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

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

The numerator and denominator exclude patients undergoing surgery 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.

For the numerator, 'in accordance' means that the antimicrobial dose prescribed aligns with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines, taking into consideration all relevant patient factors (for example, body weight).

If the patient undergoing surgery or a procedure receives multiple prophylactic antimicrobials, then all prophylactic antimicrobial doses should be in accordance with the guidelines in order for the patient to be counted in the numerator.

Presented as a percentage.

(Numerator ÷ Denominator) x 100​

Number of patients undergoing surgery or a procedure who receive the appropriate prophylactic antimicrobial dose in accordance with 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.

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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

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