Documenting Indication Improves Antibiotic Prescribing

Requiring clinicians to provide a reason for prescribing an antibiotic could curb overuse.

Pointing to high antibiotic use in pediatric long-term care facilities, researchers recently piloted an antimicrobial stewardship program at the Elizabeth Seton Pediatric Center in New York.

Antimicrobial stewardship programs have been shown to shorten hospitals stays and decrease readmission rates for children in acute care facilities, as well as lower morbidity and mortality rates in adult care facilities.

“The concept of antimicrobial stewardship is spreading fairly quickly,” J. Russell May, PharmD, FASHP, a clinical professor at the University of Georgia College of Pharmacy, told Pharmacy Times in an exclusive interview. “I think people are recognizing the importance of that and the importance of having a pharmacist very active in that antimicrobial stewardship team in hospitals.”

The antimicrobial stewardship program piloted at the Elizabeth Seton Pediatric Center aimed to reduce the number of antibiotics ordered without a documented indication, as well as to decrease the use of topical mupirocin (Bactroban) for non-infectious conditions, such as skin rashes and abrasions.

To achieve these goals, researchers built a barrier into the facility’s electronic medical records that required prescribers to document the condition that dictated their antibiotic order. The study team also conducted monthly audits of all antibiotics prescribed from April 2014 to September 2014 and reviewed the data regularly with physicians, pharmacists, nurses, and administrators.

In that 6-month period, mupirocin use dropped 59% and the amount of antibiotic prescriptions without indications decreased 83%. Additionally, all mupirocin orders placed in September 2014 were for appropriate indications, the researchers reported.

“While this is a pilot program, it is clear that we can make a sizeable impact by getting our health care providers to really think about why they are prescribing antibiotics and whether they are necessary,” stated study author Olivia Jackson, an infection control coordinator at the Elizabeth Seton Pediatric Center.

Dr. May told Pharmacy Times that pharmacists can promote antibiotic stewardship by educating patients about how bacteria are spread, and also remind patients to never share antibiotics with others.