Advertisement

International Journal of Clinical Pharmacy

, Volume 36, Issue 2, pp 377–383 | Cite as

A cross-sectional survey of the profile and activities of Antimicrobial Management Teams in Irish Hospitals

  • Aoife FlemingEmail author
  • Antonella Tonna
  • Sile O’Connor
  • Stephen Byrne
  • Derek Stewart
Research Article

Abstract

Background Surveillance of antimicrobial prescribing, in order to control the increase in antimicrobial resistance, is recommended by the Guidelines for Antimicrobial Stewardship in Hospitals in Ireland. Objective The objective of the study is to determine the profile and activities of Antimicrobial Management Teams (AMTs) in Irish Hospitals by surveying hospital pharmacists. Setting: Hospitals in Ireland. Method A self-completion postal questionnaire was developed from a recent study conducted by members of the authoring team in the United Kingdom, adapted for the Irish context. It was issued to all hospitals in Ireland (n = 70). Differences in responses, using Pearson’s Chi squared tests, were evaluated between public and private hospitals to determine whether the funding category had an effect on activities. Main outcome measures: (1) A profile of AMTs in Ireland. (2) The presence and content of antimicrobial prescribing policies and how adherence to the policies is measured. Results The response rate was 73 % (n = 51, 71 % public). 57 % (29/51) of hospitals have an antimicrobial management team in place with 93 % (27/29) having a Consultant Medical Microbiologist, 24 % (7/29) having a Consultant in Infectious Diseases and 69 % (20/29) having an Antimicrobial Pharmacist. There is an antimicrobial prescribing policy in place in 88 % (45/51) of hospitals responding. 80 % (36/51) of replies report that the volume of antibiotics prescribed is monitored, 47 % (24/51) conduct audits to measure appropriateness of all antibiotics prescribed and 43 % (22/51) conduct audits of appropriate prescribing of restricted antibiotics. Public hospitals were significantly more likely than private hospitals to review the volume of antibiotics prescribed (p = 0.021) and to audit the appropriateness of restricted antibiotics use (p = 0.003). A lack of resources was reported as the main barrier to antimicrobial surveillance by hospital pharmacists. Conclusion Around half of Irish hospitals do not have an antimicrobial management team in place but most hospitals have an antimicrobial prescribing policy. Most AMTs have representation by Consultants and Pharmacists, but audit and feedback of antibiotic prescribing activities is limited. Significant differences in audit activities were found between public and private hospitals, with private hospitals performing less well.

Keywords

Antibiotics Antibiotic prescribing Antimicrobial Management Teams Antimicrobial stewardship Hospital pharmacy Inappropriate antibiotic prescribing Ireland Survey 

Notes

Acknowledgements

The authoring team would like to acknowledge the participation of all respondents to the survey.

Funding

The first author is funded by the Health Research Board in Ireland under the Scholars Programme in Health Services Research Grant No. PHD/2007/16.

Conflicts of interest

There are no conflicts of interest to declare.

References

  1. 1.
    Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, et al. Infectious diseases society of America and the society for healthcare epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis Off Publ Infect Dis Soc Am. 2007;44(2):159–77.CrossRefGoogle Scholar
  2. 2.
    Society for Healthcare Epidemiology of America (SHEA), The Infectious Diseases Society of America (IDSA), The Pediatric Infectious Diseases Society (PIDS). Policy statement on antimicrobial stewardship. Infect Control Hosp Epidemiol. 2012;33(4):322–7. doi: 10.1086/665010.CrossRefGoogle Scholar
  3. 3.
    SARI Hospital antimicrobial stewardship working group. Guidelines for antimicrobial stewardship in hospitals in Ireland[serial on the Internet]. 2009: Available from: http://www.hpsc.ie/hpsc/A-Z/MicrobiologyAntimicrobialResistance/InfectionControlandHAI/Guidelines/File,4116,en.pdf.
  4. 4.
    Working party of the British Society for Antimicrobial Chemotherapy. Hospital antibiotic control measures in the UK. Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother. 1994;34(1):21–42.CrossRefGoogle Scholar
  5. 5.
    Health Information and Quality Authority. National Standards for the Prevention and Control of Healthcare Associated Infection.[serial on the Internet]. 2009: Available from: http://www.hiqa.ie/system/files/National_Standards_Prevention_Control_Infections.pdf.
  6. 6.
    Davey P, Brown E, Charani E, Fenelon L, Gould IM, Holmes A, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database of Systematic Reviews, 2013; 4 doi  10.1002/14651858.CD003543.pub3.
  7. 7.
    Broex E, Catry B, Latour K, Mertens K, Vankerckhoven V, Muller A, et al. Parenteral versus Oral Administration of Systemic Antimicrobials in European Nursing Homes A Point-Prevalence Survey. Drugs & aging. [Article], 2011; 28(10): 809-18.Google Scholar
  8. 8.
    Zarb P, Amadeo B, Muller A, Drapier N, Vankerckhoven V, Davey P, et al. Identification of targets for quality improvement in antimicrobial prescribing: the web-based ESAC Point Prevalence Survey 2009. J Antimicrob Chemother. 2011;66(2):443–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Tonna AP, Stewart D, West B, Gould I, McCaig D. Antimicrobial optimisation in secondary care: the pharmacist as part of a multidisciplinary antimicrobial programme–a literature review. Int J Antimicrob Agents. 2008;31(6):511–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Peat J, Barton B. Medical Statistics: a guide to data analysis and critical appraisal. Malden: Blackwell Publishing; 2005.CrossRefGoogle Scholar
  11. 11.
    Richie J, Lewis J. Qualitative research practice a guide for social science students and researchers. London: Sage Publications; 2008.Google Scholar
  12. 12.
    Institute for Healthcare Improvement. Raising the bar with bundles: treating patients with an all-or-nothing standard. 2006: Available from: www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Literature/RaisingtheBarwithBundles.htm.
  13. 13.
    Doron S, Nadkarni L, Lyn Price L, Kenneth Lawrence P, Davidson LE, Evans J, et al. A nationwide survey of antimicrobial stewardship practices. Clin Ther, 2013; 35(6): 758-65 e20 doi  10.1016/j.clinthera.2013.05.013.
  14. 14.
    Irish Antimicrobial Pharmacists Group. The impact of Antimicrobial Pharmacists in Irish Hospitals: a survey of acute hospitals. 2010.Google Scholar
  15. 15.
    Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, 2012; 6 doi  10.1002/14651858.CD000259.pub3.
  16. 16.
    Kaki R, Elligsen M, Walker S, Simor A, Palmay L, Daneman N. Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother. 2011;66(6):1223–30. doi: 10.1093/jac/dkr137.PubMedCrossRefGoogle Scholar
  17. 17.
    Von Gunten V, Reymond JP, Beney J. Clinical and economic outcomes of pharmaceutical services related to antibiotic use: a literature review. Pharm World Sci. 2007;29(3):146–63. doi: 10.1007/s11096-006-9042-6.Google Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Aoife Fleming
    • 1
    Email author
  • Antonella Tonna
    • 1
    • 2
  • Sile O’Connor
    • 1
    • 3
  • Stephen Byrne
    • 1
  • Derek Stewart
    • 2
  1. 1.School of PharmacyUniversity College CorkCorkIreland
  2. 2.School of Pharmacy and Life SciencesRobert Gordon UniversityAberdeenScotland
  3. 3.Pharmacy DepartmentBon Secours HospitalTralee, Co.KerryIreland

Personalised recommendations