Audit of the Trust's quality account antibiotic indicators for correct use in paediatrics
Objectives The objectives of this audit were to assess compliance with the paediatric antibiotic guideline for empirical treatment of infections and documentation of an indication plus stop/review date on the drug chart or medical notes.
Method The Trust's paediatric first line anti infective guideline1 was used to audit performance against. Data were prospectively collected by a pharmacist working in conjunction with two doctors during a two week period Monday to Friday. New patients who had been admitted and initiated on empirical antibiotics were identified for inclusion. The intention was to include at least 50 patients in the audit. The data were collected from all paediatric wards excluding bone marrow transplant using a data collection tool. There were three standards that the data were audited against.
Standard 1: 90% of antibiotic prescriptions should adhere to the paediatric antibiotic guidelines for empirical treatment.
Standard 2: 90% of prescriptions should have an indication written on the drug chart or in the medical notes.
Standard 3: 90% of prescriptions should have a stop or review date written on the drug chart.
A target of 90% was chosen as this is the Trust's quality account target.
Results Data were collected for 62 patients, 12 were excluded from analysis because they were on antibiotics which were not in the guideline, were based on previous microbiology cultures, or were on prophylactic antibiotics which were outside of the scope of the guideline. For the 50 included patients the following results were obtained:
Standard 1: 36 (72%) of 50 prescription charts audited adhered to the paediatric antibiotic guidelines for empirical treatment.
Standard 2: 8 (16%) of 50 prescriptions audited had an indication written on the drug chart and 47 (94%) had an indication written in the medical notes.
Standard 3: 7 (14%) of 50 prescriptions audited had a stop or review date written on the drug chart.
Conclusions The results have highlighted that there is non-compliance with the standards set. There was 72% compliance with the paediatric antibiotic guideline. Some treatment may have been clinically appropriate however this may not have been documented in the notes. There are some indications that are not included in the guideline that could be such as abdominal trauma, quinsy, cellulitis and open fracture. There is no guideline in place for prophylactic antibiotic treatment such as surgical prophylaxis. The need for this was identified.
The failure of documentation of an indication plus stop/review date on the drug chart suggests a need for education of doctors. This is something that could be incorporated during their induction. There is a proposal to redesign the current drug chart for a paediatric specific chart which includes a section for documentation of an indication and proposed duration of anti infectives; this may help to achieve compliance with this audit standard.