Improving the Appropriateness of Intravenous Ceftriaxone Use in Tuanku Ampuan Najihah Hospital
Appropriateness of antimicrobial therapy is defined as correct decision, correct choice, and correct use of antimicrobials. Overuse and inappropriate use of intravenous ceftriaxone, a third-generation cephalosporin, will increase the resistance towards it, hence the emergence of multidrug-resistant organisms. A verification study observed that the appropriateness of intravenous ceftriaxone usage in Tuanku Ampuan Najihah Hospital (HTAN) was 21.4% in the pre-intervention phase. This study aimed to improve the appropriate use of intravenous ceftriaxone in HTAN. A quality improvement study was conducted in medical, orthopaedic, and surgical wards from 2015 to 2018. All patients who were on intravenous ceftriaxone for pneumonia treatment were recruited during the antibiotic round, except for paediatric patients. Appropriate use of intravenous ceftriaxone was measured using the indicator of the percentage of appropriate intravenous ceftriaxone cases, with a standard of more than 50% based on consensus within the AMS team members. Contributing factors of low appropriateness were no indication of antibiotic (45.46%), no de-escalation or intravenous-to-oral switch (27.27%), and inappropriate choice or duration of antibiotic (27.27%). Three intervention cycles were conducted via Antimicrobial Stewardship Programme (AMS), with each cycle lasted for at least six months. Strategies implemented were the addition of intravenous ceftriaxone into the existing Antibiotic Request Form and fortnightly antibiotic rounds to assess the prescribing of intravenous ceftriaxone, renewal of Antibiotic Request Form to be more user friendly to aid the monitoring and feedback part, continuous teaching sessions, and dialogue with pharmacy staff and nurses to ensure strict adherence to new standard operating procedures. Appropriateness of intravenous ceftriaxone use was increased from 21.4% (verification study) to 54.55% (re-evaluation). The ABNA was reduced to –4.55 and ceftriaxone consumption was reduced from 90.67 DDD/1000 patient-days (January–June 2015) to 23.78 DDD/1000 patient-days (January–December 2018). Overall, multidisciplinary collaboration via AMS has successfully improved the appropriateness of intravenous ceftriaxone use in HTAN.