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Antimicrobial stewardship: 8a-The proportion of patients for whom the perioperative prophylactic antimicrobial is prescribed in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termIndicator
Short name:Help on this term8a-The proportion of patients for whom the perioperative prophylactic antimicrobial is prescribed in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines
METeOR identifier:Help on this term736894
Registration status:Help on this termAustralian Commission on Safety and Quality in Health Care, Standard 24/12/2020
Description:Help on this term

The proportion of patients for whom the perioperative prophylactic antimicrobial is prescribed in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines.

Indicator set:Help on this termClinical care standard indicators: antimicrobial stewardship 2020 Australian Commission on Safety and Quality in Health Care, Standard 24/12/2020

Collection and usage attributes

Computation description:Help on this term

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

For the numerator, 'in accordance' means that the choice of antimicrobial (active ingredient) aligns with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines, taking into consideration all relevant patient factors (for example, colonisation with a multi-drug resistant organism).

If surgical antimicrobial prophylaxis is not indicated for the surgery or procedure and a prophylactic antimicrobial is not prescribed in accordance with the guidelines, the patient should be included in the numerator.

If the patient undergoing surgery or a procedure receives multiple prophylactic antimicrobials (including topical and other off-label use), then all prophylactic antimicrobials should be in accordance with the guidelines for the patient to be counted in the numerator.  

Presented as a percentage.

Computation:Help on this term

(Numerator ÷ Denominator) x 100‚Äč

Numerator:Help on this term

Number of patients undergoing surgery or a procedure who receive the appropriate antimicrobial prophylaxis in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines.

Denominator:Help on this term

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

Comments:Help on this term

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.

Representational attributes

Representation class:Help on this termPercentage
Data type:Help on this termReal
Unit of measure:Help on this termService event
Format:Help on this term

N[NN]

Accountability attributes

Other issues caveats:Help on this term

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.

Source and reference attributes

Submitting organisation:Help on this term

Australian Commission on Safety and Quality in Health Care

Reference documents:Help on this term

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

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