Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Li CM (1), Ho HY (1), Mung MK (1), Tsang RCS (2), Yu PS (1), Chow KM (1), Lui GCY (1)
Affiliation :
(1) Department of Medicine & Therapeutics, Prince of Wales Hospital
(2) Department of Pharmacy, Prince of Wales Hospital
Introduction :
Excessive use of antibiotics fuels the threat of antimicrobial resistance, and induces unnecessary hospital stay and healthcare costs. We have witnessed exponential rise in broad-spectrum antibiotic consumption over the past decade in Hospital Authority hospitals. Antibiotic stewardship programme (ASP) is a key measure for reducing unnecessary prescriptions. Shortening duration of intravenous antibiotics and adopting oral-switch strategy can also reduce hospital length of stay.
Objectives :
1) To optimize the use of broad-spectrum antibiotics of medical in-patients through prospective audit and feedback
2) To reduce unnecessary hospitalization (both acute and convalescent) through ASP measures including early cessation of antibiotics, intravenous-to-oral switch and out-patient parenteral antimicrobial therapy (OPAT)
Methodology :
The enhanced ASP program covered in-patients of the Department of Medicine & Therapeutics of Prince of Wales Hospital. Three target groups included: 1) patients on piperacillin-tazobactam or meropenem; 2) referral to convalescent hospital for continuation of antibiotics; and 3) referral for OPAT. Corresponding patient lists were provided by pharmacists. Prospective audit and feedback of eligible patients was done daily on weekdays by ASP team, which comprised 3 infectious disease (ID) specialists and 1 infectious disease nurse. Protected time was granted to the ID specialists. Recommendations on antibiotics choice (including cessation and oral switch), and cancellation of convalescent hospital referral were recorded.
Result & Outcome :
Results
A total of 1742 patients were assessed from October to December 2023 (1227 patients on piperacillin-tazobactam or meropenem; 287 convalescent hospital referrals; 228 OPAT referrals). Recommendations on antibiotics use were provided for 499 (28.6%) patients: 179 (10.3%) antibiotic cessations and 320 (18.3%) antibiotics changes, of which 133 (41.6%) involved intravenous-to-oral switch. Majority (72.2%) of piperacillin-tazobactam and meropenem were stopped because of lack of clinical evidence of infection or having received adequate duration of therapy. Among the 44 patients referred to convalescent hospital whose intravenous antibiotic treatment were stopped, referral was cancelled for 17 (38.6%) patients. Early discharge with OPAT were arranged for 30 patients who altogether received 219 days of antibiotics as out-patients.
Conclusion
Dedicated ASP is an effective means in optimizing the use of broad-spectrum antibiotics and facilitating early discharge from hospital.
