The project involves the roll-out of targeted interventions at multiple hospital sites in Queensland and New South Wales, with a focus on Surgical Antibiotic Prophylaxis (SAP) and its social and behavioural underpinnings. This study will be an exemplar for further social and behavioural interventions which seek to pull back mis-use in hospitals.
The inappropriate use of surgical antibiotic prophylaxis, either for an inappropriately long period or used in operations in which it is not indicated is frequent in hospitals in Australia and internationally (NAPS 2015). For operations, such as knee and hip arthroplasty, non-adherence with SAP guidelines is associated with an increased risk of surgical site infection, so increasing compliance in this area also increases patient safety as well as reduces unnecessary use.
However, the greatest challenge for antimicrobial stewardship is how to sustain practice change over time in a broad range of institutional settings, for multiple antibiotic use areas, without excessive resource allocation. Educational feedback alone has been unsuccessful in optimising SAP prescribing in Australia. This project proposes that persuasive interventions addressing the key drivers of antibiotic mis-use may have efficacy in producing long-term improvements in prescribing practice and may be more cost-effective than highly regulated strategies of antibiotic monitoring. SAP will provide the case study for a roll-out of a series of interventions, and expansion of this high innovative program for optimisation and improving the safety and quality of healthcare.
Our intervention for SAP will include engagement of local surgeons, interactive multidisciplinary sessions addressing the key drivers of mis-use, and the implementation of local institution-driven performance indicator assessment. Embedding local ownership of the quality process and awareness on the part of key clinicians as to why local cultures of prescribing occur and are perpetuated has the potential to induce behavioural change that is sustained over time, and is likely to have flow-on effects in prescribing beyond SAP. This intervention will be low-cost and driven by local institutional ownership of change processes.
Advance Queensland Fund
Associate Professor Jennifer Broom, University of Queensland and Sunshine Coast University Hospital Dr Chris Anstey, Sunshine Coast University Hospital and UQ Professor Marianne Wallis, Sunshine Coast University Associate Professor Jeffrey Post, Prince of Wales Hospital and UNSW Dr Krispin Hajkowicz, State-wide AMS Service. Metro North A/Prof David Looke, Metro South and University of Queensland Dr Paul Chapman, Caboolture Hospital Dr Paul Griffin, Mater Hospital and University of Queensland