title: Evaluation of a consultant audit and feedback programme to improve the quality of antimicrobial prescribing in acute medical admissions.
abstract: OBJECTIVE
  This study aims to evaluate the effectiveness and acceptability of a pharmacist-led antimicrobial stewardship intervention, consisting of consultant performance audit and feedback, on antimicrobial prescribing quality.
  
  
  METHODS
  From October 2010 to September 2012, the prescribing performance of medical consultant teams rotating on the acute medical admissions unit was measured against four quality indicators. Measurements were taken at baseline then at quarterly intervals during which time consultants received feedback. Proportion of prescriptions adhering to each indicator was compared with baseline using paired sample z-test (significance level P < 0.01, Bonferroni corrected). Consultants' views were explored using anonymous questionnaires.
  
  
  RESULTS
  Overall, 2609 antimicrobial prescriptions were reviewed. Improvement from baseline was statistically significant in all follow-up periods for two indicators: 'antimicrobials should have a documented indication in the medical notes' and 'antimicrobials should adhere to guideline choice or have a justification for deviation', reaching 6.0% (95% CI 2.5, 9.6) and 8.7% (95% CI 3.7, 13.7), respectively. Adherence to the indicator 'antimicrobials should have a documented stop/review prompt' improved significantly in all but the first follow-up period. For the indicator: 'antimicrobial assessed by antimicrobial specialists as unnecessary', improvement was statistically significant in the first (-4.7%, 95% CI -8.0, -1.4) and fourth (-4.2%, 95% CI -7.7%, -0.8%) periods. Service evaluation showed support for the pharmacist-led stewardship activities.
  
  
  CONCLUSIONS
  There were significant and sustained improvements in prescribing quality as a result of the intervention. Consultants' engagement and acceptance of stewardship activities were demonstrated.
authors: Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK.
authors: Elaine
authors: E
authors: Roberts
authors: Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK.|Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
authors: Dalia M
authors: http://orcid.org/0000-0002-2105-1937
authors: DM
authors: Dawoud
authors: Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK.|Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK.
authors: Dyfrig A
authors: DA
authors: Hughes
authors: Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK.
authors: Christopher
authors: C
authors: Cefai
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D054869:Clinical Audit / Q000379:methods*; D003253:Consultants; D011307:Drug Prescriptions / Q000592:standards* / Q000706:statistics & numerical data*; D005246:Feedback; D019983:Guideline Adherence; D006801:Humans; D010595:Pharmacists; D010818:Practice Patterns, Physicians' / Q000592:standards; D024382:Professional Role; D015397:Program Evaluation
chemical_list: D000890:Anti-Infective Agents
keywords: antimicrobial prescribing; antimicrobial stewardship; audit and feedback; hospital-acquired infection