Introduction Antimicrobial resistance is increasing globally. Surgical inpatients are more likely to receive inappropriately broad-spectrum and prolonged antimicrobial treatment, against local policy. Electronic prescribing (e-prescribing) has the potential to promote antimicrobial stewardship. We conducted a closed-loop audit to assess the impact of e-prescribing on surgical inpatient prescriptions. Method Audit standards (from Public Health England) included: (1) documentation of allergy status, prescriber contact information, antimicrobial indication and review/stop dates; and (2) prescription of appropriate antimicrobials for appropriate durations (IV and total). Prospective data collection occurred over 1-week. The interventions included an educational session, a once weekly microbiology round of surgical inpatients and the introduction of e-prescribing (Cerner©). Results Compliance improved significantly between cycle 1 (n = 54 prescriptions) and 2 (n = 59 prescriptions), for: documentation of prescriber contact details (69 vs 100%) and appropriate antimicrobial review/stop dates (17 vs 100%), indications (78 vs 96%), selection (76 vs 90%) and IV and total antibiotic duration (63 vs 93% and 87 vs 100%, respectively); p < 0.05 throughout. Conclusions Audit compliance improved significantly, partly because Cerner© prompts clinicians to input contact details, review dates and indications before prescribing. E-prescribing in combination with appropriate education is likely to promote antimicrobial stewardship and should be considered by other Trusts using paper prescriptions.
Aim Intimate examinations are potentially uncomfortable and embarrassing. In addition to offering chaperones routinely, it is also important to clearly document the circumstances, with implications on patient dignity and safeguarding both patients and staff. We aimed to analyse the quality of chaperone documentation in the breast clinic before and after intervention. Method Audit standards (GMC and Chelsea & Westminster Trust guidelines): [1] Consent [2] Chaperone use/refusal, and [3] Chaperone role and identity should be clearly documented in the notes. We collected breast clinic data prospectively over one week, then re-audited after interventions including teaching sessions to the breast MDT, introduction of electronic (e)-notes (Cerner©), and creation of an instructional video demonstrating how to create an automatic template to easily document the aspects of chaperone use. Results 110 patients’ notes were analysed in the first cycle, and 74 in the second. Documentation improved significantly between cycle 1 and 2 for: consent (0% vs. 38%, p < 0.0001), identity of chaperone (12% vs. 35%, p = 0.0003), and role of chaperone (8% vs. 23%, p = 0.0091). Documentation for chaperone use or refusal improved, but this was not significant (27% vs. 35%, p = 0.3305). Conclusions Documentation improved significantly for most standards, likely due to the template prompting the clinician. However, documentation remains suboptimal. Possible reasons include forgetfulness in a busy clinic, or shortage of staff available to chaperone. Future recommendations include creating a mandatory template on the e-notes for all breast clinic documentation including a section for chaperone use, role, and identity, and providing more staff such as HCAs for the clinic.
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