Q J Med 2001; 94: 397
© 2001 Association of Physicians
Correspondence |
Antibiotic use
Prescot, Merseyside
Antibiotic use
Sir,
To resolve longstanding errors and omissions in hospital practice ‘we need to know more about errors and to do more about them’.1 The extensive information collected by Raveh et al.2 will lead to better prescribing and save money, but only if widely disseminated and if antibiotic policies are designed and enforced. This was our experience at a district general hospital when clinical policies were introduced from 1960. The policies related to intensive care, resuscitation and prescribing.3 The policy for the last embraced prescribing for all patients, was governed by a set of rules, and ensured higher standards. Antibiotic policies were designed in 1978 and were applied to all in-patients and clinics. A total of fifteen policies were formulated, approved by the medical administration, printed and circulated. The prescribing of thirteen antimicrobials was restricted to doctors of registrar grade or above. We think that our policies helped patients, improved doctor training and certainly saved money.4 The computer can be used as an alternative to the handbook; there are advantages (large database, speed), but the cost is a disadvantage. A trial of the computer was pioneered at the Queen Elizabeth Hospital Birmingham in the early 1970s. A terminal was placed on each ward, and drug side-effects and interactions were available. However, because of slow processing speeds at the time, this visionary idea failed to gain popularity with medical staff.5 More recently, the same hospital repeated the experiment in a renal unit over eleven months; errors were reduced.6
Safe and logical antibiotic use should join a list of basic requirements in our hospitals; hygiene, containment of acquired infection and nutrition. Methods to resolve these problems were devised decades ago but progress is frustratingly slow.
References
1. Alberti KGMM. Medical errors: a common problem. Br Med J2001; 322:501–2.
2. Raveh D, Levy Y, Schlesinger Y, Greenberg A, Rudensky B, Yinnon AM. Longitudinal surveillance of antibiotic use in the hospital. Q J Med2001; 94:141–52.
3. Gordon IJ, Jones ES. Effective clinical policies in a district general hospital. Health Care Anal1998; 6:295–304.
4. Wolfson DJ. Financial implications of a set of antibiotic policies. Pharmaceut J1980: 224:706–7.
5. Beeley L. Personal communication, 2001.
6. Nightingale PG, Adu D, Richards NT, Peters M. Implementation of rules based computerized bedside prescribing and administration: intervention study. Br Med J2000; 320:750–3.
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