Dynamics of Antibiotic Prescription in Royal Hampshire County Hospital in November 2016: A Prospective Study
Background: Antimicrobial Stewardship and The Start Smart – Then Focus strategy provide guidelines aimed at improving the increasing trend of antibiotic resistance. The aim of this study was to assess whether antibiotics were being prescribed at Royal Hampshire County Hospital (a district general hospital), in accordance with the hospital’s and the NICE guidelines and whether this followed the Start Smart – Then Focus approach.
Methods: During November 2016, medical notes of 12 randomly selected in-patients of Royal Hampshire County Hospital on 45 antibiotics, were used to measure the dynamics of their prescriptions.
Results: 91% of the 45 prescriptions were in accordance with hospital guidelines, 82% of cases had appropriate samples sent before commencing antibiotics, 5% out of 27% had a planned switch from intravenous administration to oral (the remaining 73% were initially started on oral regimes) and 80% had planned stop dates.
Conclusion: Appropriate samples, stop dates, planning and documentation in patient notes must be improved with regards to antibiotic use.
Costelloe C, Metcalfe C, Lovering A, Mant D, D Hay A. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. British Medical Journal. 2010;304:c2096. doi:10.1136/bmj.c2096
Pathiraja. Antimicrobial Stewardship Start Smart – Then Focus: Guidance for Antimicrobial Stewardship for SHSCT [Internet]. 2015 Oct. Available from: http://www.southernguidelines.hscni.net/?wpfb_dl=220 [Accessed 22nd January 2017].
NICE Guidance. Antimicrobial Stewardship: Prescribing Antibiotics (KTT9). 2015 Jan. Available from: https://www.nice.org.uk/guidance/ktt9/resources/antimicrobial-stewardship-prescribing-antibiotics-1632178559941 [Accessed 22nd January 2017].
Llewelyn M. J, Fitzatrick J. M, Darwin E, Tonkin-Crine S, Gorton C, Paul J, et al. The antibiotic course has had its day. BMJ. 2017 Jul 26;358:j3418.
World Health Organization (WHO). World Health Organization Antimicrobial Resistance Fact Sheet Updated October 2017. http://www.who.int/mediacentre/factsheets/fs194/en/ [Accessed November 6th 2017].
NICE Guidance. Antimicrobial Stewardship: Systems and Processes for Effective Antimicrobial Medicine Use (NG15). 2015 Aug. Available from: https://www.nice.org.uk/guidance/ng15/resources/antimicrobial-stewardship-systems-and-processes-for-effective-antimicrobial-medicine-use-1837273110469 [Accessed January 22nd 2017].
NICE Guidance. Antimicrobial Stewardship (QS121). 2016 Apr. Available from: https://www.nice.org.uk/guidance/qs121/resources/antimicrobial-stewardship-75545353537477 [Accessed 22nd January 2017].
Kumar A, Roberts D, E. Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006 Jun;34(6):1589-96.
Public Health England. Start Smart – Then Focus Antimicrobial Stewardship Toolkit for English Hospitals Updated March 2015 [Internet]. 2015 March. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/417032/Start_Smart_Then_Focus_FINAL.PDF [Accessed 24th January 2017].
Davies S. Annual Report of the Chief Medical Officer 2011: Volume Two. Infections and the Rise of Antimicrobial Resistance. Available from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/138331/CMO_Annual_Report_Volume_2_2011.pdf [Accessed 4th August 2017].
Start Smart Then Focus Prescribers checklist. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/366944/Secondary_care_prescribers_checklist.pdf [Accessed 28th January 2017].
Iechyd Cyhoeddus Cymru Public Health Wales. Antimicrobial Stewardship: “Start Smart – Then Focus” Guidance for Antimicrobial Stewardship for Hospitals in Wales. Available from: http://www.wales.nhs.uk/sitesplus/documents/888/Public%20Health%20Wales%20Antimicrobial%20Stewardship%20Guidance.pdf [Accessed 28th January 2017].
Lockwood AR, Bolton NS, Winton MD, Carter JT. Formalization of an antimicrobial stewardship program in a small community hospital. Am J Health Syst Pharm. 2017 Sep 1;74(17 Supplement 3):S52-S60.
Barlam TF, Cosrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an antibiotic stewardship program; guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016 May 15;62(10):e51-77.
MicroGuide. Available from: http://www.microguide.eu/ [Accessed 25th June 2017].
Huttner A, Harbarth S, Carlet J, Cosgrove S, Goossens H, Holmes A, et al. Antimicrobial Resistance: a global view from the 2013 World Healthcare-Associated Infections Forum. Antimicrob Resist Infect Control. 2013 Nov 18;2:31.
Berrevoets MA, Ten Oever J, Sprong T, van Hest RM, Groothuis I, van Heijl I, et al. Monitoring, documenting and reporting the quality of antibiotic use in the Netherlands: a pilot study to establish a national antimicrobial stewardship registry. BMC Infect Dis. 2017 Aug 15;17(1):565.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to firstname.lastname@example.org
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to email@example.com