Hamill Laura M, Bonnett Julia, Baxter Megan F, Kreutz Melina, Denny Kerina J, Keijzers Gerben
Department of Emergency Medicine, Christchurch Hospital, Canterbury DHB, Christchurch 8011, New Zealand.
School of Medicine, Griffith University, Gold Coast, QLD 4215, Australia.
Antibiotics (Basel). 2021 Jul 10;10(7):843. doi: 10.3390/antibiotics10070843.
Inappropriate antimicrobial prescribing in the emergency department (ED) can lead to poor outcomes. It is unknown how often the prescribing clinician is guided by others, and whether prescriber factors affect appropriateness of prescribing. This study aims to describe decision making, confidence in, and appropriateness of antimicrobial prescribing in the ED. Descriptive study in two Australian EDs using both questionnaire and medical record review. Participants were clinicians who prescribed antimicrobials to patients in the ED. Outcomes of interest were level of decision-making (self or directed), confidence in indication for prescribing and appropriateness (5-point Likert scale, 5 most confident). Appropriateness assessment of the prescribing event was by blinded review using the National Antibiotic Prescribing Survey appropriateness assessment tool. All analyses were descriptive. Data on 88 prescribers were included, with 61% making prescribing decisions themselves. The 39% directed by other clinicians were primarily guided by more senior ED and surgical subspecialty clinicians. Confidence that antibiotics were indicated (Likert score: 4.20, 4.35 and 4.35) and appropriate (Likert score: 4.07, 4.23 and 4.29) was similar for juniors, mid-level and senior prescribers, respectively. Eighty-five percent of prescriptions were assessed as appropriate, with no differences in appropriateness by seniority, decision-making or confidence. Over one-third of prescribing was guided by senior ED clinicians or based on specialty advice, primarily surgical specialties. Prescriber confidence was high regardless of seniority or decision-maker. Overall appropriateness of prescribing was good, but with room for improvement. Future qualitative research may provide further insight into the intricacies of prescribing decision-making.
急诊科不恰当的抗菌药物处方可能导致不良后果。目前尚不清楚处方医生受他人指导的频率，以及处方医生的因素是否会影响处方的恰当性。本研究旨在描述急诊科抗菌药物处方的决策过程、信心以及恰当性。在澳大利亚的两家急诊科进行描述性研究，采用问卷调查和病历审查相结合的方式。参与者为在急诊科为患者开具抗菌药物的临床医生。感兴趣的结果包括决策水平（自主决策或受他人指导）、对处方适应证的信心以及恰当性（5级李克特量表，5表示最有信心）。使用国家抗生素处方调查恰当性评估工具，通过盲法审查来评估处方事件的恰当性。所有分析均为描述性分析。纳入了88位处方医生的数据，其中61%自行做出处方决策。其余39%受其他临床医生指导，主要是急诊科资深医生和外科亚专科医生。初级、中级和高级处方医生对使用抗生素的信心（李克特评分分别为4.20、4.35和4.35）以及对处方恰当性的信心（李克特评分分别为4.07、4.23和4.29）相似。85%的处方被评估为恰当，在资历、决策方式或信心方面，处方恰当性没有差异。超过三分之一的处方是受急诊科资深医生指导或基于专科建议，主要是外科专科。无论资历或决策人如何，处方医生的信心都很高。总体处方恰当性良好，但仍有改进空间。未来的定性研究可能会进一步洞察处方决策的复杂性。
