Improvement Needed in Hospital Antimicrobial Prescription

The National Antimicrobial Prescribing Practice: results of the 2014 National Antimicrobial Prescribing Survey report was released by the Australian Commission on Safety and Quality in Health Care and the National Centre for Antimicrobial Stewardship in Victoria. It summarises the results of a voluntary annual audit of 248 hospitals (197 public and 51 private) from across Australia and resulted in a data set of almost 20,000 prescriptions.
A total of 248 hospitals (197 public and 51 private) participated in the NAPS in 2014, a 64% increase from the previous year. The results demonstrate a number of areas where significant improvements can be made at the hospital level, as well as regionally and nationally.
University of Melbourne Associate Professor Karin Thursky Director of NCAS says, “This report provides a snapshot of medication charts and patient records that have been assessed for appropriateness of antimicrobial prescribing and compliance with guidelines. Almost one-quarter of the prescriptions surveyed were considered to have been inappropriate.”
The report shows:

• Approximately one-quarter (24.3%) of the 19,944 prescriptions surveyed were non-compliant with guidelines, and 23 per cent were deemed to be inappropriate.


• Only 74 per cent of antimicrobials prescribed had their indications documented in the medical notes (more than 95% is considered best practice).


• Surgical prophylaxis continues to be an issue with 35.9% of the survey prescriptions continuing beyond 24 hours (less than 5 per cent is considered best practice).  40.2% of prescriptions for surgical prophylaxis were also considered inappropriate, mainly due to incorrect duration and dose, and absence of an indication for an antimicrobial.


• Infective exacerbation of chronic obstructive pulmonary disease was poorly prescribed (36.8% were deemed inappropriate), as were other respiratory tract infections such as bronchitis (50.7% inappropriate) and exacerbation of asthma (70.0% inappropriate).


• The most common prescribed antimicrobials were cephazolin, ceftriaxone and metronidazole.

The Commission’s Senior Medical Advisor, Professor John Turnidge, says, “Antimicrobial resistance is a serious and looming threat to public health. The single most powerful contributor to resistance is misuse of antibiotics.
“The NAPS report shows us there is still significant room for improvement in the appropriateness of antimicrobial prescribing at the hospital level. We need to ensure patients receive the right antibiotic for their condition, the right dose, at the right time and for the right length of time, based on accurate assessment and timely review,” he says.
The report can be accessed here.