Published: 31/03/2005, Volume II5, No. 5948 Page 30
David Jones is a senior clinical pharmacist and Dr John Cheesbrough is a consultant microbiologist at Lancashire Teaching Hospitals trust.
In January 2004, Lancashire Teaching Hospitals trust formed a partnership between the microbiology and pharmacy department to create an antibiotic ward round.
While lab-based surveillance of microbiology results identifies some patients on antibiotics who can benefit from the advice offered by medical microbiologists, the majority of patients on antibiotics (and most of the inappropriate prescribing) are missed. The ward round aims to rationalise antimicrobial therapy in line with hospital guidelines, laboratory data and evidence available.
Referral criteria by which ward pharmacists identify problem patients have been set. These include: inappropriate use, irrational combinations, unduly long treatment/unnecessary IV treatment, or where problems are occurring with therapeutic drug monitoring of aminoglycosides. If problems cannot be resolved at the ward level, the patient is reviewed on the antibiotic ward round.
A second method of recruiting patients is from the supply service provided by the trust's aseptic intravenous additive service. This is responsible for supplying a high percentage of intravenous antibiotics on a daily basis. The antibiotic pharmacist can quickly identify high cost or restricted items along with irrational combinations.
The antibiotic pharmacist and microbiologist then review the patients' clinical and laboratory data. Recommendations are documented in the notes and wherever possible discussed with the prescribing junior doctor.
Where recommendations have been made, over 75 per cent of advice is taken on board, resulting in an average of£10 per patient per day reduction in antibiotic costs. But the key success has been promoting good antibiotic prescribing to pharmacists and doctors.
No comments yet