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The baseline PPS data proved valuable in identifying key measures intended to drive improvement in the quality of antimicrobial use in hospitals; poor documentation of indication for treatment and compliance with local prescribing policy remained features of poor practice in empirical prescribing.
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Poor documentation of indications for medications and follow-up advice is worrisome as it could either be due to lack of communication or documentation or both.
Documentation of indications for infusions improved over the period of the study, with only 5% of infusions in 2009 being unclassified.
With our checklist, we aimed to support the communication and documentation of indications for the initiation and continuation of antibiotic therapy, which served to remind the treating physician to review and potentially stop therapy or target the isolated pathogen.
While the reason for this is unclear, it could be due to gestational age estimation errors, mis-documentation of indications for delivery, maternal demand for elective deliveries (despite being preterm) or a failure by providers to recognize the risks of elective preterm deliveries.
In the prescription, dosage and duration were written in more than 90%, but documentation of the indication was very poor at 20% (Fig. 3).
Documentation of an indication for a catheter remained unchanged.
Documentation of the indication for AMT was not performed in 25.5%.
The strict enforcement of guideline-based transfusion triggers for surgical patients is supported by checklists attached to each RBC and/or during electronic documentation of the indication for RBC in patient's record and during the perioperative process.
Second, categorization of therapy as necessary or unnecessary was based on review of medical records, and therefore it is possible that some regimens were misclassified due to inadequate documentation of the indications for treatment.
In the present study, the lack of documentation of the indications for urate-lowering therapy in the medical records in primary care presented a problem, particularly for patients with chronic stable gout without tophi and infrequent acute joint symptoms.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com