Hostname: page-component-7dd5485656-s6l46 Total loading time: 0 Render date: 2025-10-31T01:53:11.256Z Has data issue: false hasContentIssue false
  • English
  • Français

Improving Antimicrobial Use in the Hospital Setting by Providing Usage Feedback to Prescribing Physicians

Published online by Cambridge University Press:  21 June 2016

Forest W. Arnold ,
L. Clifford McDonald ,
R. Scott Smith ,
David Newman  and
Julio A. Ramirez
Forest W. Arnold*
Affiliation:
Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Kentucky
L. Clifford McDonald
Affiliation:
Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Kentucky
R. Scott Smith
Affiliation:
Department of Pharmacy, Veterans Affairs Hospital, Louisville, Kentucky
David Newman
Affiliation:
Department of Pharmacy, Veterans Affairs Hospital, Louisville, Kentucky
Julio A. Ramirez
Affiliation:
Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Kentucky
*
512 South Hancock Street, Carmichael Building, Room 208E, Louisville, KY 40292 (F.Arnold@louisville.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine whether feedback on antimicrobial use improves physician compliance with local hospital guidelines on antimicrobial prescribing.

Design.

In this time series analysis, in which a historical control period was compared with an intervention period, all orders for antimicrobials (except those for surgical prophylaxis) placed from November 1, 2002, through April 30, 2004, were prospectively evaluated by an antimicrobial management team (AMT) for compliance with local hospital guidelines. During the control period, orders were evaluated to determine compliance with hospital guidelines before and after recommendations by the AMT were provided to physicians. Feedback was given for the second 9-month period in the form of a weekly report to prescribing physicians, a monthly hospital newsletter, and a quarterly report to various hospital committees. During the intervention period, orders were evaluated to determine compliance with hospital guidelines before and after recommendations by the AMT were provided to physicians.

Setting.

The Veterans Affairs Medical Center, a 110-bed facility, in Louisville, Kentucky.

Participants.

Internal medicine physicians and general surgeons.

Results.

A total of 2,807 antimicrobial courses were evaluated. Compliance with hospital guidelines before AMT recommendations was 70% during the control period and 74% during the intervention period (P = .02). Compliance after AMT recommendations was 90% during the control period and 93% during the intervention period (P ≤ .01).

Conclusion.

The use of feedback had a significantly favorable impact on physician compliance with the hospital's guidelines on antimicrobial prescribing. Use of feedback should be added to the list of interventions that promote appropriate antimicrobial use in the hospital setting.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 4 , April 2006 , pp. 378 - 382
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Pestotnik, SL, Classen, DC, Evans, RS, Burke, JP. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med 1996; 124:884–890.Google Scholar
2.Kunin, CM, Tupasi, T, Craig, WA. A brief exposition of the problem and some tentative solutions. Ann Intern Med 1973; 79:555–560.Google Scholar
3.Marr, JJ, Moffet, HL, Kunin, CM. Guidelines for improving the use of antimicrobial agents in hospitals: a statement by the Infectious Diseases Society of America. J Infect Dis 1988; 157:869–876.Google Scholar
4.Shlaes, DM, Gerding, DN, John, JF Jr, et al. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Clin Infect Dis 1997; 25:584–599.Google Scholar
5.Arnold, FW, Newman, D, Smith, S, McDonald, LC, Ramirez, JA. Improving antimicrobial use: longitudinal assessment of a hospital antimicrobial team including clinical pharmacist. J Manag Care Pharm 2004; 10:152–158.Google Scholar
6.Condon, RE, Schulte, WJ, Malangoni, MA, Anderson-Teschendorf, MJ. Effectiveness of a surgical wound surveillance program. Arch Surg 1983; 118:303–307.CrossRefGoogle ScholarPubMed
7.Hux, JE, Melady, MP, Deboer, D. Confidential prescriber feedback and education to improve antibiotic use in primary care: a controlled trial. Can Med Assoc J 1999; 161:388–392.Google Scholar
8.O'Connell, DL, Henry, D, Tomlins, R. Randomised controlled trial of effect of feedback on general practitioners' prescribing in Australia. BMJ 1999;318:507–511.Google Scholar
9.Cook, P, Catrou, P, Christie, J, Young, P, Polk, R. Reduction in broad-spectrum antimicrobial use associated with no improvement in hospital antibiogram. J Antimicrob Chemother 2004; 53:853–859.Google Scholar
10.Zwar, N, Wolk, J, Gordon, J, Sanson-Fisher, R, Kehoe, L. Influencing antibiotic prescribing in general practice: a trial of prescriber feedback and management guidelines. Fam Pract 1999; 16:495–500.Google Scholar
11.Arnold, F, McDonald, LC, Mangino, P, Dobbs, S, Ramirez, J. The appropriateness of hospital antimicrobial use between medical and surgical specialties. Formulary 2004; 39:304–308.Google Scholar