacteria have developed resistance to all

Problem Diagnosis
100 cases were evaluated (define phase) to find out the major factors effecting stewardship

• These were identified mainly as wrong use/selection of antibiotics, unjustified usage of higher
  end antibiotics, non- adherence to local guidelines for prophylactic antibiotics.
• A total of eight interventions were made in this phase to minimize the errors in selected study
  population.
• As a result of this phase the areas to concentrate on were identified so as to improve the
  significance of the study.
• This define phase (Phase I) lead to the collection of data for the measure phase (Phase II) in
  which a sample size of 400 was selected in order to distribute the data collected in the measure
  Phase

Problem Remedy
In this the root causes for each error were identified from the initial potential causes.
Ishikawa (fish bone) diagram were used to depict the root causes for each error
Standard guidelines errors, Follow up errors,Improper usage errors, Prescribing errors are the identified problems, remedies for each are analyzed. Pls refer attachment.

Locking the Improvement
- Local antibiotic policy induction classes
- Education of nurses on ASP
- Introduction of lab audits on culture samples requested
- Strengthened surgical prophylaxis audit Strengthened treatment policies adherence
- Improvised documentation on antibiotic selection in case sheets
- Development of local guidelines
- Medication history collection

Cloning the Improvement
The number of improper usage errors (6), with DPMO level (3750), Sigma level (4.20). The number of prescribing (18), with DPMO (11250), and Sigma level (3.80).

Tangible Results

1. Adherence to the standard protocols
2. Best clinical outcome
3. Selection of antibiotics based on cultures
4. Collection and transportation of culture samples on time
5. Switching to IV/Oral therapy
6. Control use of higher end antibiotics
7. Selection of antibiotics based on disease status
8. Reduction in communication errors

Intangible Results

1. Reduction in mortality rate
2. Reduction in resistance rate of antibiotics