An audit of antimicrobial treatment of lower respiratory and urinary tract infections in a hospital setting

A clinical audit of sterile medical devices: a French experience of quality and safety improvement in hospital services

Objectives

To audit the quality and safe management of sterile medical devices (SMDs), to examine the pharmacist's role in a multidisciplinary team, and to provide an example of hospital staff assessment of SMDs.

Methods

SMD management was assessed using the National Agency for Support to the Performance of Health and Medical-Social Establishment tool in the Hospital Centre of Cannes, France, in August 2013. Safety policy in the healthcare establishment, and the SMD cycle in the hospital pharmacy, SMD cycle and care practices in the visceral-vascular-urological surgery care unit were evaluated by four health professionals and three hospital pharmacists. A total of 1850 references to SMDs for the hospital pharmacy and 1110 references to SMDs for the care unit were analysed. The percentage of risk control was defined as: 0-33% 'low', 34-66% 'medium', 67-100% 'high'.

Results

Risk control was 'high' (67%) for the safety policy in the health establishment, 'high' (68%) and 'medium' (64%) for the SMD cycle in the hospital pharmacy and the care unit, respectively, and 'high' (88%) for the care practices. Good scores were obtained in both services.

Conclusions

Safety and quality standards were investigated, and satisfied. Training of health professionals and information about, and the presence of, detailed procedures for safety policy and care practices showed good results. The main weak points were a deficit in IT support and a lack of procedures in the SMD cycle. The hospital pharmacist was shown to be a key figure in the multidisciplinary team.

Extensive antibiotic prescription rate among hospitalized patients in Uganda: but with frequent missed-dose days

Objectives

To describe the patterns of systemic antibiotic use and missed-dose days and detail the prescription, dispensing and administration of frequently used hospital-initiated antibiotics among Ugandan inpatients.

Methods

This was a prospective cohort of consented adult inpatients admitted on the medical and gynaecological wards of the 1790 bed Mulago National Referral Hospital.

Results

Overall, 79% (603/762; 95% CI: 76%–82%) of inpatients received at least one antibiotic during hospitalization while 39% (300/762; 95% CI: 36%–43%) had used at least one antibiotic in the 4 weeks pre-admission; 1985 antibiotic DDDs, half administered parenterally, were consumed in 3741 inpatient-days. Two-fifths of inpatients who received at least one of the five frequently used hospital-initiated antibiotics (ceftriaxone, metronidazole, ciprofloxacin, amoxicillin and azithromycin) missed at least one antibiotic dose-day (44%, 243/558). The per-day risk of missed antibiotic administration was greatest on day 1: ceftriaxone (36%, 143/398), metronidazole (27%, 67/245), ciprofloxacin (34%, 39/114) and all inpatients who missed at least one dose-day of prescribed amoxicillin and azithromycin. Most patients received fewer doses than were prescribed: ceftriaxone (74%, 273/371), ciprofloxacin (90%, 94/105) and metronidazole (97%, 222/230). Of prescribed doses, only 62% of ceftriaxone doses (1178/1895), 35% of ciprofloxacin doses (396/1130) and 27% of metronidazole doses (1043/3862) were administered. Seven percent (13/188) of patients on intravenous metronidazole and 6% (5/87) on intravenous ciprofloxacin switched to oral route.

Conclusions

High rates of antibiotic use both pre-admission and during hospitalization were observed, with low parenteral/oral switch of hospital-initiated antibiotics. Underadministration of prescribed antibiotics was common, especially on the day of prescription, risking loss of efficacy and antibiotic resistance.