Abstract
ObjectivesEvaluation of the extent and appropriateness of antimicrobial use is a cornerstone of antibiotic stewardship programs, but it is time-consuming. Documentation of the indication at the moment of prescription might be more time-efficient. We investigated the real-life feasibility of mandatory documentation of the indication for all hospital antibiotic prescriptions for quality evaluation purposes.MethodsA mandatory prescription-indication format was implemented in the Electronic Medical Record (EMR) of three hospitals using EPIC or ChipSoft HIX software. We evaluated the retrieved data of all antibiotics (J01) prescribed as empiric therapy in adult patients with respiratory tract infections (RTI) or urinary tract infections (UTI), from January through December 2017 in Hospital A, June through October 2019 in Hospital B and May 2019 through June 2020 in Hospital C. Endpoints were the accuracy of the data, defined as agreement between selected indication for the prescription and the documented indication in the EMR, as assessed by manually screening a representative sample of eligible patient records in the EMR of the three hospitals, and appropriateness of the prescriptions, defined as the prescriptions being in accordance with the national guidelines.ResultsThe datasets of hospitals A, B and C contained 9588, 338 and 5816 empiric antibiotic prescriptions indicated for RTI or UTI, respectively. The selected indication was in accordance with the documented indication in 96.7% (error rate: 10/300), 78.2% (error rate: 53/243), and 86.9% (error rate: 39/298), respectively. A considerable variation in guideline adherence was seen between the hospitals for severe community acquired pneumonia (adherence rate ranged from 35.4 to 53.0%), complicated UTI (40.0–67.1%) and cystitis (5.6–45.3%).ConclusionsAfter local validation of the datasets to verify and optimize accuracy of the data, mandatory documentation of the indication for antibiotics enables a reliable and time-efficient method for systematic registration of the extent and appropriateness of empiric antimicrobial use, which might enable benchmarking both in-hospital and between hospitals.
Highlights
Antibiotic Stewardship Programmes (ASPs) have been developed to measure and improve the appropriateness of antibiotic use while minimizing unintended consequences of antibiotic use [1,2,3]
A frequently used method to evaluate the appropriateness of antimicrobial use in a hospital is the point prevalence survey (PPS), in which all antimicrobial prescriptions and their indications are retrieved during a certain time period [6, 7]
For the purpose of this study, we focused on antibiotics prescribed as empiric therapy for patients with respiratory tract infections (RTI) or urinary tract infections (UTI), since these are the most common infections in hospitals
Summary
Antibiotic Stewardship Programmes (ASPs) have been developed to measure and improve the appropriateness of antibiotic use while minimizing unintended consequences of antibiotic use [1,2,3]. In many cases contact with the attending physician is necessary because of incomplete records, and the evaluation of appropriateness can be very time-consuming This often results in the evaluation of a relatively small number of patients and a low frequency of analysis, limited to hospitals with available personnel and resources [8]. This calls for a more efficient method to evaluate the appropriateness of antimicrobial use, in order to perform measurements more often or on a larger scale
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