Aims Increasing antibiotic resistant organisms combined with frequent, inappropriate use of antibiotics is giving rise to infections which may no longer be able to be treated1. The aim of this prevalence study was to audit antimicrobial prescribing at a Hospital against Trust antimicrobial policies to determine whether the rising trend in antimicrobial prescribing is appropriate.
Methods The data was collected in a point prevalence manner; prescriptions that were active at the time of auditing were included and those which were discontinued or prescribed and not yet administered were excluded. A data collection template was designed and distributed to ward pharmacists with education on how to complete. The following parameters were audited; allergy status, antibiotic name, route, indication, duration, review date as well as the ward and speciality. Ward pharmacists assessed whether the prescription was in line with Trust guidelines/ID/Micro recommendations. Data was collected into a central database, as well time taken to audit.
The audit standards were
90% of patients prescribed an antimicrobial for an indication in line with Trust policy or ID/Micro
90% of patients prescribed an antimicrobial for a duration in line with Trust policy or ID/Micro
90% of patients have an allergy status documented
Results 272 inpatient charts were reviewed. 153 of these patients (56%) were prescribed an antimicrobial.398 antibiotic prescriptions were included for audit. 38% of prescriptions were for medical/surgical prophylaxis. Prophylactic prescriptions were not included for further analysis. 85% of prescriptions had an indication documented either on the electronic chart (JAC) or written in the paper medical notes. 98% of prescriptions were as per policy or in line with recommendations from ID/Micro. 61% of prescriptions had a review date documented. 100% of patients had an allergy status documented. Average duration of antibiotic prescription was 8 days, range 1–50 days, median 5. 80% of prescriptions were IV. 70% of antimicrobial prescribing takes place in the ICU/cancer/transplant setting. Respiratory tract infections were the most common indication for antimicrobial prescribing, 35%. Amikacin was the most commonly prescribed antibiotic (15%), followed by piperacillin/tazobactam (14%). The audit cost in terms of pharmacist time was £763, at a total of 33 hours.
Conclusions Policy compliant prescribing was very high at 98%; this figure is surprisingly high and poses questions as to the accuracy of data collection and whether bias was present. As a Trust we are now interested and will focus on improving intravenous to oral switches and reviewing and documenting patients’ antimicrobial therapy regularly. As a tertiary/quaternary centre we treat complicated immunocompromised patients; we are unlikely to lower the burden of infection. Approximately 75% of antimicrobial prescribing was in the ICU and cancer and transplant setting, however we must optimise the use of antimicrobials and demonstrate good antimicrobial stewardship. This data will act as a baseline for a subsequent audits which will be carried out using the newly implemented EPIC® patient management system.
GOV.UK. 2019. Antimicrobial Resistance (AMR). [ONLINE]Available at: https://www.gov.uk/government/collections/antimicrobial-resistance-amr-information-and-resources [Accessed 2 July 2019].
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