A mandatory indication-registration tool in hospital electronic medical records enabling systematic evaluation and benchmarking of the quality of antimicrobial use: a feasibility study

Antimicrobial Resistance & Infection Control

Berend H. H. Beishuizen¹  Mieke van Triest¹  Cornelia C. H. Wielders¹  Michiel Duyvendak²  Eric A. F. Haak³  Chris Sytsma⁴  Jaap ten Oever⁵  Jan M. Prins⁶  Annemieke K. van den Broek⁶ 

[1] Center for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands;Department of Hospital Pharmacy, Antonius Hospital, Location Sneek, Bolswarderbaan 1, 8601 ZK, Sneek, The Netherlands;Department of Hospital Pharmacy, OLVG, Location Oost, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands;Department of Information Technology, Antonius Hospital, Location Sneek, Bolswarderbaan 1, 8601 ZK, Sneek, The Netherlands;Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands;Division of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands;

关键词: Antibiotic prescribing;    Antibiotic indication;    Antibiotic stewardship;    National surveillance;    Benchmarking;    Quality of care;   

DOI  :  10.1186/s13756-021-00973-0

来源: Springer

【 摘 要 】

ObjectivesEvaluation of the extent and appropriateness of antimicrobial use is a cornerstone of antibiotic stewardship programs, but it is time-consuming. Documentation of the indication at the moment of prescription might be more time-efficient. We investigated the real-life feasibility of mandatory documentation of the indication for all hospital antibiotic prescriptions for quality evaluation purposes.MethodsA mandatory prescription-indication format was implemented in the Electronic Medical Record (EMR) of three hospitals using EPIC or ChipSoft HIX software. We evaluated the retrieved data of all antibiotics (J01) prescribed as empiric therapy in adult patients with respiratory tract infections (RTI) or urinary tract infections (UTI), from January through December 2017 in Hospital A, June through October 2019 in Hospital B and May 2019 through June 2020 in Hospital C. Endpoints were the accuracy of the data, defined as agreement between selected indication for the prescription and the documented indication in the EMR, as assessed by manually screening a representative sample of eligible patient records in the EMR of the three hospitals, and appropriateness of the prescriptions, defined as the prescriptions being in accordance with the national guidelines.ResultsThe datasets of hospitals A, B and C contained 9588, 338 and 5816 empiric antibiotic prescriptions indicated for RTI or UTI, respectively. The selected indication was in accordance with the documented indication in 96.7% (error rate: 10/300), 78.2% (error rate: 53/243), and 86.9% (error rate: 39/298), respectively. A considerable variation in guideline adherence was seen between the hospitals for severe community acquired pneumonia (adherence rate ranged from 35.4 to 53.0%), complicated UTI (40.0–67.1%) and cystitis (5.6–45.3%).ConclusionsAfter local validation of the datasets to verify and optimize accuracy of the data, mandatory documentation of the indication for antibiotics enables a reliable and time-efficient method for systematic registration of the extent and appropriateness of empiric antimicrobial use, which might enable benchmarking both in-hospital and between hospitals.

【 授权许可】

CC BY