The impact of an antibiotic specific prescription form in the accident and emergency department
Aims An antibiotic specific prescription for use in the Accident and Emergency Department (AED) has recently been introduced to encourage appropriate antimicrobial prescribing. This prescription is used between 9:00 h and 17:00 h. The aim of this audit is to assess the impact of the recently introduced antibiotic prescription proforma by evaluating compliance with the Trust's antibiotic guidelines.
Methods A data collection form was used to determine if patients visiting AED between 15 and 28 November 2010 were prescribed an appropriate regimen of antibiotics. The Trust antibiotic guidelines were used as the audit standard. Prescriptions were included for analysis if an antibiotic was prescribed. Patient details recorded included: initials, age, clerking in time, antibiotic prescribed, route of administration, duration of therapy, clinical indication, and allergy status. Prescriptions were excluded if the name of antibiotic was missing from patient records, or if the indication being treated was not in the Trust guidelines. Patients not receiving an antibiotic were also excluded.
Results 2092 patients visited AED between 15 and 28 November 2010 of which 287 were given a prescription for an antibiotic. eight prescriptions did not have the name of the antibiotic recorded, and 20 were for clinical indications not listed in Trust guidance so were excluded from the study. Therefore, 259 prescriptions were eligible for analysis purposes of which 27 (approx 10%) were deemed non-compliant with Trust policy.
The majority of non-compliance occurred out-of-hours when the pre-printed prescription was not in use: 7/146 antibiotic prescriptions between 9:00 h and 17:00 h were non-compliant compared to 20/132 out-of-hours.
Conclusions The recently introduced antibiotic specific prescription proforma helped prescribers in AED achieve 90% compliance with the Trust antimicrobial guidelines. The majority of prescriptions that were not compliant with guidelines had been prescribed out-of-hours, when the prescription was not in use.
Nine prescriptions were for upper respiratory tract infections which are usually viral and antibiotics have not been shown to improve outcomes.1 This suggests that antibiotics are possibly being overused for this indication.
In conclusion, AED prescribers should be made aware of the Trust prescribing guidance for antimicrobials and use of the pre-printed AED prescription should be encouraged out-of-hours as a prescribing tool to encourage the prudent prescribing of antibiotics.