All outpatient healthcare facilities can participate in the outpatient module, including outpatient departments, primary healthcare centres, dental clinics, day surgery wards, community healthcare centres, etc.

Если у вас есть смешанный объект или смешанные отделы, consisting of inpatient beds as well as outpatient beds/consultation rooms, please survey these activities separately in the Global-PPS. I.e., please survey all inpatient beds according to the inpatient module, and all outpatient beds/consultation rooms according to the outpatient module.

Аптеки не могут участвовать в Global-PPS, так как наш метод ориентирован на выписку рецептов, а не на схемы выдачи лекарств.

All patients seen in consultation for any reason (by appointment or without appointment) during a defined time slot of the survey. Exclude patients who are admitted as inpatients, who require overnight admission or stay.

Important exception: if you survey emergency or observation departments, please include all patients in the survey, even if they were admitted overnight, as long as they were still present in the department during the defined time frame of the survey. This exception is made since it is not always clear for emergency and observation departments if the patient will stay, be transferred to another department or sent home

No, you cannot make a selection of patients. It is important that you include all patients, with all diagnoses and symptoms.

We will make sure you can filter based on diagnoses/symptoms in the outpatient extension of the interactive module, once we release this extension.

The number of patients that you should survey is flexible, although we recommend surveying for at least 4 hours, and perhaps a full day or for a few days if you have very few patients that are seen for consultation throughout the day.

This also depends on the aim of your survey: if you want to design targets for antimicrobial stewardship, it is advisable to check if you have collected a sufficient number of patients who receive an antimicrobial prescription (e.g., 30 patients). In this way, it will be easier to see if there is a certain pattern of prescribing. If you have an insufficient number of patients on antimicrobial prescriptions, it might be difficult to distinguish whether this prescription was in line with the normal prescribing behaviour in your setting, or if it was an exception.

If you want to do a very first screening of your healthcare setting to see where the most antimicrobials are prescribed, you may need a smaller number of patients with antimicrobial prescriptions than when you want to effectively design targets for stewardship.

All outpatient departments, emergency/observation departments, general practitioner practices, dental clinics, day surgery departments, general outpatient clinics, community healthcare centres, etc., can participate.

If you have, for example, departments with both inpatients and outpatients, you can split them up and survey the outpatients in the outpatient module. There is one exception: for emergency and observation wards. These wards have to be surveyed entirely in the outpatient module, and you will have to score the admission status for each patient.

Yes, certainly. All outpatient departments, emergency/observation departments, general practitioner practices, dental clinics, day surgery departments, general outpatient clinics, community healthcare centres, etc., can participate.

No, we do recommend to survey all departments in your institution the first time you participate, to set a baseline for your entire institution. However, it is possible to survey only a few departments in your hospital. Keep in mind that you should survey all departments of the same specialty type, because we report the numbers by specialty type in the feedback report.

Each year, there are три периода исследования: Январь-апрель, май-август, сентябрь-декабрь.

In the outpatient module, you can participate multiple times per period, if you wish to do so. Data within one survey will be aggregated in the feedback report. However, if you wish to analyse your data at more frequent intervals than these three periods, you can download your data in Excel.

The best time to conduct a survey is on a day that is representative for your usual practice. Often, this is a weekday, not during the weekend and not on a holiday.

Please choose a time period that is most representative of your setting. If regular consultation hours are between 8 a.m. and 5 p.m., it would be best to survey in that period.

If patients need to remain after their consultation, for example, to await biomarker test results or advice from an infectious disease specialist, ensure that you follow up with them until their treatment for the survey day is confirmed. Make sure to schedule the survey during a time frame that allows you to reliably follow up with each patient until their final treatment is determined.

For example, if you often have to wait a few hours before the result of a biomarker is obtained when the treatment depends on that result, survey from e.g. 8 a.m. until 12 p.m., and follow-up all patients that were seen during this time, so that you know the results by the end of the day.

Alternatively, if you capture all information in patient files, you can retrospectively survey your institution.

Yes, you can definitely collect data retrospectively, as long as you can retrieve all required information from the patient files, and as long as you survey for a consecutive period of at least 4 hours. It is important that you include all patients seen in your survey window, including patients without an antimicrobial treatment.

Please additionally make sure that all biomarker/POCT/RDT results were available at the time of the prescription. If not, please record ‘Treatment based on [biomarker][POCT/RDT]’ as ‘No’.

No, you can survey different departments on different days. But you should survey one entire department on one day.

This depends on how busy your department is. For very busy departments, it might be sufficient to survey for 4 hours. For less busy departments, it might be necessary to survey for one or multiple days, until you reach a sufficient number of patients for the analysis.

The number of patients you should survey is flexible, although we recommend that you survey e.g. at least 30 patients receiving antimicrobial treatments, in order to obtain valid results.

Yes. Unlike the inpatient module, it is possible in the outpatient module to survey multiple times within one survey period. If you want to do so, you can include the unit multiple times within one survey.

Data within one survey will be aggregated in the feedback report. However, if you wish to analyse your data at more frequent intervals than these three periods, you can download your data in Excel.

Essential data to collect are the patients’ age category, sex and presenting symptoms. Data on admission status should be additionally collected for emergency and observation departments.

More detailed information should be collected for each patient receiving antimicrobial treatment. This includes information on their specific age and underlying morbidities, as well as treatment-related information, such as:

• the specific antimicrobial agent,
• dose per administration,
• number of doses per day,
• route of administration,
• anatomical site of infection,
• indication of therapy (community- versus hospital-acquired infection or prophylaxis)
• whether the treatment was based on a Point-of-Care test, Rapid Diagnostic Test or biomarker, whether (blood) cultures were taken before the start of the treatment
• whether local guidelines are available for the prescribed treatment.

Denominator data are the number of patients that visited the department in the surveyed time slot on the day of the PPS.

There are two methods for data collection: on paper forms before data entry in the web-based application, or directly in the web-based application.

1. Data should be recorded on the Unit forms and Patient forms. Please find all forms under документы. Please print these forms in preparation of the survey, and collect all information on these forms. Afterwards, you can enter them in the web application.
2. Alternatively, it is possible to record all data directly into the web-based application.

Yes, the Unit forms and Patient forms. Please find all forms under документы. Data entry into the web-based application follows the same logic as these data collection forms.

You can include up to 6 symptoms per patient, but it is perfectly fine to record only the most relevant symptoms. The list with symptoms is available in our protocol and data collection forms, available under документы.

Yes, it is possible to contact them after the consultation. However, for some studies and in some settings, you would need informed consent to do so. Please check whether informed consent is needed before you contact the patient (or before you conduct the PPS).

Admission status is a question only asked for emergency and observation wards. Please only collect this information if your patient was seen in an emergency or observation ward. Otherwise, you do not need to collect this information.

If your patient was seen in emergency or observation care, you should collect this information for all patients, including those without antimicrobial prescriptions.

Please choose between the following options:

• Already admitted if the patient was admitted in the same institution
• Suspected admission if you strongly suspect the patient will be admitted, but this did not happen yet during the survey period
• Referral to another institution if the patient was referred to another institution
• Домашняя страница if the patient was sent home
• Unknown if it is completely unknown what happened to the patient, e.g. this was not recorded during data collection

You should consider a treatment based on a biomarker if the result of the biomarker is available at the time of the prescription on the day of the survey, and if the result solely or complementary to other clinical signs or microbiological tests contributed to the decision to treat with an antimicrobial and/or to the choice of a treatment.

Пример:

• Если результаты CRP используются в качестве индикатора наличия инфекции и, следовательно, поддерживают решение о начале антимикробного лечения, вы можете оценить это лечение как основанное на биомаркере, даже если результат CRP не используется для выбора антимикробного препарата.
• If a biomarker result was obtained the day after the survey, or a few days after the survey, and was used for review and follow-up of the antimicrobial treatment, score the treatment as not based on a biomarker, i.e. treatment based on a biomarker is ‘no’, because this result was not available during the survey.

At this moment, it is unfortunately not possible to record this information. Please record all new prescriptions, these will likely provide useful information for your facility.

In the future, we are planning to develop an ‘Outpatient institution profile’, where you can add more detailed information for your healthcare setting, such as lack of information on ongoing/previous antimicrobial prescriptions.

Если антибиотик с ингибитором ферментов назначен, например, пиперациллин с тазобактамом или амоксициллин-клавуланат, пожалуйста, запишите только сайт доза антибиотика. Исключите дозу ингибитора фермента. Например:

• 3,375 г пиперациллина/тазобактама, из которых 3 г - пиперациллин. Следует указывать только эти 3 г.
• 1,2 г амоксициллина/клавулановой кислоты, из которых 1 г - амоксициллин. Следует указывать только 1 г.

Для комбинаций активных противомикробных препаратов с фиксированной дозировкой (например, ко-тримоксазол), пожалуйста, указывайте дозировку обоих противомикробных препаратов!

Для фиксированных доз комбинации активных противомикробных препаратов, например, сульфаметоксазол и триметоприм (ко-тримоксазол), пожалуйста, укажите дозу обоих антибиотиков. Например:

• 960 мг ко-тримоксазола, из которых 800 мг сульфаметоксазола и 160 мг триметоприма. Вы должны сообщить о 960 мг.

Пожалуйста, регистрируйте комбинации с фиксированными дозами как один антимикробный препарат в Global-PPS! Для этих комбинированных препаратов добавьте дозу первого противомикробного препарата (800 мг) к дозе второго противомикробного препарата (160 мг).

Исключение: Если врач назначает два противомикробных препарата для лечения одного диагноза, но это не комбинация с фиксированной дозой (например, амоксициллин и кларитромицин), вы должны записать это как два отдельных противомикробных препарата для одного диагноза, и для каждого указать свою дозу.

Несколько примеров комбинаций с фиксированной дозировкой включают

• Сульфаметоксазол и триметоприм
• Артесунат и амодиахин
• Ампициллин и клоксациллин (“Ампиклокс”)
• Рифампицин, изониазид, пиразинамид и этамбутол
• Эмтрицитабин, тенофовир алафенамид и рилпивирин

Если пациент получает постоянное противомикробное лечение несколько раз в неделю, например 3 раза в неделю (даже если пациент не получает лечение в день опроса), вы должны записать дозу единицы как фактическую дозу, которую получает пациент, но изменить N доз/день на 0,5 (каждый второй день), 0,43 (дважды в неделю), 0,33 (каждые 72 часа), 0,29 (дважды в неделю), 0,14 (раз в неделю) и т. д.

Примеры:

• 500 мг каждый второй день: Единичная доза = 500 мг. N доз/день = 0,5 (= 1 доза / 2 дня)
• 750 мг каждые 72 часа: Единичная доза = 750 мг. N доз/день = 0,33 (= 1 доза / 3 дня)
• 2 г каждую неделю: Единичная доза = 1,2 г. N доз/день = 0,14 (= 1 доза / 7 дней)
• 1 г 2 раза в неделю: Разовая доза = 1 г. N доз/день = 0,29 (= 1 доза / 3,5 дня)

Please record the diagnosis as the reason to treat the patient. For the diagnostic code, use the list of diagnostic codes in the Outpatient Patient Forms (Appendix I), which is categorized by anatomical site and which you can find under документы.

Choose the most applicable option if the antimicrobial was prescribed for more than one reason. Request additional information from doctors, nurses, or pharmacists if needed. If there is no ‘most applicable option’, you could choose the first identified infection, or you would simply have to make a choice.

If a patient has sepsis with a known origin, such as urosepsis, please choose the appropriate anatomic site for the diagnostic code . Do not choose the code sepsis, since this code is only meant for cases of sepsis where the anatomic site is unknown.

Например: Для пациентов с уросепсисом это будет Pye/Cys (предпочтительно Pye, так как это с большей вероятностью вызовет сепсис). Для пациентов с менингитом, пожалуйста, выберите CNS.

If an incorrect diagnosis was made, e.g. due to incorrect interpretation of diagnostic tests, and this was discovered during the audit, please continue in the PPS as if the correct diagnosis was made: consider the given diagnosis at the time of prescription during the survey for the guideline compliance, reason in notes, etc.

Если неправильный диагноз и, соответственно, назначенное лечение могут нанести какой-либо вред пациенту, пожалуйста, немедленно сообщите об этом врачу, чтобы обеспечить безопасность пациента. Пожалуйста, запишите в опросник первоначальный (неправильный) диагноз, даже если этот диагноз и лечение были впоследствии изменены, поскольку именно так бы и произошло, если бы аудитор не сообщил об этом врачу.

By definition, if the patient has been discharged from the hospital < 48 hours и has a known hospital infection or a new infection < 48 hours after discharge from hospital, this classifies as a hospital-associated infection. Additionally, if the patient develops an infection >48 hours after admission and is still admitted, it counts as hospital-associated infection.

If the patient develops symptoms >48 hours after discharge, or within the first 48 hours of admission, then it classifies as a community-acquired infection.

Исключение: if a patient was re-admitted with a surgical site infection, this is by definition code HAI.

Примеры:

• If a patient comes in for consultation with an infection, and has not been admitted/discharged for >48 hours before their consultation, then this infection counts as a community-acquired infection.
• If a patient comes in for consultation with an infection but was discharged the day before, it counts as a hospital-associated infection.
• All early-onset sepsis (i.e. at age <48 hours) is classified as community acquired (CAI) according to the protocol.
• If a patient comes in for consultation with a suspected infection and was on dialysis, chemotherapy or was a recipient of OPAT in the past month, you should still classify this as CAI, since the patient was not admitted for any of these therapies. Outpatient related infections are not defined in the Global-PPS, therefore, to keep it simple, please record this as CAI.
• If a patient comes back 4 days after (inpatient or outpatient) surgery with a surgical site infection, this is classified as HAI1.

No, you can only score one reason to treat. You cannot score multiple diagnoses and indications. If your prescription was based on multiple diagnoses and indications, please choose the most relevant one.

Выберите для диагностического кода вариант профилактики для наиболее подходящего анатомического участка. Если профилактика носит общий характер и не направлена на конкретный орган или участок, выберите "Медицинская профилактика в целом" (MP-GEN).

After choosing the appropriate diagnostic code, select ‘Indications’ to record whether it concerns a Medical or Surgical Prophylaxis. For Surgical Prophylaxis, additionally choose between a single dose Surgical Prophylaxis (SP1), one day Surgical Prophylaxis (SP2), or >1 day Surgical Prophylaxis (SP3).

Примеры:

• Выберите "Профилактика респираторных патогенов" (Proph RESP), если, например, азитромицин назначается в качестве профилактики обострений ХОБЛ. Поскольку этот препарат не назначается в качестве хирургической профилактики, выберите "Медицинская профилактика" в качестве показания.
• Please choose Prophylaxis for Gastro-Intestinal pathogens (Proph GI) if e.g. amoxicillin clavulanate is prescribed as prophylaxis for elective abdominal surgery. Please choose Surgical Prophylaxis as Indication.

Reason in Notes captures information on whether the reason for prescribing an antimicrobial  is documented in the notes (medical, nursing, or other files) at the start of the treatment. It must be clearly written down so anyone (e.g. replacing clinician or other staff member) can easily understand the rationale when consulting the medical or nursing files. 

Пример:

• Даже если все сотрудники знают, что, например, амоксициллин-клавуланат (Augmentin) назначается при пневмонии определенному пациенту, но это не записано в истории болезни, вы должны поставить ‘нет’ за "Причину в записях".
• Если причина очень кратко, но четко описана в файле пациента, поставьте ‘да’ в графе "Причина в записях".
• Если назначающее лицо не записало ее, но, например, медсестра или фармацевт записали причину назначения, то причина все равно будет видна в истории болезни пациента, что и является целью данной переменной. В этом случае оцените ‘да’ для параметра "Причина в примечаниях".
• Если в отчете об операции есть раздел с перечнем всех назначенных лекарств, вы можете отметить ‘да’ в поле "Причина в примечаниях", если в нем присутствует антимикробный препарат, даже если он не обозначен как хирургическая профилактика. Разумно предположить, что антибиотик был назначен с этой целью, учитывая его контекст в рамках периоперационного лечения.

The local guidelines considered in the Global-PPS are any institution guidelines, national guidelines, WHO guidelines, or e.g. the WHILE App or any book that is used in the institutions.

Please choose between the following options: Yes, No, Unknown, No information. No information is chosen when the diagnosis is completely unknown. Unknown is chosen when it is truly not known whether guidelines exist for the diagnosis, but please first check with the prescriber, or any physician, nurse or pharmacist within the institution to see whether there are any guidelines available.

If guidelines exist, you will need to assess whether the drug, dose, duration and route of administration was according to these local guidelines.

You can consider a prescription as guideline complaint when the prescription is for example adapted to the antibiogram, according to the weight or renal function of your patient, and/or following the advice of an infectious disease specialist who is the expert in the institution.

Choose between: Yes, No, Not assessable, Unknown. Not assessable can be chosen when guidelines exist, but do not describe the guideline for e.g. route of administration, even though they do describe the guideline for drug and dosing.

Please consult the prescriber or other prescribers in your institution for the guideline compliance assessment. It might be the case that the written guideline is not followed, but that the prescription was adapted based on the antibiogram/consult of ID specialist/etc.

Guideline compliance must be recorded per antimicrobial prescription: if one patient receives multiple antimicrobials, please assess for each prescription whether it is according to the local guidelines.

If multiple antimicrobials are prescribed for one diagnosis, but the guidelines recommend monotherapy, then please score one of these antimicrobials as guideline-compliant (if the guidelines do recommend monotherapy with this antimicrobial), and score the other antimicrobials as non-compliant.

В отчете об отзывах мы анализируем соблюдение рекомендаций на уровне пациента и диагноза:

• Если все антимикробные препараты соответствуют требованиям для одного диагноза = лечение соответствует руководству
• Если один антимикробный препарат не соответствует требованиям, но другие антимикробные препараты соответствуют требованиям при одном диагнозе = лечение не соответствует руководству

Данные могут быть введены в нашем веб-приложение. Please find more detailed instructions in the user manuals in the application. To begin, ensure you’re logged in and have registered your institution. After that, select the appropriate survey period for which you collected data. Then, follow these steps for data entry:: (1) create your departments under ‘Departments’, (2) create a new unit under ‘Surveys’ > ‘Outpatient module’, (3) add new patients under ‘Surveys’ > ‘Outpatient module’ in the appropriate unit.

This depends on the availability of your data. If you have already collected all data on paper forms, it takes approximately 1-2 minutes to enter the data for a patient with an antimicrobial prescription, and (less than) a minute to enter the data for patients without an antimicrobial prescription.

If you want to enter the data directly in the web-based tool without collecting it first on paper, the time it takes to enter your data depends on whether you have to ask the patient all required information, if you have to look the information up from the patient file, and how organized and accurate your patient files are.

It can take ±3-8 minutes to enter the data of each patient with an antimicrobial prescription, again depending on how long it takes to ask the patient or to look up their file in the system of your institution. It usually takes 1-2 minutes to enter patients without antimicrobial prescriptions, since only a few questions are asked.

Yes, you can edit patient information at any time before the survey is closed.

If you collect patient information on paper forms, ensure that you write the survey number automatically assigned to each patient in the web-based application once their information is entered. This allows you to trace which patient corresponds to the data in the web application. Since the web application does not allow entering an institution identifier, it’s essential to record the assigned survey number on the paper form. If you have finalized your unit or finalized the survey and you still want to make edits or correct data, you can re-open the survey and re-open the unit before making any edits.

If the survey is closed, you can contact us at global-pps@uantwerpen.be with the question to re-open the survey.

You can obtain the results in different ways: an Excel export, and feedback slides.

The Excel file contains your raw data. In this file, each row is one antimicrobial prescription. Some variables will be automatically added, such as ATC-codes, AWaRe classification and DDDs. You can download this within the Global-PPS application.

You obtain the feedback report in a PDF-file, where all data are pre-analysed. You can download this feedback report after finalizing your units and survey.

Вы можете загрузить все результаты из нашего сайта веб-приложение:

• Отчет Excel: перейдите в меню ‘Опросы’ > ‘Экспорт’, и результаты будут автоматически загружены. Если вы хотите экспортировать результаты другого опроса, сначала перейдите в раздел ‘Опросы’ > ‘Подписка’ и выберите соответствующий опрос в разделе ‘Действие’. Затем загрузите экспорт для этого опроса.
• Отчет об отзывах по одной точке: Go to ‘Surveys’ > ‘Outpatient module’ and finalize your units and your survey if you have not yet done this. Then, a new button will appear: ‘Generate feedback’. After clicking this, your feedback report will be sent to you by email.