Surveillance of antibiotic use in a hospital

Background: the antibiotic committee of a hospital sets rules for the use of antibiotics. For adequate quality control the committee needs feedback about the adherence to her guidelines. We developed computerized surveillance of antibiotic use in our hospital.

Objective: to have a feedback tool about adherence to the antibiotic policy of the hospital with the purpose to adept the policy when this was to the point or improve adherence when necessary.

Methods: the hospital uses a computerized prescription system for medication (medicator). The antibiotic committee has indicated a number of antibiotics as not free for prescription. This means that the prescriber has to fill in a motivation explaining why he chooses the antibiotic in question in this case. The motivations are judged by a small group of assessors, specialists in microbiology and infectious diseases, using the following classifications: correct, incorrect regarding indication for treatment, choice or dosage according to antibiotic policy, and unsatisfactory information for judgment. Twice a year the antibiotic committee makes reports for the heads of departments to give them feedback about prescription practices of their staff. Once yearly a report is made showing the heads of departments how they perform in comparison with the others.

Results: the results are summarized in the table. The surveillance started in 2005. The number of departments increased gradually explaining the increase in reports and (assessed) prescriptions. The most frequent reasons for unsatisfactory information are referring to the advice of another specialist and not giving the weight of the patients for drugs that are dosed on body weight. The percentage of correct prescriptions gradually increased. The percentage of incorrect prescriptions stayed around one third of the prescriptions. The surveillance led to a number of specific actions of the antibiotic committee, e.g. adaption of the guideline of antibiotic prophylaxis after removal of a urinary catheter, correction of overdosing of children weighing 40 kg or more by pediatricians, stopping the pre-operative administration of mupirocine to all cardiac surgery patients, adaptation of the guideline for treatment of granulocytopenic children, discussing the overuse of chinolones and co-amoxiclav with departments that use these antibiotics incorrectly.  

	2005		2006		2007		2008
	number	%	number	%	number	%	number	%
Reports	8		33		48		48
Prescriptions			4816		7977		7886
Assessments	1488		3680	76	4959	62	5924	75
Correct	610	41	1703	46	2232	45	3119	53
Incorrect	664	45	1030	28	1734	35	1801	30
Unsatisfactory information	214	14	947	26	993	20	1004	17

Conclusions: the surveillance system for antibiotic use proved to be a valuable tool for the antibiotic committee that guides the activities of the committee to promote prudent use of antibiotics.