Article Text

Download PDFPDF
CP-089 ‘Start smart’: Improving the quality of empiric antimicrobial prescribing in a tertiary children’s hospital setting
  1. M Kirrane1,
  2. R Cunney2
  1. 1Temple Street Children’s University Hospital, Pharmacy, Dublin 1, Ireland Rep
  2. 2Temple Street Children’s University Hospital, Microbiology, Dublin 1, Ireland Rep


Background Rational antibiotic prescribing, in line with local guidelines, improves patient outcomes and reduces adverse events. The ‘Start Smart, then Focus’ antimicrobial care bundle provides a framework for rational antibiotic prescribing. Compliance with the care bundle was suboptimal at this tertiary paediatric hospital.

A team with representatives from the pharmacy, microbiology and emergency departments collaborated with prescribers to improve the quality of empiric antibiotic prescribing at this institution.

Purpose The project aim, using the ‘Model for Improvement’, was to ensure ≥90% of children admitted to the hospital via the emergency department (ED) and commenced on antibiotic therapy have a documented indication and a choice of therapy in line with local antimicrobial guidelines.

Material and methods Results of weekly audits of the first 10 children admitted via the ED and started on antibiotics were fed back to prescribers. Frontline ownership techniques borne from brainstorming sessions with ED staff were used to develop ideas for change. These included: regular antibiotic prescribing discussion at Monday morning handover meeting, an antibiotic ‘spot quiz’ for prescribers, updates to prescribing guidelines (along with improved access and promotion of prescribing app), colour coded quick reference guideline summary cards which could be attached to prescriber ID badges and reminders and guideline summaries at point of prescribing in the ED.

Collection of audit data initially proved challenging, but was resolved through a series of rapid Plan-Do-Study-Act (PDSA) cycles. Presentation of weekly run charts to prescribers fostered considerable support among consultants and non-consultant doctors.

Results Documentation of indication and guideline compliance increased from a median of 30% in December 2014/January 2015 to 100% in February–May 2015. Monthly antibiotic expenditure for the hospital decreased from €32 000 in January 2015 to €13 000 in May 2015. Ongoing monthly audits continue to show 100% compliance.

Conclusion Prescriber engagement, frequent data feedback and rapid audit cycles resulted in a sustained improvement in the quality of empiric antibiotic prescribing at this hospital.

These interventions could easily be adapted by hospital pharmacists in other settings.

References and/or Acknowledgements I would like to acknowledge the support of our ED team and hospital prescribers. This sense of ownership contributed to the success of this quality improvement project.

No conflict of interest.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.