Audit and feedback of antibiotic use

Summary Background: There is now little doubt that improving antimicrobial use is necessary for the containment of resistance. Objective: To determine whether providing individualised feedback to doctors about their recent compliance with the hospital’s antibiotic policy improves compliance with the policy. Methods: This study was conducted at a teaching hospital in Sydney, Australia. Computerised alerts integrated into the electronic prescribing system (ePS) inform prescribers of the local antibiotic policy. We utilised prescribing data extracted from the ePS for ‘audit and feedback’. Thirty-six prescribers were sent feedback letters via email. We also interviewed doctors who had received letters to explore their views of the feedback and the policy in general. Results: There was no significant change in compliance with the policy following implementation of the feedback intervention (0% compliant vs 11.9%; p = 0.07). Several problems with the policy and the approval process were identified by researchers during auditing and by prescribers during interviews. Some problems identified made it difficult to accurately assess compliance and for doctors to comply with the policy. Conclusions: Our intervention did not result in improved compliance with the antibiotic policy but revealed practical problems with the policy and approval process that had not been identified prior to the trial. Greater support for the policy by senior doctors and the assignment of more clearly defined roles and responsibilities associated with antibiotic use and approval may result in improved compliance. Harnessing the full potential of technology would streamline the antimicrobial approval process and allow more efficient and reliable monitoring of antibiotic use and compliance. Many of the problems we identified are generic issues of importance to all organisations seeking to integrate antimicrobial stewardship into ePS. Citation: Baysari MT, Oliver K, Egan B, Li L, Richardson K, Sandaradura I, Westbrook J I, Day RO. Audit and feedback of antibiotic use: Utilising electronic prescription data. Appl Clin Inf 2013; 4: 583–595 http://dx.doi.org/10.4338/ACI-2013-08-RA-0063

摘要 背景：目前，几乎毫无疑问的是，改善抗菌药物的使用对于控制耐药性是必要的。 目的：确定向医生提供关于他们近期遵守医院抗生素政策的个性化反馈是否能提高对该政策的遵守情况。 方法：本研究在澳大利亚悉尼的一家教学医院进行。集成到电子处方系统（ePS）中的计算机化警报会告知处方者当地的抗生素政策。我们利用从ePS中提取的处方数据进行“审核与反馈”。通过电子邮件向36名处方者发送了反馈信件。我们还采访了收到信件的医生，以探究他们对反馈以及总体政策的看法。 结果：在实施反馈干预后，对政策的遵守情况没有显著变化（遵守率0%对比11.9%；p = 0.07）。研究人员在审核过程中以及处方者在访谈中都发现了政策和审批流程存在的一些问题。所发现的一些问题使得难以准确评估遵守情况以及医生难以遵守该政策。 结论：我们的干预措施没有提高对 antibiotic政策的遵守情况，但揭示了在试验前未被发现的政策和审批流程方面的实际问题。高级医生对政策给予更大支持以及明确规定与抗生素使用和审批相关的角色和职责，可能会提高遵守率。充分利用技术的潜力将简化抗菌药物审批流程，并能更有效、更可靠地监测抗生素的使用和遵守情况。我们所发现的许多问题是所有试图将抗菌药物管理整合到ePS中的组织都面临的重要共性问题。 引用：Baysari MT, Oliver K, Egan B, Li L, Richardson K, Sandaradura I, Westbrook JI, Day RO. 抗生素使用的审核与反馈：利用电子处方数据. Appl Clin Inf 2013; 4: 583–595 http://dx.doi.org/10.4338/ACI - 2013 - 08 - RA - 0063