Format of medical order sheet improves security of antibiotics prescription: The experience of an intensive care unit*


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Abstract

ObjectiveTo assess whether formatting the medical order sheet has an effect on the accuracy and security of antibiotics prescription.DesignProspective assessment of antibiotics prescription over time, before and after the intervention, in comparison with a control ward.SettingThe medical and surgical intensive care unit (ICU) of a university hospital.PatientsAll patients hospitalized in the medical or surgical ICU between February 1 and April 30, 1997, and July 1 and August 31, 2000, for whom antibiotics were prescribed.InterventionFormatting of the medical order sheet in the surgical ICU in 1998.Measurements and Main ResultsCompliance with the American Society of Hospital Pharmacists’ criteria for prescription safety was measured. The proportion of safe orders increased in both units, but the increase was 4.6 times greater in the surgical ICU (66% vs. 74% in the medical ICU and 48% vs. 74% in the surgical ICU). For unsafe orders, the proportion of ambiguous orders decreased by half in the medical ICU (9% vs. 17%) and nearly disappeared in the surgical ICU (1% vs. 30%). The only missing criterion remaining in the surgical ICU was the drug dose unit, which could not be preformatted. The aim of antibiotics prescription (either prophylactic or therapeutic) was indicated only in 51% of the order sheets.ConclusionsFormatting of the order sheet markedly increased security of antibiotics prescription. These findings must be confirmed in other settings and with different drug classes. Formatting the medical order sheet decreases the potential for prescribing errors before full computerized prescription is available.

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