Objective:Determine baseline knowledge of antimicrobial stewardship, and safe
prescribing among junior medical officers, monitor their level of
participation in interactive education during protected teaching time and
assess day-to-day prescribing behaviours over the subsequent 3-month
period.Methods:A voluntary and anonymous survey of all non-consultant level medical officers
was conducted with the use of an audience response system during mandatory
face-to-face orientation sessions at a tertiary paediatric hospital. Routine
prescribing audits monitored compliance with national and locally derived
quality use of medicines indicators.Results:Eighty-six percent of medical officers participated by responding to at least
one question (171/200). Response rate for individual questions ranged
between 31% and 78%. Questions that addressed adverse drug
reactions, documentation and monitoring for empiric antibiotics and the
error-prone abbreviations IU and U were correctly answered by over
90% of participants. Other non-standard and error-prone abbreviations
were less consistently identified. In practice, 68% of patients had
complete adverse drug reaction documentation (113/166). Error-prone
abbreviations were identified on 5% of audited medication orders
(47/976), approximately half included a documented indication and intended
dose.Conclusions:Participants demonstrated a good understanding of safe prescribing and
antimicrobial stewardship. Audits of prescribing identified potential
discrepancies between prescribing knowledge and behaviours.
Palivizumab is often prescribed without meeting recognised best practice guidelines, and patients eligible are frequently not prescribed palivizumab. The streamlined IPU, implemented in hospital A, excluded patients who did not meet guidelines. The pro forma needs further refinement, and complementary strategies introduced to improve compliance.
The incidence of childhood bacterial meningitis has declined in the Northern Territory of Australia, but Indigenous children are disproportionately affected. Routine immunisation is beneficial for all, although further efforts to 'Close the Gap' between health outcomes in Indigenous and non-Indigenous Australians is required.
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