eP90 Interventions to improve prescribing accuracy in the management of intra-abdominal sepsis in emergency general surgical patients; experiences from an acute teaching hospital

Background

Antibiotic stewardship reduces microbial resistance and spread of multidrug-resistant organisms, reducing patient morbidity, mortality, and length of stay.

Sepsis is a significant contributor to poor patient outcomes.

Fishbone conceptualisation suggests possible causes of poor prescribing compliance for intra-abdominal sepsis (IAS) may include lack of experience, awareness, accessibility, and training of prescribing guidelines.

‘Enabling’ interventions, such as audit and feedback, have been proven as most effective in improving pan-specialty antibiotic prescribing practices.

Question

Can enabling, behaviour change techniques successfully improve antibiotic prescribing accuracy for intra-abdominal sepsis in a large, tertiary general surgical unit?

Methods

Data on antibiotic choice was collected for all consecutive patients with a new diagnosis of IAS, over two 2-week periods, one pre- and one post-enabling interventions.

Interventions were: Presentation of audit and group feedback data at consecutive governance meetings attended by key multidisciplinary team members; regular group educational emails; streamlined access to prescribing guidelines with concurrent graphic reminder of sepsis parameters, placed in strategic prescribing locations.

Results

N= 33 across both cycles. Predominant causes of IAS were cholecystitis (N=10) and appendicitis (N=9).

Correct antibiotic choice, initially 18%, significantly increased to 74% after 1 month of sustained interventions.

Discussion/Conclusions

Established interventions to improve antibiotic prescribing practices can be successfully applied in the context of emergency general surgery.

Educational outreach of recommended change, shared directly with target prescribing groups may substantially improve surgical departments’ prescribing practices and antibiotic stewardship, thus improving patient outcomes.

Sustainability of these interventions over time and with rotational staff requires further investigation.