Question. Will reporting be for overall compliance or compliance for each individual measure?
Answer. Compliance will be reported for each measure.
Question. Can individual measures be collected separately from different patients in different ward areas? For example could nurses collect the doses administered measure in one ward and the AMT or pharmacy team collect compliance and IV review in another ward?
Answer. No. We are aiming for all elements of prescribing and administration to be correct in every infection episode.
Question. If data is collected for a patient on IV or combination therapy, can we collect data on the same patient when they are switched to oral therapy only?
Answer. Yes because we are interested in the process for prescribing, administering and monitoring antibiotics.
Question. Some patients are in hospital for prolonged periods, is it acceptable to collect data on the patient each time the drug therapy changes?
Answer. Yes because we are interested in the process for prescribing, administering and monitoring antibiotics.
Question. If the reason for a missed dose is documented in the notes, is it correct that we shouldn't count this as a missed dose, or is that only the case if the reason documented is acceptable?
Answer. Acceptable reasons will have a code so the reason should not require interpretation. If certain codes are repeatedly used and may have an adverse effect on patient care then data should be shared with the clinical team to highlight that improvement is required.
Question. These audits are assigned to downstream wards so what if the missed dose happened in the receiving ward? Staff in downstream wards may not be happy to take responsibility for doses missed prior to coming to the ward.
Answer. We are just monitoring documentation so all data should be included. However the results should be shared with receiving wards if that is where the problem with missed doses lies.
Question. The audit won’t distinguish between an infection episode with one missed dose and an episode with many missed doses. Should we not put some kind of weighting on this measure?
Answer. We are aiming for all elements of prescribing and administration to be correct for every episode but acknowledge we have a long way to go to achieve this. Detail of numbers should be shared with the clinical team who can make improvements and their response will vary depending on how ‘bad’ the results are.
Question. Is the medicine chart the only place a duration or review date should be recorded for oral antibiotics?
Answer. No, it could also be in the medical notes. 8
Question. For oral antibiotics, does duration/stop date have to be recorded or does a review of antibiotics count?
Answer. A review does not count: duration or stop date should be recorded as the duration will be specified within the local guideline. An exception to this might be if the diagnosis was unclear, in which case the recommendation would be to not include the infection episode in the audit.
Question. If the patient is on both IV and oral drugs (e.g. pip/taz IV and oral clarithromycin) for the same infection episode, how should this be handled? The duration for the oral drug usually depends on the diagnosis and the response to IV therapy so it is unlikely that a duration can be stated.
Answer. If a patient is on combination IV and oral therapy for an infection episode, respond accordingly to the question “IV or combination antibiotics prescribed” and complete the subsequent questions in the same way as you would if they were only prescribed IV antibiotics.
Question. What constitutes an acceptable documented review for IV or combination therapy? Often, “continue on IV antibiotics” is written after routine daily review. Because of this, a duration or specific review date for IV/combination antibiotics may not be recorded but the review is actually taking place.
Answer. There must be documentation of a review by a prescriber with the date the review was conducted. Best practice is that when IV or combination antibiotics are continued, a reason for continuing is specified, rather than simply writing “continue on IV antibiotics.” The sub-measure of the outcome of review will capture whether a reason for continuing is documented.
Question. For IV or combination therapy, if there is no evidence of a clinical review but there is a duration on the Kardex would that be considered acceptable as a review?
Answer. No, this is not sufficient to constitute a review. Even for indications where treatment duration is known and can be documented at the time of prescribing (e.g. give 14 days of IV therapy), review of the patient should still take place to ensure they are responding to treatment.