Development of the Antifungal National Antimicrobial Prescribing Survey
Ms Anna Khanina1,2, Dr Rodney James3, Ms Xin Fang3, Dr David Kong3,5,6, Prof Monica Slavin1,2,4, Prof Karin Thursky1,2,3,4
1National Center For Infections In Cancer at Peter MacCallum Cancer Centre, Melbourne, Australia
2Sir Peter MacCallum Department of Oncology, The University of Melbourne , Melbourne, Australia
3The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
4Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
5Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University , Parkville, Australia
6Ballarat Health Services, Ballarat, Australia
Background
Antifungal stewardship (AFS) refers to coordinated interventions to monitor and direct appropriate use of antifungals, with the aim of optimising clinical outcomes, minimising selective pressure and reducing occurrence of adverse events. Core recommendations for AFS advise that hospitals should audit antifungal prescribing and invasive fungal infection (IFI) management, utilising data to drive quality improvement. The Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) is an online qualitative audit tool utilised to evaluate antimicrobial guideline compliance and appropriateness. The Hospital NAPS data fields and methodology require refinement to allow in-depth analyses specific for the high-risk patients most commonly prescribed antifungal agents.
Method
An expert steering group was assembled comprising infectious diseases physicians, microbiologists and pharmacists specialising in antimicrobial stewardship and management of immunocompromised adult and paediatric patients. The existing Hospital NAPS tool was reviewed and modifications to the survey were recommended to allow for focussed assessment of antifungal prescribing. Results of an international expert consensus Delphi survey on important and feasible metrics for AFS were incorporated.
Results
The Antifungal NAPS audit tool has been developed. The tool takes into consideration patient risk factors for IFI as well as the phases of IFI prescribing (prophylaxis, empiric and directed therapy). The audit captures the occurrence of drug toxicity, the rate of breakthrough IFI, incidence of IFI, infection outcome and mortality.
Conclusion
The Antifungal NAPS provides auditors the ability to perform standardised, meaningful deep dive audits into antifungal prescribing practices and clinical outcomes. This will allow identification of targets for quality improvement AFS interventions.
Biography:
Ms Anna Khanina is a clinical pharmacist specialising in infectious diseases and antimicrobial stewardship, having completed a clinical pharmacy fellowship in the area. Anna is undertaking a PhD in the area of antifungal stewardship with the National Centre for Infections in Cancer at PeterMacallum Cancer Centre. She is also a project manager developing an electronic surveillance system for invasive fungal infection in high risk cancer patients.