NAUSP and AMS at a Tertiary Hospital

Using National Antimicrobial Utilisation

Surveillance Program (NAUSP) reports

to stimulate and support antimicrobial

stewardship interventions

Pam Konecny and Suman Adhikari

St George Hospital

Background NAUSP

NAUSP reports antibiotic usage in Australian acute inpatient care

Funded by Australian government through Australian Commission on

Safety and Quality in HealthCare (ACSQHC)

Managed by the Infection Control Service, SA Health (2001- )

‘Contributors’ (contributing health facilities) provide total monthly

antimicrobial usage and bed occupancy data

Antibiotic usage rates derived from custom-built database

conversion of dispensing data

Data aggregated and de-identified distributed to contributors and

Dept Health and Ageing, and ACSQHC.

http://www.sahealth.sa.gov.au/nausp

June 2015 - 130 hospitals (>50 beds) SGH

NAUSP Data

Standardised WHO defined usage density rate

number of Defined Daily Doses (DDDs) per 1000

occupied bed days (OBDs)

Internationally recognised parameter, developed by the

World Health Organization for epidemiological investigation

of medication usage

http://www.sahealth.sa.gov.au/nausp

NAUSP reports include a ‘national average’ to enable

contributors to benchmark usage with peer grouped hospitals

Peer grouping is guided by the Australian Institute of Health

and Welfare (AIHW) Classifications

Bi-monthly reports and Annual Report

NAUSP Reports

http://www.sahealth.sa.gov.au/nausp

St George Hospital

– 600 bed tertiary referral hospital

• Clostridium difficile rates 2006

• MRAB closed ICU March – April 2007

• VRE emergence SGH early 2008

– 10 bacteraemia in 12 months

– Screening: up to 30-35% VRE some wards

SGH Executive”VRE Working party”: Included AMS

We USED NAUSP Data:

BEFORE Implementing AMS

Evidence for

– Benchmarking nationally

– Longitudinal trends

– Identifies antibiotic prescribing challenges

– Directs planning of formulary restriction

http://www.sahealth.sa.gov.au/nausp

Using NAUSP Data: Before Implementing AMS

Using NAUSP Data:

Evaluating AMS intervention

Longitudinal usage trends

National benchmarking

Individual antibiotic level usage

Target “hot spots” for intervention

→ AMS round

→ Guidance MS reports

→ Departmental report → Dept meeting

Using NAUSP Data: AMS Program Evaluation

St George Hospital

AMS Implementation AMS Implementation AMS Implementation

Using NAUSP Data:

AFTER AMS intervention - Informing

NAUSP data informs

– AMS Committee, Facility Executive, Local Health District

Clear dashboard data for easy viewing and distribution

Executive sponsorship sustainability

Facility comparisons identify AMS enablers and barriers

(CEC AMS Advisory Group)

NAUSP 2009 Annual Report

NAUSP 2009 Annual Report

NAUSP 2009 Annual Report

Using NAUSP Data:

Executive support AMS - SGH

Executive support Area-wide roll-out of computerised

decision support system (Guidance MS)

→ sustainability

Ensuring Data Integrity

Data Principles

Numerator : Antimicrobial usage data (DDD)

Denominator: Occupied Bed Days (OBDs)

Monthly usage of

antimicrobial for acute

inpatient ward per

NAUSP inclusion criteria

Monthly occupancy of

same acute inpatient

wards included to

calculate monthly usage

http://www.sahealth.sa.gov.au/nausp

http://www.whocc.no/ddd/definition

http://www.sahealth.sa.gov.au/nausp

APPLYING Bimonthly NAUSP Data

Highlights trends for further investigation

Informs individual departmental reporting

Identifies potential programmatic issues

eg AMS ‘fatigue’, intervention review

Using NAUSP Data: Monitor intervention and planning

Increasing trend

of pip-taz

Using NAUSP Data: Monitor intervention and planning

Increasing

trend of pip-taz

High use ward: Indication assessed, intervened

0.00

20.00

40.00

60.00

80.00

100.00

120.00

DD

D/1

00

0 O

BD

s

Prescribing Trend of Ceftriaxone & Piperacillin-tazobactam: Ward R

Ceftriaxone

Piperacillin-tazobactam

Using NAUSP Data: Monitor intervention and planning

Carbapenems

above national

average

Using NAUSP Data: Monitor intervention and planning

Carbapenems above

national average

0.00

20.00

40.00

60.00

80.00

100.00

120.00

140.00

160.00

Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13

DD

D/1

00

0O

BD

s

Prescribing Trend of Meropenem: Department H

Highest using Department : Investigated, intervened

Guidance MS

2012

Using NAUSP Data: Monitor intervention and planning

Using NAUSP Data: AMS Program Comparison

McNeil at el, Poster 2.16 Antimicrobial 2014 ASA

Using NAUSP Data: AMS Program comparison

McNeil at el, Poster 2.16 Antimicrobial 2014 ASA

Limitations

OBDs do not reflect number of episodes of infection

Creates bias when recommended dosing for a specific

condition differs from DDD eg: ceftriaxone 2g 12 hrly for

CNS indication (DDD = 2g)

WHO may revise reference values (DDD) potentially

making longitudinal comparisons difficult – rare NAUSP

check with annual QA process

Relies on 2.1 FTE!

Schechner et al, Clinical Microbiology Reviews 2013

http://www.whocc.no/ddd/definition

Using NAUSP Data

AMS program Evaluation

Monitor intervention

and Planning

Before Implementing

AMS Program

- Fuel for driving AMS engine

Acknowledgements

NAUSP Team:

Vicki McNeil

Erin Connor

….some of the

SGH AMS Team

survivors