The goal of this observational study is to learn about the implementation of a process to review antimicrobial prescriptions for adult patients in Intensive Care Unit (ICU). The main question it aims to answer is: can a structured antimicrobial review can be implemented in ICUs? Implementation will be supported by the use of local protocols, audit and feedback, and education. It will be evaluated by daily data collection of clinical processes and interviews with local champions. Resources to conduct the study are provided by the Wellcome Flagship Innovations award. ("Collaboration for Research, Implementation and Training in Critical Care in Asia and Africa", reference 224048/Z/21/Z).
Study Type
OBSERVATIONAL
Enrollment
6,300
The appropriateness of the documented indication, route of administration, expected duration and stop date of all antimicrobials will be reviewed within 48 hours of their prescription.
Fidelity
The proportion of prescriptions reviewed as intended (reviewed within 48hours with documentation of all 4 review components: indication, route, duration, stop date). Reported as a proportion of the number of possible reviews.
Time frame: Evaluated over calendar month periods during months 4-6 (i.e. the three months immediately following implementation)
Reach
Proportion of eligible patients who receive a review
Time frame: Evaluated over calendar month periods during months 4-6 (i.e. the three months immediately following implementation)
Adoption
Proportion of prescriptions reviewed as intended once implementation support has been withdrawn
Time frame: Evaluated over the calendar month period of month 7
Antimicrobial Density (AD)
Defined Daily Dose / 1000 patient-days. This measure of antimicrobial consumption will compare prescribed daily doses of antimicrobials to those specified by the World Health Organization (WHO) (Anatomical Therapeutic Classification (ATC) J01 Defined Daily Doses). To correct for ICU unit size the investigators will standardise by number of admitted patient-days during that month in that ICU.
Time frame: Evaluated over calendar month periods during months 1-7 of the study.
Duration of Therapy
Number of Days of antimicrobial Therapy / 1000 patient-days Analysed at the ICU level
Time frame: Evaluated over calendar month periods during months 1-7 of the study
Antimicrobial Redundancy Rate
Days of Therapy of prespecified redundant combinations of antimicrobials. Analysed at the ICU level.
Time frame: Evaluated over calendar month periods during months 1-7 of the study
Antimicrobial resistance rate
Number of multidrug-resistant pathogens (as specified by WHO priority list) / number of patients
Time frame: Evaluated over calendar month periods during months 1-7 of the study
Antimicrobial prescribing rate
Number of patients receiving at least 1 antimicrobial / number of patients admitted to ICU in the same period
Time frame: Evaluated over calendar month periods during months 1-7 of the study
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.