106-603 / Institutional Program for the Optimization of Antimicrobial Treatment (PRIOAM)

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GOP Information
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Directorade of Quality, Research, Development and Innovation
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Topic
Quality improvement project
Category
Infection control / Prevention of surgical site infections
Assessment of risk and harm
GOP Description
Implementation level
Regional
Clinical settings
Andalusian Public Health System Hospitals
Objectives
1. Optimize the use of antimicrobials in the hospital.
2. Reduce mortality of patients with severe infections.
3. Reduce morbidity of patients with severe infections.
4. Reducing bacterial resistance.
5. Reduce economic costs.
Population
program directed towards all antibiotic prescribers of Andalusian Public Health System
Methods
Methodology
Design and implementation:
Step 1: Institutional agreements
Step 2: Constitution of a multidisciplinary operations team
Step 3: Elaboration of local guidelines
Step 4: PRIOAM implementation
Step 5: The main activity of the program consists on a training program directed towards all antibiotic prescribers of the center based on counselling interviews
Step 6: Improvement of antimicrobial prescription.
Timeframe implementation
The program began in January 2011, implementation in 3 years
Implementation tools available
Guidelines, training program, PRIOAM advvisors
Implementation cost
Staff required: 1 post-doctoral researcher …………………… 27.000 €
2-years contract as a part-time job.
– Office supplies (including 1 personal computer) ……….…. 900 €
– Dissemination of the results ……………………………………… 3.700 €
One international congress and one national congress, travel costs included.TOTAL: 31.600 €
Results
Method used to measure the results
The main activity of the program consists of a training program directed towards all antibiotic prescribers of the centre based on counselling interviews (CI) which will be held by experts on infectious diseases from the centre face-to-face with antibiotic prescribers.

1st year end-points: Improvement of antimicrobial prescription and reduction in antibiotic consumption.
It was considered to be achieved, if a significant increase in CI marks was recorded by the 4th trimester after the implementation of the ASP. Evaluations were performed not only for overall CI, but also specifically in each clinical department. The trend in overall and specific antimicrobial consumption, measured as number of DDD/1000 occupied bed-days, werealso assessed during the same period.

2nd year end-points: clinical and ecological impact of the program.
Data on antibiotic resistance, as well as morbidity and mortality related to severe infections will be prospectively recorded. By the end of the second year, the sample size and the time elapsed is expected to be appropriate to make such comparison. The aforementioned end-points include influence on mortality-morbidity related to severe infections and bacterial resistance, as well as its impact on economic costs.

Results
1006000€ saved in a year in the pilot Hospital
Analysis of the results
Our results demonstrate significant benefits of PRIOAM, an institutional, education-based ASP 12 months after its implementation. The rate of appropriate treatments was improved by 30%, whilst antimicrobial consumption was decreased by 26% and acceptance among clinicians of the centre was excellent.

These data have proven that an educational program with an institutional basis can be as effective as direct-control interventions. The rate of appropriate treatments by the end of the first year was superior to 75%, results that are similar to those published for other audit-based programs.

Our program also achieved an important decrease in all-class antimicrobial consumption by 26%. At the end of 2011, this consumption was recorded to be 874.2 DDD/1000 bed-days. This rate of consumption places our hospital near the average of other tertiary Spanish hospitals in 2009, reported to be 864 DDD. This result is in favour of our center, considering our noticeably higher number of ICU beds (90 beds vs. a mean of 28 ICU beds in other centers) and the especially active transplantation program.

This reduction has not been achieved through restrictive measures targeted towards specific antibiotics, but through the training of clinicians in the sensitive use of antimicrobials. Its pedagogic approach has been the key to the program’s success and its excellent level of acceptance among interviewed clinicians.

Finally, there are novel elements incorporated by this program ensuring its sustainability, e.g. its transversal design, the involvementof clinicians from all departments, the low extra-burden of work required to implicate the proposed pedagogic methodology in daily clinical practice, and the strong institutional support, which has linked the program consecution to economic incentives.

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