Omitted doses as an unintended consequence of a hospital restricted antibacterial system: a retrospective observational study
File(s)
Published version
Author(s)
Powell, N
Franklin, BD
Jacklin, A
Wilcock, M
Type
Journal Article
Abstract
Objective: To determine the frequency of omitted doses of antibacterial agents and explore a number of risk factors, including the effect of a restricted antibacterial system.
Methods: Antibacterial data were extracted from a hospital electronic prescribing and medication administration system for the period 1 January to 30 April 2014. Percentage dose omission rates were calculated. Omission rates for the first dose of antibacterial courses were analysed using logistic regression to identify any correlation between first dose omission rates and potential risk factors including the antibacterials’ restriction status and whether or not they were ward stock.
Results: 90,761 antibacterial doses were included. Of these, 6,535 (7.2%) were documented as having been omitted; 847 (0.9% of 90,761) due to medication being unavailable. Non-restricted, ward stock antibacterials had the lowest frequency of omission with 6.2% (271 of 4,391) first doses omitted. The prevalence was 10.4% (27 of 260) for restricted, ward stock antibacterials (OR = 1.6, 95% CI: 1.0 – 2.4, p = 0.027), and 15.5% (53 of 341) for non-restricted, non-ward stock antibacterials (OR = 2.7, 95% CI: 2.0 – 3.7, p = <0.001). Restricted, non-ward stock antibacterials had the highest frequency of 30.7% (71 of 231; OR = 6.2, 95% CI: 4.5 to 8.4, p = <0.001).
Conclusions: Antibacterials not stocked in clinical areas were significantly more likely to be omitted. The prevalence of omitted doses increased further if the antibiotic was also restricted. To achieve safe effective antimicrobial use, a balance is needed between promoting antimicrobial stewardship and preventing unintended omitted doses.
Methods: Antibacterial data were extracted from a hospital electronic prescribing and medication administration system for the period 1 January to 30 April 2014. Percentage dose omission rates were calculated. Omission rates for the first dose of antibacterial courses were analysed using logistic regression to identify any correlation between first dose omission rates and potential risk factors including the antibacterials’ restriction status and whether or not they were ward stock.
Results: 90,761 antibacterial doses were included. Of these, 6,535 (7.2%) were documented as having been omitted; 847 (0.9% of 90,761) due to medication being unavailable. Non-restricted, ward stock antibacterials had the lowest frequency of omission with 6.2% (271 of 4,391) first doses omitted. The prevalence was 10.4% (27 of 260) for restricted, ward stock antibacterials (OR = 1.6, 95% CI: 1.0 – 2.4, p = 0.027), and 15.5% (53 of 341) for non-restricted, non-ward stock antibacterials (OR = 2.7, 95% CI: 2.0 – 3.7, p = <0.001). Restricted, non-ward stock antibacterials had the highest frequency of 30.7% (71 of 231; OR = 6.2, 95% CI: 4.5 to 8.4, p = <0.001).
Conclusions: Antibacterials not stocked in clinical areas were significantly more likely to be omitted. The prevalence of omitted doses increased further if the antibiotic was also restricted. To achieve safe effective antimicrobial use, a balance is needed between promoting antimicrobial stewardship and preventing unintended omitted doses.
Date Issued
2015-08-27
Date Acceptance
2015-08-01
Citation
Journal of Antimicrobial Chemotherapy, 2015, 70 (12), pp.3379-3383
ISSN
1460-2091
Publisher
Oxford University Press (OUP)
Start Page
3379
End Page
3383
Journal / Book Title
Journal of Antimicrobial Chemotherapy
Volume
70
Issue
12
License URL
Publication Status
Published