Optimizing Antibiotic Prescribing in Elderly Inpatients: A PDSA-Based Quality Improvement Project

Introduction 

Elderly inpatients are particularly vulnerable to complications from prolonged antibiotic therapy, such as adverse drug reactions, Clostridium difficile infections, and antimicrobial resistance. On the Care of the Elderly (COTE) wards at Lister Hospital, prolonged antibiotic use beyond guideline recommendations was frequently observed. This quality improvement (QI) project aimed to reduce inappropriate antibiotic durations in patients aged ≥65 using the Plan-Do-Study-Act (PDSA) methodology.

Methods: 

Conducted on Level 9 of Lister Hospital, data were collected from four wards on two dates: 23/03/25 (baseline) and 09/05/25 (post-intervention). Patients with deep-seated infections or who had died during admission were excluded. A course was classified as inappropriately prolonged if a single antibiotic was prescribed for >10 days without microbiology input.

The intervention consisted of: (1) a seminar on adverse effects and trust guidelines; (2) a knowledge assessment questionnaire; and (3) reminders via email and in person. Outcomes were analysed using chi-squared and t-test methods.

Results: 

Data were collected for 60 patients at baseline and for 58 patients post-intervention; of these, 44 and 42 patients, respectively, were receiving antibiotics. Co-amoxiclav accounted for over 50% of prescriptions in both groups.

Following the intervention, practice of prescribing antibiotics with a set duration on EPMA improved by 56% (20% vs 76%, p<0.0001). This was associated with a 14% absolute reduction in patients receiving unnecessarily prolonged courses from (16% vs 2%, p<0.0001).  Notably, a 45% increase was noted in the use of appropriate IV-to-oral antibiotic switch (p=0.047).

Additionally, 60% of doctors correctly identified guideline-recommended durations in the follow-up questionnaire.

Conclusion:

Targeted education and communication strategies significantly reduced prolonged antibiotic prescribing in elderly inpatients. This project demonstrates how simple, focused interventions can lead to meaningful improvements. Continued emphasis on education and antimicrobial stewardship is essential to sustain progress.