Background Antimicrobial stewardships in hospitals work with healthcare practitioners to help patients receive the most appropriate antimicrobial with the correct dose and duration. Time is one of the main limitations for optimal programme implementation.
Purpose To assess data in the first 3 months after a semi-automatic validation tool for antimicrobial prescribing was implemented.
Material and methods A semi-automatic validation tool for antimicrobial prescribing based on real time antibiogram was developed.
Patients’ antimicrobial treatments were obtained using the Farmatools application from the Computerised Physician Order Entry System (CPOE). The Omnium antimicrobial susceptibility database was checked against the microbiology laboratory. Both databases were integrated and associated in Access using ODBC. Inpatients with antimicrobial treatments and at least 1 antibiogram in the last 15 days were selected.
The software automatically assessed antimicrobials and antibiograms for all inpatients, and checked and notified whether medical prescriptions were appropriate. A report with a colour code for prescribed treatment was generated: green for proper antimicrobial prescriptions, orange for intermediate susceptibility and red for antimicrobial resistance.
Automatically generated reports were validated by the pharmacist each day. The pharmacist reported to the physicians discrepancies detected between antimicrobial prescriptions and antibiograms, using CPOE.
From 01 July 2015 to 15 October 2015, medical department, antimicrobials involved and pharmaceutical interventions were recorded. The latter were classified as withdrawal of treatment, therapy change, and incorrect antimicrobial dose or frequency.
Results The new software allowed the pharmacist to review all inpatients with antimicrobials and antibiograms every day in under an hour/day. There were 188 pharmacist interventions: 130 withdrawals of treatment proposals, 51 suggestions for therapy change, 6 incorrect antimicrobial doses and 1 incorrect frequency. The drugs most frequently involved were: piperacillin-tazobactam (19.7%), ceftriaxone (11.7%), amoxicillin-clavulanic (7.4%), imipenem (6.4%), cefuroxime-axetil (5.8) and other (49%). Pharmaceutical interventions were detected in internal medicine (38.3%), surgery (13.8%) and digestive (9.6%) departments, among others.
Conclusion The semi-automatic validation tool allows time optimisation: the antimicrobial stewardship team was able to check all inpatient antimicrobial prescriptions each day, based on antibiograms.
Almost three-quarters of pharmacist interventions were withdrawal treatment proposals, followed by suggestions for therapy change.
The most frequent discrepancies detected were in broad spectrum antibiotics, most of them in internal medicine and surgery inpatients.
References and/or Acknowledgements
Doron S, Davidson LE. Antimicrobial stewardship. Mayo Clin Proc 2011;86:1113-23
References and/or AcknowledgementsNo conflict of interest.
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