Sarah Blackmore is Senior House Officers at sunny Nelson Hospital. Roshani has an interest in medical subspecialties, in particular Dermatology. Sarah maintains an interest in Infectious Diseases and surgical subspecialties.
Empiric Antibiotic Prescribing In General Medical Patients In Nelson Hospital
The primary aim of this audit was to determine adherence to District Health Board (DHB) guidelines for empiric antibiotic prescribing in patients admitted under General Medicine in Nelson Hospital, New Zealand.
A two-cycle retrospective audit of patients admitted under General Medicine prescribed intravenous (IV) antibiotics was conducted. Adherence to guidelines was assessed before and after implementation of the intervention. This included updating of guidelines and targeted education. Cycle 1 included consecutive patients admitted from 26 April 2019 to 19 May 2019, Cycle 2 included consecutive patients admitted from 15 October 2019 to 5 November 2019.
Among the patients included in Cycle 1, overall compliance with DHB empiric antibiotic prescribing guidelines was 42%. In cases with a respiratory source of infection, 36% were adherent to guidelines. In non-adherent cases, 44% were prescribed ceftriaxone in non-severe community acquired pneumonia, and 56% were prescribed amoxicillinclavulanate in the places of amoxicillin.
Following intervention, in Cycle 2 overall compliance with empiric antibiotic prescribing guidelines was 76%. In cases with a respiratory source of infection, 65% were adherent to guidelines. In non-adherent cases, 14% were non-adherent to guidelines for prescribing ceftriaxone in non-severe community acquired pneumonia, and 85% of cases prescribing amoxicillin-clavulanate in the places of amoxicillin.
The median number of days in delay of IV to oral switch was zero, with a mean of 0.67 (0-4). Complications of IV therapy were identified in 27% of patients.
Conclusions and/or Clinical Practise Point:
ollowing prescriber education and making guidelines more user friendly there was an overall increased adherence to guidelines for empiric antibiotic prescribing. However, the use of excessively broad spectrum and inappropriate antibiotics remains a considerable problem.