Monitoring

Monitoring and reporting of antibiotic consumption

Monitoring and reporting of antibiotic consumption help identify areas and units (e.g. departments, clinics) with potential for improvement. 

Although it is possible to develop a local monitoring system in-house, hospitals are recommended to join ANRESIS, the Swiss Centre for Antibiotic Resistance. ANRESIS has been collecting data on antibiotic use in hospitals since 2006. Hospitals receive more than just feedback: the data can be accessed online at any time via the interactive dashboard, and the integrated benchmarking functions also enable hospitals to compare themselves with other institutions. 

1

Ensure that the hospital joins the ANRESIS platform to monitor antibiotic use.

Hospitals should submit their antibiotic consumption data to the platform at least once a year. 

The consumption data (DDD/100 patient-days) should, in particular, be used to carry out benchmarking with hospitals of a similar size (target: below that average) and to determine the proportion of Watch and Reserve group antibiotics according to the AWaRe classification (target: lower than comparable hospitals). 

If the hospital is considering setting up its own local monitoring of antibiotic consumption:

  • Base the monitoring of antibiotic consumption on aggregated data from the clinical information system (CIS) or on pharmacy dispensing data.
  • Report primarily on the total consumption of antibiotics per antibiotic group, AWaRe category and unit (e.g. department, clinic). Monitor primarily the proportion of antibiotics with a very broad spectrum of activity.

If prescription data from the CIS is used: report preferably Days of Therapy (DOT) per 100 patient-days and/or Defined Daily Doses (DDD) per 100 patient-days, or as a proportion of the total. 

  • If pharmacy dispensing data is used: Report DDD per 100 patient-days or as a proportion of the total. 
  • Ideally, the following indicators should also be provided and analysed. These enable a nuanced assessment of prescribing behaviour: 
    • Days of Antibiotic Spectrum Coverage (DASC) or Simplified Spectrum Score (S3-Score), particularly in large hospitals
    • Stratification of prescribing data by therapeutic category, perioperative antibiotic prophylaxis and medical antibiotic prophylaxis
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2

Ensure that the results are reported and discussed with prescribers

A procedure must be established to ensure that the results are discussed with relevant stakeholders (e.g. heads of clinical departments and prescribers).

Present the results at unit level (e.g. department, clinic). This encourages engagement from managers and prescribers, as they can relate the data directly to their own patients.

Discuss the results with managers and prescribers, particularly if antibiotic use is increasing or above-average use is identified.

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3

Use comparisons to identify areas within your hospital with improvement potential

Comparisons help identify areas for improvement and allow tailored training and other interventions. In this way, resources can be focused on the areas (topics and units) that offer the greatest improvement potential in prescribing practice.

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4

Ensure that the hospital also participates in the national surveillance of antibiotic use (point prevalence survey, PPS, and surveillance of surgical site infections, SSI)

These regular assessments provide comprehensive information on antibiotic use and form a basis for improving the quality of prescribing.

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Monitoring of antibiotic consumption provides insight into trends in prescribing. Access statistics for the interactive dashboard can indicate whether the monitoring results are being utilised. If no trend is apparent, steps should be taken to ensure that local practice and the continuation of the ASP are reviewed and discussed within the relevant committees.

Tools

Links
Consult ANRESIS
The WHO AWaRe classification (Access, Watch, Reserve)
Further information on the WHO’s AWaRe classification