Cheap interventions improve antibiotic prescribing
A series of “relatively cheap but multifaceted” interventions have improved antibiotic prescribing in a Dutch hospital.
The mean time to first antibiotic dose fell from 4.1 to 2.6 hours for
all cases in a study designed to assess the interventions. For
potentially severe infections time to first dose fell from 2.7 to 1.7
hours and halved to 4.1 hours for mild infections. Switching from
intravenous to oral routes increased from 46 to 62 per cent of eligible
patients. However, dosage adjustment for renal function remained unchanged.
Pharmacists and doctors from the Nijmegen University Medical Centre,
Netherlands, report the improvements in Archives of Internal Medicine (2004;164:1206). Their interventions included audit and feedback for
all physicians and nurses in peer discussions, mailings, stickers added
to guidelines booklets, adjustment of computers and presentations by
a local opinion leader. No individual advice was given.
On the wards, a serious cause of delay to first dose was nurse misinterpretation
of the urgency of a prescription. Transfer from the emergency department
was another cause of delay if the patient had not received the first
dose on the emergency ward. The researchers also found problems in administration
schedules, such as fitting in antibiotics round mealtimes and during
the night.
Failure to switch patients from IV to oral therapy was due largely to
lack of staff awareness of this policy. Adjusting dose to renal function
was often omitted because staff
underestimated the prevalence of renal insufficiency and did not have
access to the appropriate formula. Computerised support to help implement
pharmacokinetic formulae may help to solve this problem, the researchers
suggest.
“Interventions supported by a multidisciplinary team consisting
of infectious diseases specialists, medical microbiologists, clinical
pharmacists,
nephrologists and nurses lead to improvements of the process of care
in administration of antibiotics,” they conclude.
Hayley Wickens, microbiology pharmacist, St Mary’s Hospital, London,
said the study highlighted several areas in which pharmacists can help
to promote rational antimicrobial use. “Increasing numbers of hospital
pharmacists are working closely with their microbiology and infectious
diseases teams, identifying patients who would benefit from specialist
input and optimising therapy.”
Dr Wickens added: “Interestingly, the Dutch team showed that educational
measures alone are not always sufficient to improve prescribing; individualising
therapy with
respect to renal function and antibiotic sensitivity reports is the type
of patient-specific
intervention at which clinical pharmacists excel.”
The importance of multidisciplinary working to improve antibiotic prescribing
will feature in a meeting to be held at the Royal Pharmaceutical Society
next week
organised by a Government committee on antimicrobial resistance.
News feature, p10 |
The
Pharmaceutical Journal
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