Banca de QUALIFICAÇÃO: MANUELA VEIGA DIAS ROCHA

EVALUATION AND IMPROVEMENT OF ANTIMICROBIAN MANAGEMENT IN A PUBLIC HOSPITAL

Quality Improvement; Antimicrobial Management; Patient safety

Introduction: Antimicrobial resistance is a major public health concern as it is becoming ineffective. Although microbial resistance is a natural phenomenon, its spread is directly related to factors such as antimicrobial misuse and infection control programs and management of inadequate or non-existent antimicrobial therapy. Objective: Analyze the management of antimicrobials in a public hospital in São Luís - MA, to propose and implement an intervention for their proper management. Method: This is a quasi-experimental study without a control and error group, combining time series analysis and before and after analysis to improve the quality of antimicrobial management. Developed in a public hospital in São Luís - MA from November 2018 to October 2019. Based on the improvement cycles the study sought through the analysis of problems, and the identification of causes in the same way to develop with focus on the scope of the given quality rating. The multi-faceted intervention was participatory data-driven, covering improved standards and norms, improved information systems, communication, and education of staff and patients. The context was analyzed using MUSIQ. For the quality criteria conformity estimates 95% confidence intervals were calculated. To analyze the effect of changes, absolute and relative improvement values and differences in measures before and after interventions should be estimated, tested for meaningful statistics and calculated or Z-value. Results: In the initial quality assessment used in two requirements, safe prescription of antimicrobials and prescription according to the empirical antibiotic guide, which applies only 4%  (4%) in the first criterion and 12% (4%) in the second. When analyzing the context MUSIQ shows the score 111, suggesting that the intervention may be successful, but faces contextual barriers. Post-intervention data have not yet been measured. Conclusions: An assessment of the initial quality of antimicrobial management at the hospital demonstrated significant opportunity for improvement in the antimicrobial management process.