Adult
e-Prescribing of Antimicrobials
How to prescribe antimicrobials on EPR
- Prescribe antimicrobials ONLY when clinically justified
- Always give first antimicrobial dose promptly (i.e. ideally within 1 hour)
- e-prescriptions will default to "give first dose now"
- Ensure nursing staff are aware of the prescription and the need to start treatment within 1 hour.
- Initial antimicrobials prescriptions should be for less than 72 hours
- ENSURE review of empiric antimicrobial therapy within 48-72 hours of start
- see also ARK (Antibiotic Review Kit)
- and START SMART then FOCUS
Mandatory fields
- Indication:
- e.g. CAP or sepsis
- nonsense symbols are not appropriate and are being audited continually e.g. - > : +
- very broad or location specific terms are not appropriate (e.g. "BIU" or "infection")
- Duration:
- expected: up to 72 hours or 3 days
- prolonged: over 72 hours - should be discussed with Micro/ID
- Infection status:
- possible - infection is one of a number of potential diagnoses
- probable - infection is likely to be present
- finalised - clinical condition, investigations, microbiology has been reviewed.
Good antimicrobial prescribing practice
- All antimicrobial prescriptions should follow Trust guidelines where they exist. The rationale behind any deviations from these guidelines must be documented in the medical notes. Repeated breaches of the Trust antimicrobial policy will be reviewed by the Medical Director.
- Prescribers are advised to follow the START SMART then FOCUS guideline by initially prescribing 48-72 hours of antimicrobial treatment. At this point, review of diagnosis, clinical condition, investigations including microbiology should occur. The prescriber can then decide whether to stop, continue or change antimicrobials.
- Consider the following individual patient and drug-specific factors:
- Previous antimicrobial history;
- Previous infection with multi-resistant organisms;
- Allergy to antimicrobials;
- Availability of antimicrobials and effective absorption by oral route
- Prescribe intravenous (IV) therapy only for those patients with severe infections and/or who are unable to take oral antimicrobials.
- Review microbiology results regularly and use them to rationalise antimicrobial therapy.
- Broad-spectrum antimicrobials should be restricted to the treatment of serious infections when the pathogen is not known or when other effective agents are unavailable. Using narrower spectrum agents reduces the likelihood of the emergence of resistant organisms and super-infections e.g. diarrhoea associated with Clostridioides difficile.