DOI: 10.1097/01.CCM.0000114993.74094.A9
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PMID: 15090980
Issn Print: 0090-3493
Publication Date: 2004/03/01
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Excerpt
In this issue of Critical Care Medicine, Dr. Wasserfallen and colleagues (4) share with journal readers a simple, yet elegant, intervention that increased safe antibiotic prescription practices in two intensive care units in Switzerland. In their study, they observed antibiotic prescription practices at their surgical (SICU) and medical (MICU) intensive care units from February to April 1997 to obtain a baseline rate of safe antibiotic orders when the medical order sheet was loosely formatted. The authors found that only 66% and 48% of orders in the MICU and SICU, respectively, were considered to be safe according to criteria set by the American Society of Hospital Pharmacists. The authors then shared their findings with both units and decided to implement a simple, formatted order sheet in the SICU the following year. In 2000, they performed another audit in both units, finding that safe antibiotic orders increased to 74% in both units at the expense of fewer ambiguous orders and fewer omissions, even when they had no further intervention in the MICU and the SICU did not fully comply with all the required variables.
This article is important because it shows how a simple intervention, such as preprinting an order format with minimum requirements, has a definite effect in safe prescription practices. More importantly, though, it shows that just observing a process and making people aware of it has a positive effect, such as was seen in their MICU, for which no further intervention was done after the initial observational period, yet antibiotic prescription safety improved. Nevertheless, this study has some limitations. The most relevant is the minimalist approach to antibiotic safety when so much more should be considered than the right name or dose, such as the appropriateness of the prescription for a particular patient and infection. There is little value to an appropriately administered antibiotic if the antibiotic was the wrong one to use in the first place or if no antibiotic was warranted at all. Another problem is the relatively short periods of observation (only a couple of months each time), with very large gaps in between. This could affect the study by introducing seasonal or temporal bias.
As the authors state at the end of their article (4), the future of this area most likely rests on informatics and computerized order entry (5, 6). This is an exciting area of medical information technology, in which expert systems integrated with several drug databases, pharmacy computers, laboratory computers, and patient information will provide both the “edit checks” and “appropriateness checks” required to reach that patient safety state we are all striving to achieve (7, 8). While we wait for these systems to be available, fully functional, and integrated into our hospitals (9), simple interventions like the one described by Dr. Wasserfallen and colleagues (4), along with good clinical judgment and just being careful when we write orders, should get us (and our patients) through the day.
