title: Lack of weight recording in patients being administered narrow therapeutic index antibiotics: a prospective cross-sectional study.
abstract: OBJECTIVE
  Patient weight is a key measure for safe medication management and monitoring of patients. Here we report the recording of patient's body weight on admission in three hospitals in West London and its relationship with the prescription of antibiotic drugs where it is essential to have the body weight of the patient.
  
  
  METHODS
  A prospective cross-sectional study was conducted in three teaching hospitals in West London. Data were collected during March 2011-September 2011 and July 2012-August 2012, from adult admissions units, medical and surgical wards. Data from each ward were collected on a single day to provide a point prevalence data on weight recording. Patient medication charts, nursing and medical notes were reviewed for evidence of weight and height recording together with all the medication prescribed for the patients. An observational study collecting data on the weight recording process was conducted on two randomly selected wards to add context to the data.
  
  
  RESULTS
  Data were collected on 1012 patients. Weight was not recorded for 46% (474) of patients. Eighty-nine patients were prescribed a narrow therapeutic antibiotic, in 39% (35/89) of these weight was not recorded for the patient. Intravenous vancomycin was the most commonly prescribed antibiotic requiring therapeutic monitoring. In total 61 patients were receiving intravenous vancomycin and of these 44% (27/61) did not have their weight recorded. In the observational study, the most frequently identified barrier to weight not being recorded was interruptions to the admission process.
  
  
  CONCLUSIONS
  Despite the clinical importance of body weight measurement it is poorly recorded in hospitalised patients, due to interruptions to the workflow and heavy staff workloads. In antibiotics a correct, recent patient weight is required for accurate dosing and to keep drugs within the narrow therapeutic index, to ensure efficacy of prescribing and reduce toxicity.
authors.affiliation: Faculty of Medicine, The National Centre for Infection prevention and Management, Imperial College London, London, UK.
authors.forename: Esmita
authors.initials: E
authors.lastname: Charani
authors.affiliation: Faculty of Medicine, The National Centre for Infection prevention and Management, Imperial College London, London, UK.
authors.forename: Myriam
authors.initials: M
authors.lastname: Gharbi
authors.affiliation: Therapy Services, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Hickson
authors.affiliation: National Institute of Health Research/Wellcome Trust Imperial Clinical Research Facility Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Shokri
authors.initials: S
authors.lastname: Othman
authors.affiliation: National Institute of Health Research/Wellcome Trust Imperial Clinical Research Facility Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Aisha
authors.initials: A
authors.lastname: Alfituri
authors.affiliation: Faculty of Medicine, Department of Medicine, Imperial College London, London, UK.
authors.forename: Gary
authors.initials: G
authors.lastname: Frost
authors.affiliation: Faculty of Medicine, The National Centre for Infection prevention and Management, Imperial College London, London, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Holmes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001835:Body Weight; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008499:Medical Records / Q000592:standards*; D008875:Middle Aged; D009737:Nursing Records / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: THERAPEUTICS
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