Optimising carbapenem use through a national quality improvement programme

Robson, Siân E. and Cockburn, Alison and Sneddon, Jacqueline and Mohana, Abdulrhman and Bennie, Marion and Mullen, Alexander B. and Malcolm, William and Armstrong, Jennifer and Patton, Andrea and Seaton, Ronald Andrew (2018) Optimising carbapenem use through a national quality improvement programme. Journal of Antimicrobial Chemotherapy, 73 (8). pp. 2223-2230. ISSN 0305-7453 (https://doi.org/10.1093/jac/dky171)

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Background: Concern about increasing carbapenem and piperacillin/tazobactam use led the Scottish Antimicrobial Prescribing Group (SAPG) to develop national guidance on optimal use of these agents, and to implement a quality improvement programme to assess the impact of guidance on practice. Objectives: To evaluate how SAPG guidance had been implemented by health boards, assess how this translated into clinical practice, and investigate clinicians’ views and behaviours about prescribing carbapenems and alternative agents. Methods: Local implementation of SAPG guidance was assessed using an online survey. A bespoke Point Prevalence Survey was used to evaluate prescribing. Clinicians’ experience of using carbapenems and alternatives was examined through semi-structured interviews. National prescribing data were analysed to assess the impact of the programme. Results: There were greater local restrictions for carbapenems than for piperacillin/tazobactam. Laboratory result suppression was inconsistent between boards and carbapenem sparing antibiotics were not widely available. Compliance with local guidelines was good for meropenem but lower for piperacillin/tazobactam. Indication for use was well documented but review/stop dates were poorly documented for both antibiotics. Decisions to prescribe a carbapenem were influenced by local guidelines and specialist advice. Many clinicians lacked confidence to de-escalate treatment. Use of both antibiotics decreased during the course of the programme. Conclusions: A multi-faceted quality improvement programme was used to gather intelligence, promote behaviour change and focus interventions on use of carbapenems and piperacillin/tazobactam. Use of these antimicrobials decreased during the programme; a trend not seen in Europe outwith the UK. The programme could be generalised to other antimicrobials.