Feasibility of a Tertiary Hospital Antimicrobial Stewardship Ward Round Using an Electronic Prescribing System—A Pilot Study

Abstract

Objectives The aim was to conduct a pilot study to determine staff resource requirements for an antimicrobial stewardship (AMS) ward round informed by electronic prescriptions, and the number of restricted antimicrobial prescriptions that would prompt a ward round recommendation.

Methods Prescription data on 26 restricted antimicrobial agents (which have specific prescribing criteria defined by the national drug funding agency) were extracted from the electronic prescribing and administration system (MedChart). A language query was used for specific antimicrobial names on Mondays, Wednesdays, and Fridays over 4 weeks. Prescriptions that had ceased or had an appropriate indication documented were excluded. The remaining prescriptions were evaluated in the ward round upon clinical record review with theoretical AMS recommendations made and time requirements recorded. The ward rounds were performed by two clinical staff, a doctor and pharmacist.

Results In 12 days, 622 prescriptions were extracted. Of these, 66 were evaluated in ward rounds, with 67% (44/66) being for ciprofloxacin or piperacillin-tazobactam. Theoretical AMS recommendations were made in 61% (40/66) of cases, 45% (18/40) being to use a narrower spectrum agent, 30% (12/40) to consult the Infectious Diseases Service, and 23% (9/40) to stop antimicrobial therapy. Data extraction took an analyst approximately 15 minutes, screening by a doctor approximately 20 minutes, and ward rounds approximately 41 minutes per day.

Conclusion Our approach required, in total, approximately 100 clinical staff minutes per day to screen approximately 50 prescriptions and identify and evaluate approximately four prescriptions and showed clinical value. Resource planning should also consider Infectious Diseases and/or Microbiology (physician and service) involvement, and audit capability.

Keywords

electronic prescriptions - pharmacy - medicine - antimicrobial stewardship - antimicrobial resistance - Infectious Diseases Service - resident doctor

Protection of Human and Animal Subjects

In accordance with guidance from the New Zealand Health and Disability Ethics Committee (https://ethics.health.govt.nz/), this project did not require full ethical review as it was a noninterventional audit-related activity to determine the resourcing requirements for a quality improvement initiative.

Publication History

Received: 03 November 2019

Accepted: 30 July 2020

Article published online:
22 September 2020

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