Antimicrobial Prescribing in the Emergency Department; Who Is Calling the Shots?

Antibiotics

Laura M. Hamill¹  Kerina J. Denny²  Julia Bonnett³  Megan F. Baxter³  Melina Kreutz³  Gerben Keijzers³ 

[1] Department of Emergency Medicine, Christchurch Hospital, Canterbury DHB, Christchurch 8011, New Zealand;Department of Intensive Care, Gold Coast University Hospital, Gold Coast, QLD 4215, Australia;School of Medicine, Griffith University, Gold Coast, QLD 4215, Australia;

关键词: antibiotics;    antimicrobial stewardship;    appropriateness;    emergency department;    prescribing;   

DOI  :  10.3390/antibiotics10070843

来源: DOAJ

【 摘 要 】

Objective: Inappropriate antimicrobial prescribing in the emergency department (ED) can lead to poor outcomes. It is unknown how often the prescribing clinician is guided by others, and whether prescriber factors affect appropriateness of prescribing. This study aims to describe decision making, confidence in, and appropriateness of antimicrobial prescribing in the ED. Methods: Descriptive study in two Australian EDs using both questionnaire and medical record review. Participants were clinicians who prescribed antimicrobials to patients in the ED. Outcomes of interest were level of decision-making (self or directed), confidence in indication for prescribing and appropriateness (5-point Likert scale, 5 most confident). Appropriateness assessment of the prescribing event was by blinded review using the National Antibiotic Prescribing Survey appropriateness assessment tool. All analyses were descriptive. Results: Data on 88 prescribers were included, with 61% making prescribing decisions themselves. The 39% directed by other clinicians were primarily guided by more senior ED and surgical subspecialty clinicians. Confidence that antibiotics were indicated (Likert score: 4.20, 4.35 and 4.35) and appropriate (Likert score: 4.07, 4.23 and 4.29) was similar for juniors, mid-level and senior prescribers, respectively. Eighty-five percent of prescriptions were assessed as appropriate, with no differences in appropriateness by seniority, decision-making or confidence. Conclusions: Over one-third of prescribing was guided by senior ED clinicians or based on specialty advice, primarily surgical specialties. Prescriber confidence was high regardless of seniority or decision-maker. Overall appropriateness of prescribing was good, but with room for improvement. Future qualitative research may provide further insight into the intricacies of prescribing decision-making.

【 授权许可】

Unknown