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Why share PPS results?

Alison MacDonald discusses using point prevalence surveys for local improvement, and why we need to share PPS results.
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Hi, my name is Alison MacDonald. I’m the antimicrobial pharmacist for NHS Highland in the north of Scotland. Today, I’m going to be talking about why we use antibiotic point prevalence surveys for local improvement within NHS Highland. Why conduct an antibiotic point preference survey? In NHS Highland, we have conducted these point prevalent surveys in a number of clinical areas over the last few years. At the moment, because there is no electronic prescribing record available in the hospital, the indication for antibiotic prescribing is recorded in the paper based medical notes, and the drug therapy is prescribed on a paper drug chart– both of these items are kept at ward level during the admission for the patient.
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In order to obtain detailed information on antibiotic use and the indication for choice of therapy, we need to link the paper based records from current inpatients. We use the point prevalence survey to describe the number and range of infections being treated at any one time in a clinical area. Planning your point prevalence survey– past surveys covering the whole hospital were very time consuming for data collection purposes, including analysis and feedback of learning. So now we target discrete areas, such as all the general medical boards, or all the orthopaedic wards, and target our feedback accordingly. We aim to conduct a survey in each clinical area every six months, with an annual survey in GP-led community hospitals. Who collects the data?
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Depending on the area chosen and the availability of staff, data collection may be conducted by anti-microbial pharmacists, ward pharmacists, infection control nurses, or ward staff nurses. In the past, we’ve also had involvement of junior medical staff, but this is not consistently available. When using non-specialist staff to collect the data, this is useful if you’re distant from the site involved, but sometimes the data may be incomplete and require further clarification. Personally, when I collect the data, I tend to write more information on the sheet to remind me of the patient when I collate the data, and therefore can go back and speak to the infection specialist to discuss specific cases in more detail.
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Giving feedback– we try to use existing clinical forum to deliver the results of the survey, as the attendance by the clinical teams at such a meeting is usually better than trying to arrange something specific. Face-to-face delivery is much more effective than email. Usually at these sessions, there’s a brief presentation of the results, drawing out a few key messages for improvement. Describing the results, including any changes since the last point prevalence survey, can be useful, but bear in mind that surveys done at different time points in the year are not necessarily comparable.
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When delivering the feedback, it’s important to concentrate on a few key messages for improvement, as this is an opportunity for education and learning for the clinical team that you’re delivering the feedback for. This is also an opportunity, if a change in guidelines is imminent or has recently been implemented, as new evidence for the change– or any change in therapy can be explained, with allowing any time for any questions. These sessions have also been used to discuss options for changing therapeutic choices, as the key consultants are often available. A recent example of this is our switch from piperacillin tazobactam to amoxicillin, gentamicin, and metronizadole combination for the management of intra-abdominal sepsis in general surgery.
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The face to face feedback session also allows questions from the guideline users, and this is vital to shape the guidelines, as these are written by experts but for the general ward users. In addition, a formal report is submitted and discussed at the next meeting of the local anti-microbial management team, as it is important to share the results with a wider audience. In summary, the antibiotic point prevalence survey allows us to find real patient data on linking the indication for antibiotic therapy, and also the choice of therapy for that infection. It’s important to use anyone and everyone that you can to collect the data, bearing in mind the limitations depending on the specialty or the profession that you use.
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It’s important to share the results with the clinical team involved as soon as possible for the results to be meaningful. A two-way system for delivering feedback allows the users to discuss the issues that have been raised by the survey, and also ask questions of the guideline developers. We view these point prevalence surveys as excellent education opportunities with the front line clinical teams, and will continue to conduct them on a regular basis.

The most important part of a PPS is sharing the results. Otherwise, no actions to improve prescribing will happen.

While using written reports to inform managers and policy makers about the results is essential to gain management support for change, engagement with clinicians is key to change behaviour around prescribing.

To encourage a whole team approach it is beneficial to share results at multi-professional meetings and this can be done informally at ward meetings or via hospital or directorate level audit meetings.

As well as sharing local data, it is also useful to show comparisons between wards within your own hospital or with other nearby hospitals as peer comparison is a useful enabler to facilitate change.

Remember to highlight success as well as identify areas for improvement and encourage discussion of how changing ward processes may help to improve prescribing.

Sharing PPS results is also an important opportunity to provide education for the clinical team on the local policy and other stewardship initiatives.

In this video, Alison Macdonald, Lead Antimicrobial Pharmacist, Inverness, Scotland shares her experience of PPS and how she engages clinicians to share the results.

Please note the video is shown here by kind permission of the University of Dundee (UoD) and was first used in the UoD and BSAC course Antimicrobial Stewardship: Managing Antibiotic Resistance which is also available on FutureLearn.

Before moving on to the next step, let us know in the comments what you think would be the most effective way to share PPS data.

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Challenges in Antibiotic Resistance: Point Prevalence Surveys

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