engleski

Antimicrobial Prescribing at a University Hospital: Justitied or "Just in Case". Testing a New Scoring System as a Key Quality Indicator

Background: Inappropriate use of antimicrobials in hospitals contributes to the emergence of resistant miocroorganisms, increased costs and unnecessary exposure of patients to drugs. There is a variety of methods that aim to improve their use. However, criteria for evaluation of appropriateness or quality of antimicrobial drug use have not been defined. Measurment of quality by using specific indicators has been suggested as an effective measure of performace. Objective. To evaluate the quality of antimicrobial drug prescribing at a department of medicine at a university hospital by using a new scoring system as a quality indicator. Design. A prospective, longitudinal survey, during a 21-week period. The necessity of antimicrobial treatment for all inpatients at the department of medicine for whom new antimicrobials were prescribed was asessed using a scoring system based on the presence of signs and symptoms of an infection. If the total score sum was 3 or more the antimicrobial treatment was deemed justified ; if the score was less than 3 the antimicrobial treatment was regarded as questionable. Setting. Department of medicine (279 patient-beds) at the University Hospital Center Rijeka, a 1200-bed teaching hospital in Croatia. Results. Antimicrobials were prescribed to 15% of the patients. They were given for tretment in 89% of the patients, of whom 67% empirically. According to the scoring system, 29% of the patients did not have justified indication for antimicrobial treatment. Conclusion. The proposed quality indicator (the scoring system) that we used is a simple method for assessment of the quality of antimicrobial use. It has pointed at areas that require in-depth analysis. We suggest futher validation of this key quality indicator.

antimicrobial prescribing; quality indicator; scoring system

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