A comprehensive system for antimicrobial monitoring and review using a mandatory antimicrobial ordering sheet

A comprehensive antimicrobial monitoring and review program using computer screening of information provided by antimicrobial order sheets (AOS) is needed to meet increasing pressures for ongoing review of all antibiotic use by indication. This article describes a program that has been successful in rapidly identifying areas of concern for further review and resolution. These multi-faceted programs passed JCAH scrutiny. Based on the authors experience, a system incorporating mandatory use of an AOS was preferred to a voluntary system. When used voluntarily, compliance to the use of an AOS was 84%. Compliance to use of parts of the form were stronger where check-off boxes were used instead of fill-in blanks. Surgical services personnel and first year residents were the most noncompliant. Admission orders lended themselves to noncompliance. Pharmacists using the forms were less compliant than physicians using them voluntarily, and gave different indications for use than did the physicians. Data documented on the AOS were verifiable with notes in the patient's medical record 92% of the time. Pharmacy coding and collection methods for AOS data presented problems in accurately determining compliance. When the use of the AOS became "mandatory," compliance increased to 97%. Trends in antimicrobial use were reported by an array of computer-generated reports of which several are illustrated. The system described here allows for the identification and monitoring of areas of concern in antimicrobial use, improves the efficiency of quality assurance activities, and can assess the effectiveness of a corrective action.