Abstract for presentation at National Medicines Symposium 2006

Influencing antibiotic prescribing in the management of community-acquired pneumonia in hospital emergency departments - The CAPTION project

  • Ms Angela Wai, National Prescribing Service, Australia
  • Ms Fiona Horn, National Prescribing Service, Australia
  • Ms Judith Mackson, National Prescribing Service, Australia
  • Mr David Maxwell, NSW Therapeutic Advisory Group, Australia
  • Ms Kylie McIntosh, Victorian Drug Usage Evaluation Group, Australia
  • Ms Lisa Stanton, University of Tasmania, Hobart, Australia
  • Ms Lisa Pulver, School of Pharmacy, University of Queensland, Australia
  • Ms Anita Marwood, Department of Health, Adelaide, Australia

    • Purpose: CAPTION (Community-acquired pneumonia: Towards improving outcomes nationally) is a collaborative, multicentre drug use evaluation (DUE) project to increase the use of objective severity assessment (Pneumonia Severity Index [PSI]) and appropriate antibiotic selection based on the Therapeutic Guidelines, Antibiotic, version 12 (Guideline), in the management of community-acquired pneumonia (CAP) in hospital emergency departments (EDs).
    Methods: National and state steering committees were established. DUE methodology was employed with participating hospitals collecting data retrospectively on PSI use and antibiotic prescribing in CAP management, and implementing educational interventions. Post-intervention audits were conducted. Interventions included academic detailing, group discussions, detailing card, posters, and disease severity assessment tools. Changes in documented PSI use and concordant antibiotic prescribing were used to measure the impact of the interventions.
    Results: Of 32 hospitals that participated in the initial audit (615 patients), 28 completed a post-intervention audit (543 patients). The educational intervention involved 576 ED staff in academic detailing and 808 in group discussions. The educational intervention significantly increased documented use of PSI (23.8% v 5.5%, p<0.0001) and guideline concordant antibiotic prescribing (30.9% v 19.2%, p<0.0001) compared with pre-intervention. There was a significant reduction in monotherapy use (beta-lactam or macrolide/doxycycline) by 5.2% (p<0.05) and increased empiric dual therapy use (beta-lactam plus macrolide/doxycycline) by 10.1%, (p<0.05).
    Conclusion: Audit and educational interventions were effective at improving the management of CAP in the ED. Continued interventions may be required to sustain changes in prescribing practices as ED personnel are transitory. Release of updated guidelines provides an opportunity to repeat the educational messages. CAPTION was supported and funded by the NPS.

    Conference Organiser - ICMS Pty Ltd