Antimicrobial use in Australian hospitals – NAUSP
The National Antimicrobial Utilisation Surveillance Program (NAUSP) collects data on the volume of antimicrobial usage from Australian hospitals; the results of the analyses of these collections are published by the Commission to support hospitals in their antimicrobial stewardship programs and the safety and quality of health services.
NAUSP is a voluntary program, administered by SA Health, which undertakes standardised measurement of antimicrobial use in Australian adult public and private hospitals. Antimicrobial usage for adult hospitals is measured in defined daily doses per 1,000 occupied bed days. In partnership with the Commission, work has been undertaken to include more than 200 hospitals, from all states and territories, contributing to NAUSP, including all Principal Referral Hospitals.
NAUSP provides an important tool for hospitals to support their local antimicrobial stewardship (AMS) programs. Participation in NAUSP can also assist hospitals to meeting the AMS requirements of the National Safety and Quality Health Service (NSQHS) Standard Preventing and Controlling Healthcare-Associated Infection.
The Commission has published a series of reports on analyses of NAUSP data. NAUSP routinely publishes six monthly benchmarking reports for hospital peer groups, speciality units, states and territories.
For more information about NAUSP, including becoming a contributor, visit the NAUSP website.
Current NAUSP contributors should note that from February 2020, there is a new URL for the NAUSP portal for data entry and generating reports.
NAUSP paediatric feasibility study
Antimicrobial usage in paediatric hospital inpatient populations is not currently monitored through NAUSP, primarily due to the lack of a universally accepted method to measure antimicrobial use in this population.
NAUSP and the Commission have completed a project to assess the feasibility, challenges and accuracy of different methods for measuring antimicrobial use for inpatients in Australian paediatric hospitals. Six Australian Children's Hospitals submitted dispensing data, patient administration data and occupancy data from two wards each for the month of June 2018 for the project. Administration data were collected from electronic medicine management (EMM) systems in hospitals where these operated, or through manual review of medication charts.
The six participating hospitals are:
- Sydney Children’s Hospital, Sydney Children’s Hospital Network, New South Wales
- Westmead Children’s Hospital, Sydney Children’s Hospital Network, New South Wales
- John Hunter Children’s Hospital, New South Wales
- Royal Children’s Hospital, Victoria
- Monash Children’s Hospital, Victoria
- Women’s and Children’s Hospital, South Australia.
The casemix of these wards was diverse, ranging from: general medical, surgical, adolescent and children, intensive care, oncology, neurology, orthopaedic, cystic fibrosis, renal, cardiac, neurosurgery, metabolic, endocrine, gastroenterology to hepatology services.
One vial per dose policies were in place in 60% of the hospitals. The hospitals used either the Australian Medicines Handbook Children’s Dosing Companion as the antimicrobial dosing reference or Therapeutic Guidelines: Antibiotic.
The short data collection period and range of wards that were able to contribute data limited capacity for analyses of the utility of the usual dispensing data submitted to NAUSP, as a metric for monitoring antimicrobial use in these hospitals. While the study was valuable in supporting improvement in antimicrobial stewardship in these services, following review of the results of the study and its limitations, it was determined that, in the absence of widespread use of electronic medication management (EMM) systems in hospitals, it is not feasible to expand NAUSP to paediatric services. Limitations related to the ability to collect individual patient data, such as administration details, patient weight or days of therapy (DOTs) to continuously monitor paediatric antimicrobial usage using the paediatric preferred methods of DOTs.
Options for surveillance of antimicrobial usage in Australian paediatric hospitals through NAUSP will be considered further when EMM has been more widely implemented.