Antimicrobial stewardship: 8d-The proportion of patients who were prescribed prolonged antimicrobials following a surgery or procedure that is discordant with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines

The numerator and denominator exclude patients undergoing surgery or a procedure for which there are no documented guidelines for the administration of prophylactic antimicrobials or where prophylaxis is not indicated due to the patient’s current antimicrobial therapy. The numerator and denominator also exclude patients who have not received antimicrobials perioperatively.

Presented as a percentage.

(Numerator ÷ Denominator) x 100​

Number of patients who receive prophylactic antimicrobial prior to surgery or a procedure whose antimicrobial is continued following surgery against recommendations in the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines.

Number of patients undergoing surgery or a procedure for which there are documented guidelines on the use of prophylactic antimicrobials.

As per the Antimicrobial Stewardship Clinical Care Standard (ACSQHC 2020), the term ‘locally endorsed guidelines’ should meet the following specific requirements:  

Therapeutic Guidelines: Antibiotic provides national, evidence-based guidelines for antimicrobial use in Australia. However, in some cases, evidence-based and formally endorsed local adaptations may be more relevant to local patterns of antimicrobial resistance or specific patient populations requiring a localised approach or with highly specialised diagnoses out of the scope of Therapeutic Guidelines. Ensure that local adaptations of guidelines are based on Therapeutic Guidelines and, where they deviate, a clear rationale based on published clinical evidence and local epidemiology is documented and endorsed by a governing body. Endorsing bodies may include peer review at a drug and therapeutics, antimicrobial stewardship or medicines advisory committee, or equivalent.

See the Antimicrobial Stewardship Clinical Care Standard (ACSQHC 2020) for key considerations to optimise the use of antimicrobials in surgical prophylaxis.

Services may select specific procedures to focus on as part of the audit process, based on their mix of patients and priorities.

N[NN]

Applicable settings:

All hospital settings, including public and private hospitals, subacute facilities, outpatient and day procedure services

General practice and other community and primary healthcare settings such as Hospital in the Home, Aboriginal community controlled health services, dental practices and community pharmacies

Residential aged care services.

Australian Commission on Safety and Quality in Health Care. Antimicrobial Stewardship Clinical Care Standard. Sydney: ACSQHC; 2020.