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Hospital antibiotic prescribing successfully modified by 'immediate concurrent feedback'
British Journal of Clinical Pharmacology
|March 1, 1996
Summary
Immediate concurrent feedback (ICF) effectively reduced inappropriate intravenous prescribing of sultamicillin and co-amoxiclav. This strategy promoted oral antibiotic use, leading to significant cost savings and improved antibiotic stewardship.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Health Services Research
Background:
- Intravenous (IV) administration of certain antibiotics like sultamicillin and co-amoxiclav may be inappropriate when oral routes are accessible.
- Unnecessary IV antibiotic use contributes to increased healthcare costs and potential antimicrobial resistance.
- Optimizing antibiotic prescribing practices is crucial for effective patient care and resource management.
Purpose of the Study:
- To evaluate the effectiveness of ongoing immediate concurrent feedback (ICF) in reducing inappropriate parenteral prescribing of sultamicillin and co-amoxiclav.
- To assess the impact of ICF on antibiotic usage patterns, cost, and adherence to oral prescribing guidelines.
- To determine the acceptance and feasibility of implementing an ICF strategy in a hospital setting.
Main Methods:
- A prospective controlled audit was conducted over 20 months involving hospital inpatients.
- An educational program preceded the implementation of an ongoing ICF strategy.
- Specially trained nurses provided daily memos to prescribers of IV sultamicillin or co-amoxiclav when deemed inappropriate, recommending oral alternatives.
Main Results:
- Significant reductions were observed in the monthly proportions of admissions prescribed IV sultamicillin or co-amoxiclav (38%, P < 0.001).
- Inappropriate IV route usage decreased by 75% (P < 0.001) following ICF implementation.
- Statistically significant reductions in IV/oral usage ratios, expenditure on IV forms (≥43%, P < 0.01), and estimated net monthly savings of HK$26-30,000 were achieved.
Conclusions:
- Ongoing immediate concurrent feedback is an effective strategy for minimizing inappropriate IV antibiotic prescribing.
- The ICF approach promotes the use of oral antibiotics, leading to cost savings and improved antibiotic stewardship.
- This simple, well-accepted intervention demonstrates a positive impact on hospital prescribing practices.