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Supporting hospital prescribers with advice and feedback reduces antibiotic scripts

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The widespread adoption of the interventions focusing on feedback and support could have “considerable impact” on reducing unnecessary antibiotic prescribing in hospitals, according to Cochrane researchers.

Based on their review, UK researchers stated that policies promoting better targeting of antibiotics have the greatest impact when they are also supported by effective ways to support behaviour change in clinicians.

“Successful adoption of the interventions we have studied could have considerable impact”

Peter Davey

The Cochrane review team found interventions providing advice or feedback to prescribers were more effective at improving practices than those that did not include such information for clinicians.

Looking at 29 studies, involving 23,394 participants, the researchers assessed the effectiveness and safety of interventions designed to improve how nurses and doctors prescribed antibiotics.

The interventions broadly fell into two categories – “restrictive” rules to make clinicians prescribe properly and “enabling” advice or feedback to help them make more informed prescribing decisions.

Enabling interventions included audit and feedback, educational outreach through reviewing individual patients with recommendation for change, and circumstantial reminders – posters or pocket cards summarising antibiotic policies – targeted at clinicians who were managing specific patients.

They found either type of intervention led to 58% of inpatients receiving treatment in line with prescribing guidelines, compared with 43% in standard practice groups.

The interventions shortened the duration of antibiotic use from 11 days to nine per patient, and probably reduce hospital stay from an average of 13 days to 12 per patient.

The data suggested that reducing antibiotic use did not lead to an increase in harm, but there was only limited evidence of a link between adopting the interventions and fewer hospital infections.

Interventions that involved either enabling or restrictive techniques were consistently more effective than relying on simple education alone – such as meetings or distribution of guidelines – said the study authors in the Cochrane Database of Systematic Reviews.

In addition, the reviewers said adding enabling techniques – such as reminders, audit and feedback – boosted the effectiveness of restrictions that reduced the freedom to prescribe some antibiotics.

University of Dundee

Feedback helps nurses cut unnecessary antibiotic scripts

Peter Davey

However, they noted that only 10% of interventions used the most effective enabling techniques – goal-setting, feedback, and action planning.

Lead reviewer Professor Peter Davey, from the University of Dundee, said: “A wide variety of different interventions have been successful in safely reducing unnecessary antibiotic use in hospitals.

“We do not need more studies to answer the question of whether these interventions reduce unnecessary antibiotic use, but we do need more research to understand why the most effective behaviour change techniques are not more widely adopted within hospital settings,” he said.

He added: “Successful adoption of the interventions we have studied could have considerable impact on health service, policy, and future decision-making for patients.”

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