Antibiotic use and the effect of prescribing guidelines in care of the elderly.

The study examined the effect and acceptability of the introduction of prescribing guidelines on antibiotic prescribing in elderly, hospitalised patients. Three audits of antibiotic use were carried out, one before (n=324) and two after (n=302 & 263) the introduction of the antibiotic treatment guidelines. Three types of hospital bed were included in the audit: geriatric assessment, long stay and general practitioner. The guidelines, consisting of wall charts and booklet, were based on published clinical evidence and local bacterial sensitivities and produced in collaboration with medical practitioners. They were introduced using various promotional strategies, including seminars, posters, stickers and feedback of audit data. After the introduction of the guidelines there was no significant difference in the mean cost of treatment, mean total length of course, mean length of intravenous course, level of documentation in medical notes or compliance with Grampian Healthboard antibiotic policy. There were, however, significant improvements in the following areas: an increase in the percentage of patients for whom an antibiotic prescription was deemed appropriate. (Phase 1: 73.4%; Phase 2: 81.5%; Phase 3; 86.7%; p = <0.001, Chi-square test). A reduction in the percentage of patients where a non-formulary antibiotic was used without valid reason. (Phase 1: 24.1%; Phase 2: 22.8%; Phase 3: 12.5%; p = < 0.01, Chi-square test) an overall reduction in length of course for single treated infection (Phase 1: 8.46 ± 6.58 days (mean ± S.Dev) Phase 2: 7.31 ± 3.36 days; Phase 3: 7.31 ± 3.7; p = <0.05, Tukey-HSD test). This was also observed in certain specific infections in particular groups of patients. An improvement in the percentage of patients where an appropriate dose was chosen for the patient's renal function. (Phase 1: 72.8%; Phase 2: 83.1%; Phase 3: 85% p = < 0.0001, Chi-square test). An audit was carried out on 209 microbiological specimen reports. Only 11% of these resulted in a new prescription for an antibiotic. Where an antibiotic has already been prescribed, in the majority of the cases, the report did not lead to a change in therapy. Questionnaires (n = 32) and interviews (n = 25) employed to gauge guidelines acceptance showed that medical staff found the guidelines valuable (eg: wall charts of great value 11/32; some value 17/32; no value 4/32) and felt they had influenced prescribing (eg: choice of antibiotic 27/32). The guidelines have heightened prescribers' awareness of antibiotic use and proved a useful tool with which to audit practice.

Grantor dc:publisher.institution

Robert Gordon University

Year dc:date.issued

1997

Author dc:creator

• Hind, Caroline Anna

Advisor dc:contributor.advisor

• D. McCaig

• Prescribing guidelines
• Antibiotics
• Elderly patients
• Hospitalised patients
• Grampian health

Language dc:language

en

Identifier

oai:rgu-repository.worktribe.com:2807413
https://doi.org/10.48526/rgu-wt-2807413

OAI identifier oai:identifier

oai:rgu-repository.worktribe.com:2807413