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  • Using audit and feedback to encourage primary healthcare prescribers to record indications for antimicrobial prescriptions: a quality improvement initiative

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Using audit and feedback to encourage primary healthcare prescribers to record indications for antimicrobial prescriptions: a quality improvement initiative
  1. Jason Robert Vanstone1,2,
  2. Shivani Patel1,
  3. Warren Berry1,
  4. Michelle Leigh Degelman1,
  5. Caitlin Hanson3,
  6. Casey Phillips1,2,
  7. Robert Parker1,2
  1. 1Stewardship and Clinical Appropriateness, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
  2. 2Antimicrobial Stewardship Program, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
  3. 3Digital Health, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
  1. Correspondence to Dr Jason Robert Vanstone; jason.vanstone{at}saskhealthauthority.ca

https://doi.org/10.1136/bmjoq-2021-001760

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    Introduction

    In many countries, most antimicrobial use for human consumption occurs in primary healthcare (PHC),1–4 making this sector an important focus for antimicrobial stewardship (AMS). It is important to know the indications for antimicrobial use to design targeted AMS interventions. Studies have shown that approximately 15% of PHC-associated antimicrobial prescriptions in England5 and 18% of ambulatory care-associated antimicrobial prescriptions in the USA6 lack a documented indication. Locally, in Regina, Saskatchewan, Canada, we have seen that the proportion of undocumented indications can be much higher among PHC prescribers (figures 1–3), although there is a paucity of data to determine how this compares among other Canadian jurisdictions.

    Figure 1

    Example of the monthly email and data sent to clinics for audit and feedback. Emails with attached Excel files were sent to a contact in each clinic who distributed the files to prescribers within their clinics. The Excel file included a filter allowing prescribers to select their individual number to view their percentage of indications over time (line graph) and the number of antimicrobial prescriptions compared with the number of indications for those prescriptions (histogram) each month. The orange line in the line graph represents the minimum target of 80% of antimicrobial prescriptions with a documented indication.

    Figure 2

    Upward trend in the percentage of antimicrobial prescriptions with indications. The data in this control chart highlight an upward trend (green data points indicate an unstable trend in the preferred direction) in the postintervention data (ie, following a process change). Prior to the intervention, 21.4% of prescriptions had a documented indication (blue line; January 2019–February 2020). Following the initiation of the monthly audit and feedback report, the monthly percentage of indications increased and the postintervention average was 37.8% (March 2020—August 2021). Red and green data points indicate unstable points and trends identified by the software (QI …

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