Quality statement 4: Microbiological samples

Quality statement

People in hospital who are prescribed an antimicrobial have a microbiological sample taken and their treatment reviewed when the results are available.

Rationale

Analysing microbiological samples allows more targeted and effective prescribing of narrow‑spectrum antimicrobials or stopping antimicrobials if they are not necessary or effective. In hospital, microbiological samples should be taken before antimicrobials are prescribed. In some situations, it may be necessary to start antimicrobial treatment immediately (for example, in people with severe sepsis or life‑threatening infections) but the treatment should be reviewed when the microbiological results are available.

Quality measures

Structure

Evidence of local arrangements and processes to ensure that people in hospital who are prescribed an antimicrobial have a microbiological sample taken and their treatment reviewed when the results are available.

Data source: Local data collection, Start smart then focus toolkit and TARGET Antibiotics toolkit.

Process

a) Proportion of prescriptions for antimicrobials issued to people admitted to hospital with a record of a microbiological sample being taken.

Numerator – the number in the denominator with a record of a microbiological sample being taken.

Denominator – the number of prescriptions for antimicrobials issued to people admitted to hospital.

Data source: Local data collection.

b) Proportion of prescriptions for antimicrobials issued to people admitted to hospital and reviewed when microbiological results become available.

Numerator – the number in the denominator reviewed when the microbiological results become available.

Denominator – the number of prescriptions for antimicrobials issued to people admitted to hospital with a record of a microbiological sample being taken.

Data source: Local data collection.

Outcome

a) Altered or withdrawn prescriptions for antimicrobials following microbiological results showing lack of effectiveness of initial antimicrobial treatment.

Data source: Local data collection.

b) Antimicrobial prescribing rates in hospitals.

Data source: Local data collection.

c) Length of hospital stay.

Data source: Local data collection.

What the quality statement means for service providers, prescribers and commissioners

Service providers (hospitals) ensure that systems are in place for people in hospital to have a microbiological sample taken before they are prescribed an antimicrobial, and have the treatment reviewed when the microbiological results are available.

Prescribers in hospitals ensure that microbiological samples are taken before they prescribe antimicrobials and that they review the treatment when the microbiological results are available.

Commissioners (clinical commissioning groups, NHS England) ensure that they commission services that take microbiological samples from people in hospital before they are prescribed antimicrobials, and that review the treatment when the microbiological results are available.

What the quality statement means for patients, people using services and carers

People who are in hospital have a sample taken before they are prescribed an antimicrobial to find out what is causing the infection. They may be given an antimicrobial immediately, but once the test results come back the prescription is checked to make sure that the antimicrobial is the right one and will work against the infection.

Source guidance