Paediatric antimicrobial stewardship and safe prescribing-an assessment of medical staff knowledge and behaviour

Abstract

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.

Documenting the indication for antimicrobial prescribing: a scoping review

“…An additional 15 citations were identified from the grey literature search for a total of 123 publications (figure 1). 13–135 Of the 123 studies, 64 were peer reviewed, 53 were conference proceedings and 6 were online documents (eg, reports).…”

“…Overall, 52 studies reported the prevalence of indication documentation 13–15 17 19 21 23 26–29 40 45–47 49 53 60 61 65 67 71 72 74 75 78 82 83 87 89 91 92 97 100–102 106 108 109 109 110 112 114 115 117 124–129 135. The median reported prevalence of indication documentation was 75%; however, there was a wide range across studies from 4% to 100% of antimicrobial orders with an indication documented, with an IQR of 51%–85%.…”

Review on a Potential of Antibiotics

“…Phytochemicals can inhibit peptidoglycan synthesis, damage microbial membrane structures modify bacterial membrane surface hydrophobicity and modulate quorum-sensing. 42 With increasing antibiotic resistance in recent years, the potential of new plantderived antibiotics is under investigation.…”

Impact of ‘never use’ abbreviations (Error Prone Abbreviations-EPA’s) list on incidence of EPAs in inpatient medical prescriptions in apex tertiary care public hospital in India

“…These were Qd, OD, U, mcg, trailing zeros or failure to include a leading zero when the dose is less than a one. [9] Audits in a Sri Lankan hospital, showed use of following error-prone abbreviations - μg (microgram), mcg (microgram), u (units), cc (cubic centimeter), OD (once a day), @ sign, d (days/daily), m (morning) and n (night) - at a rate of 17.4%, 0.1%, 1.9%, 0.2%, 0.2%, 4.9%, 23.5%, 4.4% and 15.8% respectively among all prescriptions reviewed. [10] In our study, overall incidence of error prone abbreviations before intervention was 47.5%.…”

“…These were Qd, OD, U, mcg, trailing zeros or failure to include a leading zero when the dose is less than a one. [9] Audits in a Sri Lankan hospital, showed use of following error-prone abbreviations - prescriptions reviewed. [10] In our study, overall incidence of error prone abbreviations before intervention was 47.5%.…”