Considering cost, waste and medicines optimisation in prescribing practice: answers

AbstractAntibiotic overuse is a major factor for causing antibiotic resistance globally. However, only few studies reported the implementation and evaluation of antimicrobial stewardship programs in Gulf Cooperation Council. This study was conducted within 8-months periods to evaluate the effect of the newly implemented antibiotic stewardship program on improving the prescribing practice of surgical antibiotic prophylaxis in a secondary care hospital in the United Arab Emirates by releasing local hospital guidelines. The data of 493 in patients were documented in the predesigned patient profile form and the prescribing practice of surgical antibiotic prophylaxis for clean and clean-contaminant surgical procedures was compared and analyzed two months’ prior (period A) and post (period B) the implementation of antibiotic stewardship program. The 347 patient’s data (PD) were analyzed during period A and 146 PD during period B. The prescription of piperacillin/tazobactam was decreased from 2.4% from all surgical prophylaxis antibiotic orders in period A to 0% in period B. The appropriateness of the antibiotic therapy was found to differ non significantly for the selection of prophylactic antibiotic (p = 0.552) and for the timing of first dose administration (p = 0.061) between A and B periods. The total compliance was decreased non significantly (P = 0.08) from 45.3 to 40.2%. Overall, the guidelines have improved the prescribing practice of antibiotics prior to surgery. However, further improvement can be achieved by initiating educational intervention via cyclic auditing strategy.

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Development of an explicit tool assessing potentially inappropriate medication use in Hong Kong elder patients

BMC Geriatrics ◽

10.1186/s12877-021-02024-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Huanyu Zhang ◽

Eliza LY Wong ◽

Eng-kiong Yeoh ◽

Bosco HM Ma

Keyword(s):

Hong Kong ◽

Inappropriate Medication ◽

Delphi Process ◽

Potentially Inappropriate Medication ◽

Medical Conditions ◽

Modified Delphi ◽

Adverse Health Outcomes ◽

Elder Patients ◽

Prescribing Quality ◽

Prescribing Practice

Abstract Background Potentially inappropriate medication (PIM) use has adverse effects on health, particularly in elder patients. Various country-specific explicit criteria have been developed to measure the appropriateness of prescribing worldwide. However, it is difficult to apply the criteria developed from other regions to measure and guide the local prescribing practice in Hong Kong. This study aims to develop a Hong Kong-specific PIM assessing tool from previously published criteria and validate this tool using the modified Delphi method. Methods A disease-oriented Hong Kong-specific preliminary PIM list was developed based on nine sets of reference criteria selected from a literature review. Any medication or medication class appeared in at least two sets of the reference criteria as well as its related medical conditions were selected as PIM candidates. After examining the availability of PIM candidates by the Hong Kong Hospital Authority drug formulary, the Hong Kong-specific preliminary PIM list was validated by a two-round of modified Delphi process. Eight experts from different specialties were invited to rate the degree of inappropriateness of each PIM candidate using a five-point Likert scale. The experts were also encouraged to propose therapeutic alternatives and new PIM candidates not covered by the preliminary PIM list. The PIM candidates that the expert panel didn’t reach consensus on were excluded from the final Hong Kong-specific PIM list. Results After two rounds of the Delphi process, eight PIM candidates remained questionable and thus were excluded from the PIM list. The final Hong Kong-specific PIM list included a total of 164 statements applicable to older adults aged 65 years or above, among which 77 were under PIMs independent of diagnoses, and 87 were under PIMs considering specific medical conditions. Conclusions The Hong Kong-specific PIM list can be used as a quality measure and an educational tool to improve the local prescribing quality. Further studies should validate its association with adverse health outcomes in clinical and research settings.

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District nurses' prescribing practice and its link to structural conditions

Journal of the American Association of Nurse Practitioners ◽

10.1002/2327-6924.12234 ◽

2015 ◽

Vol 27 (10) ◽

pp. 568-575 ◽

Cited By ~ 1

Author(s):

Susanne Blanck ◽

Maria Engström

Keyword(s):

District Nurses ◽

Prescribing Practice

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P-16 Audit of adherence to prescribing standards as a means of improving prescribing practice on drug charts in a hospice in-patient unit

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2017-00133.16 ◽

2017 ◽

Vol 7 (Suppl 1) ◽

pp. A6.1-A6

Author(s):

Annelise Matthews ◽

Nick Green ◽

Sunil Hathi ◽

Hamna Jaffar ◽

Arjun Kingdon ◽

...

Keyword(s):

Prescribing Practice ◽

P 16

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Medicines optimisation

Nursing Standard ◽

10.7748/ns.30.44.64.s47 ◽

2016 ◽

Vol 30 (44) ◽

pp. 64-65

Author(s):

Rachel Makombe

Keyword(s):

Medicines Optimisation

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115 An Audit on Dexamethasone Prescribing Practice on Surgically Managed Metastatic Spinal Cord Compression Patients in the Manchester Centre for Clinical Neurosciences: Lessons Learned in Closing the Loop

British Journal of Surgery ◽

10.1093/bjs/znab134.370 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

R Laurente ◽

R Mohammed ◽

M Elmalky

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cord Compression ◽

Lessons Learned ◽

Metastatic Spinal Cord Compression ◽

Loading Dose ◽

The Past ◽

Prescribing Practice ◽

Closing The Loop ◽

Almost All

Abstract Metastatic Spinal Cord Compression is a surgical emergency owing to its propensity to cause significant morbidity and mortality. Dexamethasone is prescribed to reduce oedema and promote vascular membrane stabilization. The is done so until a more definitive management has been performed. This is a retrospective study evaluating the steroid-prescribing practice for MSCC patients in 2018 at a tertiary spinal unit in Greater Manchester. Thirty-three patients who underwent stabilisation were evaluated in terms of both steroid prescribing and weaning practices. Standards used against for both were the NICE guidelines and the Edinburgh/Christie’s guidelines. Of the 33 patients evaluated, only 1 patient received the correct loading dose of 16mg, whilst 27 went straight to being given 8mg BD. 5 did not receive dexamethasone at all. In terms of discontinuation/weaning, 26 were weaned accordingly and 2 were not weaned to continue as adjuvant treatment. Dexamethasone prescribing practises has since improved over the past two years. 93% of the patients have been correctly weaned as compared to 38% in the past. In terms of prescription, much needs to be done as almost all the patients evaluated did not get the correct loading dose despite receiving the appropriate maintenance.

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