Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence–Practice Gap in Antibiotic Prescribing
Jaclyn Bishop,
Mark Jones,
James Farquharson,
Kathrine Summerhayes,
Roxanne Tucker,
Mary Smith,
Raquel Cowan,
N. Deborah Friedman,
Thomas Schulz,
David Kong,
Kirsty Buising
Affiliations
Jaclyn Bishop
National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, Australia
Mark Jones
Pharmacy Department, Ballarat Health Services, Drummond Street North, Ballarat, VIC 3350, Australia
James Farquharson
Pharmacy Department, Colac Area Health, Connor Street, Colac, VIC 3250, Australia
Kathrine Summerhayes
Clinical Improvement, Risk and Innovation, Wimmera Health Care Group, Baillie Street, Horsham, VIC 3400, Australia
Roxanne Tucker
Clinical Improvement, Risk and Innovation, Wimmera Health Care Group, Baillie Street, Horsham, VIC 3400, Australia
Mary Smith
Department of Health and Human Services (Victoria), McLachlan Street, Horsham, VIC 3000, Australia
Raquel Cowan
Department of Internal Medicine, Ballarat Health Services, Drummond Street North, Ballarat, VIC 3350, Australia
N. Deborah Friedman
Department of Infectious Diseases, Barwon Health, Ryrie Street, Geelong, VIC 3220, Australia
Thomas Schulz
National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, Australia
David Kong
National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, Australia
Kirsty Buising
National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, Australia
Despite the availability of evidence-based guidelines, antibiotics for cellulitis remain inappropriately prescribed. This evidence–practice gap is more evident in low-resource settings, such as rural hospitals. This implementation study developed and introduced a cellulitis management plan to improve antibiotic prescribing for cellulitis in three health services in regional Australia. Appropriateness of antibiotic prescribing for cellulitis at Day 1 was the primary outcome measure. Adults with ICD-10-AM codes for lower-limb cellulitis admitted as inpatients of the three health services between May and November 2019 (baseline, n = 165) and March and October 2020 (post-implementation, n = 127) were included in the assessment. The uptake of the cellulitis management plan was 29.1% (37/127). The appropriateness of antibiotic prescribing for cellulitis at Day 1 was similar at baseline (78.7%, 144/183) and in the intention-to-treat post-implementation group (81.8%, 126/154) [95% CI −5.6% to 11.3%, p = 0.50]. Commencement of the cellulitis management plan resulted in a non-statistically significant increase in antibiotic appropriateness at Day 1 compared to when a cellulitis management plan was not commenced (88.1% vs. 79.5%; 95% CI −5.6% to 19.8%; p = 0.20) Evaluation of more real-world strategies to address evidence–practice gaps, such as the appropriateness of antibiotic prescribing for cellulitis, is required.
