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Measuring the quality of antimicrobial use

Measuring the quality of antimicrobial use
PPP Point Prevalence Survey
© UoD and BSAC

Point Prevalence Survey (PPS) data.

We have looked at ways to measure the quantity of antibiotics used but how can the quality of prescribing be measured?

Remember we need to measure to improve therefore we will focus on qualitative measurement using Point Prevalence Surveys (PPS) to assess antibiotic prescribing and identify targets for quality improvement considering the following:

  • What is a PPS?
  • What is the recommended core data set?
  • What are the key principles for conducting a PPS.

In the absence of electronic prescribing in hospitals Point Prevalence Surveys (PPS) are used to audit the quality of antimicrobial prescribing. Repeated use of PPS has been audited at European and national level to map trends over time in relation to quality measures such as % patients receiving an antibiotics, % intravenous antibiotics, % compliance with local antibiotic policy and to identify local and national priorities for improvement.

Ideally a PPS is a snapshot taken on a single day across a whole hospital to collect information about patients prescribed antibiotics. However this is seldom practical so usually the PPS will be carried out over a period of one or two weeks to allow staff collecting data sufficient time to visit all wards. Large national PPS usually have a one or two-month window for participating hospitals to collect and submit data.

For a PPS we use a standard data collection tool which may be electronic or paper-based and the data collected is then analysed either via an on-line database system or manually using an Excel spreadsheet.

PPS data may be useful for feedback within national organisations to inform policy, while results from local surveys can be fed back to managers and clinicians. Audit tools used in these PPS can also be utilised to undertake bespoke audits focusing on specific wards or specific antibiotics to support improvement activity.

The European Surveillance of Antimicrobial Consumption programme has carried out several Europe-wide Point Prevalence Surveys.

The table below shows the data that will be included in the tool for each patient:

Data element Data options
Name of drug From filtered WHO Drug list
Route Parenteral, Oral, Rectal, Inhalation
Unit dose Grams or MU, to three decimal places
Dosage frequency 1-12 per day, every (18,36,48) hours, twice per week, three times per week, continuous infusion
Indication Coded list of indications
Indication group Indication Group
Prophylaxis Surgical, Medical
Diagnosis Coded list of diagnoses
Day of therapy 1-28,29+,Long Term, Unknown
Is Review / Stop Date Documented y/n/unknown
Reason in notes y/n/unknown
Complies with (local) guidance y/n/unknown
Date start Indication DD/MM/YY (the date first antimicrobial was prescribed for indication)

This may look like a large task to collect this data set for all patients on antibiotics but several studies from various countries have shown that on average one third of patients in a ward will be prescribed an antibiotic on a given day.

So that means for a 30-bedded ward there will be ten patients receiving an antibiotic. Important factors to consider when planning a PPS are:

  • Sufficient time to plan visiting all wards
  • Training for all data collectors to ensure a standard approach.
  • Communication to clinical staff that the PPS is taking place and how they can assist with making medicine charts and medical notes available.
  • Dedicated time for data collectors to visit all wards – other duties may have to be suspended during the PPS.
  • A plan for analysis and feedback of the data to clinical staff, managers etc.

If you have not participated in a PPS you may find it useful to try collecting some data for one patient to see how it is done or maybe for all patients prescribed an antibiotic in your ward.

You can use this simplified data tool below (available to download as PDF file at the bottom of this article.)

Patient ID  
Name of drug  
Unit dose  
Dosage frequency  
Complies with (local) guidance  

Could you conduct a PPS in your location? Post your comments on how you would do this and discuss with other learners.

If you would like to learn more about conducting a PPS in your practice, the BSAC FutureLearn course on Point Prevalence Surveys is a free two week course led by Jacqueline Sneddon and William Malcolm.

© UoD and BSAC
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Antimicrobial Stewardship: Managing Antibiotic Resistance

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