Hospital antibiotic prescribing successfully modified by ‘immediate concurrent feedback’

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Abstract
To determine the effectiveness of ongoing immediate concurrent feedback (ICF) in minimizing ‘inappropriate’ sultamicillin or co‐amoxiclav prescribing via the parenteral route (i.e. when the oral route was accessible and not contraindicated), a prospective controlled audit was carried out on hospital inpatients over a 20 month period. After an education programme to promote oral rather than unnecessary intravenous (i.v.) use of sultamicillin, co‐amoxiclav and certain other drugs, an ongoing ICF strategy was instituted. ICF entailed issue of memos on the following day to prescribers of i.v. sultamicillin or co‐amoxiclav for inpatients in whom this route was deemed ‘inappropriate’, by a specially trained nurse using strict objective criteria. The memos recommended oral prescribing (particularly of co‐amoxiclav, currently the less expensive alternative). After starting ICF, there were consistent, clinically and statistically significant reductions in the monthly proportions of (i) admissions prescribed i.v. sultamicillin or co‐amoxiclav (38%P < 0.001), (ii) those in whom the route was ‘inappropriate’ (75%, P < 0.001), and (iii) corresponding ratios of i.v./oral usage and expenditure, oral sultamicillin/co‐amoxiclav usage and expenditure, as well as total and per admission expenditure on i.v. forms (> 43%, P < 0.01). For i.v. cefuroxime (for which there was no ICF) and its oral counterpart cefuroxime‐axetil, there were no comparable changes in usage or expenditure. This simple, ongoing ICF strategy was effective and well accepted; estimated net monthly savings being HK$26–30,000.