Action 3:
Document indication and review date
Documenting the indication for therapy is an important aspect of prescribing any medicine. It enhances the communication between team members and ensures a shared understanding of the patient’s clinical condition and rationale for therapy.
Documenting indication for therapy can aid in optimising the dose of antimicrobial therapy.1, 2 Pharmacists can play an important role in optimising dosing for the clinical condition by checking dose against guidelines such as Therapeutic Guidelines: Antibiotic,3 to ensure the prescribed dose is appropriate to the patients individual characteristics (e.g. renal function, weight) and clinical condition.
Ensuring the correct duration of antimicrobial therapy is important to help minimise the risk of antimicrobial resistance. Courses of antimicrobials are often continued for longer than necessary. This may occur because prescriptions are not time limited, and because there is no definite responsibility for a course of therapy to be cancelled, no-one remembers to cancel them. Resistance selection increases with longer courses of antimicrobials, as does the risk of other unwanted effects including increased length of hospital stay.
Documenting the indication and review date at the commencement of therapy can also help ensure timely review of the patient’s progress, response to therapy and the decision to de-escalate, change therapy, cease or switch from intravenous to oral therapy. For antimicrobial prescribing, studies have shown that documenting indication and review date of therapy on hospital medication charts decreases unnecessary antibiotic use and reduces the incidence of Clostridium difficile (C.difficile).7 Fact Sheet Action 4: Review and reassess antibiotics at 48 hours provides further information regarding the importance of regularly reviewing antimicrobial therapy.
Useful resources
Refer to Therapeutic Guidelines: Antibiotic,7 for guidance on the duration of prophylactic, empirical and targeted antimicrobial therapy.
References and further reading
1. Duguid M, Cruickshank M (editors). Antimicrobial Stewardship in Australian Hospitals. Sydney: Australian Commission on Safety and Quality in Health Care, 2011.
2. Dellit T, Owens R, McGowan J, Gerding D, Weinstein R, Burke J, Huskins W, Paterson D, Fishman N, Carpenter C, Brennan P, Billeter M, Hooten T. Infectious Diseases Society of America (ISDA) and the Society for Healthcare Epidemiology of America (SHEA) guidelines for developing an institutional program to enhance antimicrobial stewardship. Clinical Infectious Diseases 2007;44(2):159-177
3. Antibiotic Expert Group. Therapeutic Guidelines: Antibiotic. Version 14. Melbourne: Therapeutic Guidelines Ltd; 2010
4. National Health Service. Antimicrobial prescribing: a summary of best practice. Saving Lives: Reducing Infection, Delivering Clean and Safe Health Care. London: UK Department of Health, 2009.
5. Richard P, Delangle M, Merrien D, Renaud A, Minozzi C, Richet H. Fluoroquinolone use and fluoroquinolone resistance: is there an association? Clinical Infectious Diseass 1994:19(1):54-59
6. Guillemot D, Carbon C, Balkau B, Geslin P, Lecoeur H, Vauzelle-Dervroedan F, Bouvenot G, Eschwege E. Low dosage and long duration of beta-lactam: risk factors for carriage of penicillin-resistant Streptococcus pneumoniae. Journal of the American Medical Association 1998:279(5);365-370
7. Botros S, Nathwani D. 2012. How to decrease the risk of Clostridium difficile in a ward environment and help prevent the emergence of any new cases – a Ninewells success story. Poster presented at the International Society for Quality in Health care 29th International Conference, Geneva 21-24 October 2012.
This document is intended for use by health professionals. It has been created from information contained in Antimicrobial Stewardship in Australian Hospitals 2011 and reviewed by clinical experts. Reasonable care has been taken to ensure this information is accurate at the date of creation. This fact sheet is intended to be used in it original version. It can be downloaded from the Australian Commission on Safety and Quality in Health Care web page www.safetyandquality/AAW2013
“No action today, no cure tomorrow” is adopted from the WHO World Health Day 2011.
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