E-prescribing would help hospitals control infection
Dr Kari Lounatmaa/Science Photo Library
Clostridium difficile likely to thrive without electronic prescribing |
Hospitals will continue to struggle to control outbreaks of infectious diseases unless they introduce electronic prescribing, says the Health Protection Agency.
“We’ve got to get some form of computerised monitoring of
our prescribing,” said
Andrew Pearson, deputy director of the HPA’s centre for infections. “The
problem is that very few hospitals in the UK have electronic prescribing — just
three.”
Dr Pearson was speaking at a conference on health care-associated infections
in Lon-don last week. He said it was crucial that patients received the
correct treatment but the evidence suggests that often they do not. Without
knowledge of what has been prescribed, when and at what dose, infections
like Clostridium difficile will continue to thrive, he added.
In the US, where electronic prescribing in hospitals is well established,
the University of Maryland uses computer software to monitor antibiotic
use at different hospitals, said Dr Pearson. The software flags up prescribing
errors so patients’ drugs can be corrected. In a trial comparing
patients whose errors were corrected with those that were not, the difference
in death rate was 4.5 per cent at three months so the trial was stopped,
he said.
“This was [an] uncomplicated way of measuring the errors and this
dramatic effect is now being picked up by 44 hospitals in the States
and will
be piloted by one hospital here later in the year.”
James Nash, a director of infection prevention and control at East Kent
Hospitals NHS Trust, explained that restricting the use of antibiotics
is one way of helping to reduce the errors associated with them, and
it can be effective in reducing cases of C difficile.
Cases of the infection fell dramatically twice in three Kent hospitals:
first, when ceftriaxone was taken out of ward stocks in 2003 and secondly
when other antibiotics were restricted alongside infection control measures
in 2005 in response to an outbreak of the 027 strain of C difficile.
There was huge opposition to the antibiotic restrictions among hospital
staff, Dr Nash said, but it had significant benefits for patients, with
C difficile rates falling even further in 2006.
Hospital pharmacists played a key role in this, said Dr Nash. “Changing
the antibiotics is the most difficult thing to do and it needs the help
of management and of the pharmacists in controlling access.”
But computer prescribing would be better than occasional audits. “Because
we don’t have electronic prescribing in place we only have an approximate
idea of what antibiotics are being given,” Dr Nash added.
Speaking to The Journal after the conference, Shilpa Jethwa, a specialist
pharmacist in antibiotics at Northwick Park Hospital, London, said that
electronic prescribing would be a helpful, but costly, intervention. “If
it worked it would be really useful and a very good audit tool,” she
said.
She added that electronic prescribing would cut the time needed to chase
hospital notes and that a record of local resistance patterns would allow
clinicians to prescribe the most appropriate treatment for patients.
Sir Liam Donaldson, England’s chief medical officer, is expected
to write to NHS trusts to recommend they implement enhanced surveillance
sampling for C difficile. |
The
Pharmaceutical Journal
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