Are we prescribing antibiotics on paper charts safely? A QIP assessing antibiotic prescribing on geriatric wards in Wales.

Introduction:

Antimicrobial stewardship is a key patient safety priority within the NHS, particularly in older adults who are at increased risk of adverse drug reactions, Clostridioides difficile infection, and harm related to polypharmacy. NICE antimicrobial stewardship guidance (NG15) and the “Start Smart – Then Focus” framework recommend that all antibiotic prescriptions include clear documentation of the clinical indication and duration to support safe and appropriate use. In hospitals where paper drug charts remain in use, adherence to these standards may be variable. This quality improvement project (QIP) evaluates antibiotic prescribing documentation in geriatric wards within a district general hospital in Wales.

The aim of this two-cycle QIP was to measure and improve documentation of antibiotics indication and duration on paper drug charts in geriatric wards, in accordance with national antimicrobial stewardship guidance.

Methods:

Data were collected on a single randomly selected day by reviewing paper drug charts for all patients prescribed antibiotics. Patients receiving prophylactic antibiotics were excluded. Following the first cycle, an educational intervention was delivered to the geriatric ward doctors, highlighting the importance of antimicrobial stewardship. Data collection was then repeated using the same methodology.

Results:

In cycle one, a total of 93 patients were reviewed across three wards, of whom 39 were prescribed antibiotics (n = 39) (42.0%). Documentation of antibiotic indication was present in 76.9% (n = 30) of drug charts, while a duration was documented in 38.5% (n = 15).

In cycle two, 93 patients were reviewed, with 32 receiving antibiotics (n = 32) (34.4%). Documentation of indication improved to 93.8% (n = 30), and duration improved to 71.9% (n = 23).

Conclusion:

This QIP demonstrated a marked increase in documentation of antibiotic indication following a targeted educational intervention. While documentation of intended duration improved, further cycles are required to achieve sustained adherence to national standards.