Cotta M O, Robertson M S, Upjohn L M, Marshall C, Liew D, Buising K L
Victorian Infectious Diseases Service, Melbourne Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2014 Mar;44(3):240-6. doi: 10.1111/imj.12353.
Appropriateness of antimicrobial use is a measure of key importance in evaluating safety and quality of prescribing but has been difficult to define and assess on a wide scale. Published work is limited and has generally focused on tertiary public hospitals, whereas the private sector provides a significant proportion of care in many countries. Information on prescribing in the private hospital context is needed to identify where intervention might be required. An antimicrobial prescribing survey tool was utilised to assess the appropriateness of antimicrobial prescribing among large private hospitals in Australia.
'Appropriateness' of antimicrobial therapy was evaluated by a team consisting of an infectious diseases physician and specialist infectious diseases pharmacist based on clear criteria.
Thirteen hospital-wide point-prevalence surveys were conducted. Three thousand, four hundred and seventy-two inpatient medication charts were reviewed to identify 1125 (32.4%) inpatients on 1444 antimicrobials. An indication was documented in 911 (63.1%) of surveyed prescriptions, and overall, 757 (52.4%) of antimicrobials were assessed as appropriate. Antimicrobials prescribed for treatment had a higher proportion of appropriateness when compared with antimicrobials prescribed for surgical prophylaxis (80.4% vs 40.6%). The main reason for a treatment prescription to be considered inappropriate was incorrect selection, while prolonged duration (>24 h) was the main reason for inappropriate surgical prophylaxis prescriptions.
This study provides important data on antimicrobial prescribing patterns in Australian private hospitals. Results can be used to target areas for improvement, with documentation of indication and surgical antibiotic prophylaxis requiring initial attention.
抗菌药物使用的合理性是评估处方安全性和质量的一项关键指标，但一直难以在广泛范围内进行定义和评估。已发表的研究工作有限，且通常集中在三级公立医院，而在许多国家，私立部门提供了相当比例的医疗服务。需要私立医院环境下的处方信息来确定可能需要干预的地方。我们利用一种抗菌药物处方调查工具来评估澳大利亚大型私立医院抗菌药物处方的合理性。
由一名传染病医生和一名传染病专科药剂师组成的团队根据明确的标准对抗菌治疗的“合理性”进行评估。
开展了13次全院范围的现患率调查。审查了3472份住院患者用药记录，以确定1444例使用抗菌药物的1125名（32.4%）住院患者。911份（63.1%）受调查处方记录了用药指征，总体而言，757份（52.4%）抗菌药物被评估为合理。与用于手术预防的抗菌药物相比，用于治疗的抗菌药物合理性比例更高（80.4%对40.6%）。治疗处方被认为不合理的主要原因是选择不当，而用药时间过长（>24小时）是手术预防处方不合理的主要原因。
本研究提供了有关澳大利亚私立医院抗菌药物处方模式的重要数据。研究结果可用于确定需要改进的领域，用药指征的记录和手术抗生素预防需要首先关注。
