Use of antibiotic agents in a large teaching hospital The impact of
            <i>Antibiotic Guidelines</i>

Harvey, Ken; Stewart, Roslyn; Hemming, Mary; Moulds, R. F. W.

doi:10.5694/j.1326-5377.1983.tb122427.x

Cited by 43 publications

(8 citation statements)

References 11 publications

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“…That the majority of IAP was due to unjustified antibiotic use and incorrect choice of antibiotic was in keeping with another large Australian study. 10 However, the variables that were associated with IAP in our study differed from those identified in other studies -such as increased patient age, HA infection, prophylaxis and fluoroquinolone usage. 5,11,12 This highlights the need for hospitals to conduct their own audits to identify site-specific factors associated with IAP.…”

Section: Brief Communicationcontrasting

confidence: 81%

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Point‐prevalence study of inappropriate antibiotic use at a tertiary Australian hospital

Ingram¹,

Seet²,

Budgeon

et al. 2012

Internal Medicine Journal

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A point‐prevalence study at a tertiary Australian hospital found 199 of 462 inpatients (43%) to be receiving antibiotic therapy. Forty‐seven per cent of antibiotic use was discordant with guidelines or microbiological results and hence considered inappropriate. Risk factors for inappropriate antibiotic prescribing included bone/joint infections, the absence of infection, creatinine level >120 µmol/L, carbapenem or macrolide use and being under the care of the aged care/rehabilitation team. In the setting of finite antimicrobial stewardship resources, identification of local determinants for inappropriate antibiotic use may enable more targeted interventions.

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Section: Brief Communicationcontrasting

confidence: 81%

“…10 However, the variables that were associated with IAP in our study differed from those identified in other studies -such as increased patient age, HA infection, prophylaxis and fluoroquinolone usage. The casemix at our centre, including the state cystic fibrosis and neurosurgical units may partially explain this finding.…”

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confidence: 81%

Point‐prevalence study of inappropriate antibiotic use at a tertiary Australian hospital

Ingram¹,

Seet²,

Budgeon

et al. 2012

Internal Medicine Journal

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“…The results of this study add to concern raised by previous research that has shown newly qualified doctors taking sole responsibility for around 20–35% of the prescriptions that they chart [31, 32]. The WUSCEs in particular enabled six out of the eight of core drugs and therapeutic problems as outlined by Maxwell & Walley [33] and the Medical School Council Safe Prescribing working group [2] to be assessed.…”

Section: Discussionmentioning

confidence: 72%

The performance of junior doctors in applying clinical pharmacology knowledge and prescribing skills to standardized clinical cases

Harding

Britten

Bristow

2010

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Safe prescribing is a core competency in undergraduate medical education.• A large proportion of undergraduate medical students and recently graduated doctors in the UK are not confident in their ability to prescribe effectively and safely.• Errors are common in all healthcare settings and prescribing errors are the most common type. WHAT THIS STUDY ADDS• This study produced twelve valid and statistically reliable assessments of clinical pharmacology and therapeutics (CPT) knowledge and prescribing skills in areas that pose a high risk to patient safety. • The findings show that a large proportion of foundation year 1 (FY1) doctors fail to demonstrate the level of CPT knowledge and prescribing ability judged by a subject matter expert (SME) panel to be required at this stage of their careers.• We suggest strategies and areas where teaching can be focused to improve the safety and effectiveness of prescribing by FY1 doctors. AIMSRecent studies suggest a worryingly high proportion of final year medical students and new doctors feel unprepared for effective and safe prescribing. Little research has been undertaken on UK junior doctors to see if these perceptions translate into unsafe prescribing practice. We aimed to measure the performance of foundation year 1 (FY1) doctors in applying clinical pharmacology and therapeutics (CPT) knowledge and prescribing skills using standardized clinical cases. METHODSA subject matter expert (SME) panel constructed a blueprint, and from these, twelve assessments focusing on areas posing high risk to patient safety and deemed as essential for FY1 doctors to know were chosen. Assessments comprised six extended matching questions (EMQs) and six written unobserved structured clinical examinations (WUSCEs) covering seven CPT domains. Two of each assessment types were administered over three time points to 128 FY1 doctors. RESULTSThe twelve assessments were valid and statistically reliable. Across seven CPT areas tested 51-75% of FY1 doctors failed EMQs and 27-70% failed WUSCEs. The WUSCEs showed three performance trends; 30% of FY1 doctors consistently performing poorly, 50% performing around the passing score, and 20% performing consistently well. Categorical rating of the WUSCEs revealed 5% (8/161) of scripts contained errors deemed as potentially lethal. CONCLUSIONSThis study showed that a large proportion of FY1 doctors failed to demonstrate the level of CPT knowledge and prescribing ability required at this stage of their careers. We identified areas of performance weakness that posed high risk to patient safety and suggested ways to improve the prescribing by FY1 doctors.

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“…4 Initial studies have shown that despite the popularity of these guidelines only a small proportion of antibiotic prescribing complied with the recommendations. 5 Grilli and Lomas have identified the value of guidelines as an acceptable basis for clinical practice. 6 Poor acceptance usually arises from a lack of ownership or where there is difficulty in application at the clinical interface.…”

Section: Introductionmentioning

confidence: 99%

Impact of an Educational Program on Antibiotic Use in Paediatric Appendectomy Procedures

Angalakuditi

Sunderland²,

Roberts

et al. 2005

Pharmacy Practice and Res

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Aim To evaluate antibiotic use in paediatric appendectomy procedures. Method Demographic, clinical and antibiotic prescribing data for patients who had appendectomies were reviewed in two paediatric hospitals retrospectively (pre‐intervention). The data was analysed against standard guidelines for abdominal surgery. A multifaceted education strategy was designed and administered only in the case hospital. A post‐intervention evaluation was conducted in both hospitals (case and control). Results 207 cases and 224 controls were evaluated. There was no significant difference (p > 0.05) between gender, age and length of stay between the groups. Post‐intervention, appropriateness of theatre antibiotics changed from 0 to 65% (cases) and from 52.9% to 53.3% (controls). The appropriateness of ward antibiotics changed from 48 to 84.7% (cases) and 76.4 to 71.4% (controls). The total antibiotic dosage appropriateness changed from 0 to 58.2% (cases) and 12 to 3.8% (controls). Conclusion Antibiotic use significantly improved following the multifaceted educational intervention.

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Use of antibiotic agents in a large teaching hospital The impact of Antibiotic Guidelines

Cited by 43 publications

References 11 publications

Point‐prevalence study of inappropriate antibiotic use at a tertiary Australian hospital

Point‐prevalence study of inappropriate antibiotic use at a tertiary Australian hospital

The performance of junior doctors in applying clinical pharmacology knowledge and prescribing skills to standardized clinical cases

Impact of an Educational Program on Antibiotic Use in Paediatric Appendectomy Procedures

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