Antibiotic Prescribing Trends Before and After Implementation of an Audit and Feedback Program in Internal ward of a Tertiary Hospital in Tehran

Document Type: Research article

Authors

1 Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Department of Pharmaceutical Care Unit, Emam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Food Safety Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 Department of Infectious Diseases, Imam Hossein Teaching and Medical Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

5 Department of Pulmonary and Critical Care Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

We implemented a post prescribing review and feedback program to investigate its effect on appropriateness of antimicrobial use and antimicrobial consumption rate.
A pre-post interventional study conducted in internal ward of Imam Hossein teaching hospital. For nine months of intervention phase, medical file of all patients who received intravenous antibiotic were reviewed by a clinical pharmacy specialist. Discrepancies from international and local guidelines were discussed with physicians. Outcome measures included appropriateness of antimicrobial usage, length of stay, and broad-spectrum antimicrobial usage rate.
A total of 198 antibiotic courses (154 in intervention phase and 44 in pre-intervention phase) were reviewed. One-hundred sixty-seven recommendations in treatment course of 75.3% of patients were made. The most common recommendations were discontinuing antibiotics and changing from intravenous to oral therapy (35% and 22%). The acceptance rate was 80.2%.
Rate of discrepancies from guidelines was compared between pre-intervention and two last months of intervention period which showed a significant reduction in antibiotic choosing (47%, P-value < 0.001), de-escalation (48%, P-value < 0.001), on time changing intravenous to oral therapy (60%, P-value < 0.001) and dosing schedule (30%, P-value = 0.003).
Hospital length of stay showed a significant reduction from 16.1 days to 11.6 days (P-value < 0.05) between pre-intervention and post-intervention group. Mortality rate was not different in the patients that intervention in their treatment was accepted vs. rejected (P-value = 1.00). There was a reduction trend in consumption rate of Carbapenems, Vancomycin, and Ciprofloxacin.
Therefore, prospective audit and feedback program effectively decreased inappropriate treatment and hospital length of stay with no effect on mortality.

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