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PAPERS: P G Nightingale, D Adu, N T Richards, and M Peters Implementation of rules based computerised bedside prescribing and administration: intervention study BMJ 2000; 320: 750-753 [Abstract] [Full text]

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Improving antibiotic policy awareness

Andy Levy, Debbie Campbell, Robert Heyderman, Robert Spencer   (27 March 2000)

Computerised bedside prescribing

P G Nightingale, D Adu, N T Richards, M Peters   (3 April 2000)

Improving antibiotic policy awareness 27 March 2000
Andy Levy, Reader in Medicine, Medical Directorate Pharmacist, Senior Lecturer Path and Micro and Cons microbio Bristol Royal Infirmary and Bristol University, Debbie Campbell, Robert Heyderman, Robert Spencer Send response to journal: Re: Improving antibiotic policy awareness	In contrast to Nightingale and others who examined prescribing in a specialist unit, the problem for most of us with 'free range' medical staff prescribing for patients scattered throughout a hospital is ensuring that the rule base is available at the time and place of prescription. Although the Division of Medicine antibiotic policy was sent to all medical staff, an audit of antibiotic usage showed significant deviation from the guidelines. While the concept of an antibiotic policy was not questioned by prescribers and there was great willingness to adhere to it in principle, a proportion of the house staff could either not locate a copy at the time and place of prescription or completely denied the existence of such information. Re-circulating the policy in its original form on three A4 sheets was thought to have little chance of success as the papers would once again be lost within the mass of other information distributed in similar format. A laminated A5 card small enough to fit in a white coat pocket was also deemed inappropriate as it was acknowledged that few of the house staff chose to wear white coats. The antibiotic policy was therefore re-drafted in diagrammatic form using Illustrator 6.0 (Adobe: Figure attached) at a size suitable for printing onto a pager-sized sticky label (Avery Laser Media Labels L7671- 25). These were overlaid with a sheet of self adhesive clear plastic film (from a high street stationer) and distributed to the house staff. Re- audit of antibiotic policy awareness showed that 100% of house staff were aware of the policy and found it serviceable and straightforward to use. The problem was solved at a cost of < 5p/person by abandoning conventional approaches and exploiting the one hard surface that all of the target population habitually carried with them. Presbyopia amongst the senior staff did not entirely prevent them appreciating the shrewdness of the approach.
Computerised bedside prescribing 3 April 2000
P G Nightingale, Statistician Wolfson Computer Laboratory, Department of Medicine, The University of Birmingham, D Adu, N T Richards, M Peters Send response to journal: Re: Computerised bedside prescribing	The efforts of Levy et al to improve antibiotic policy awareness at minimal cost are to be applauded. However, their suggestion that computerised bedside prescribing could not be used effectively when patients are scattered throughout a hospital is incorrect. In a whole hospital implementation each directorate could have the system set up to reflect its own prescribing policy for its patients wherever thay may be located. The system could be accessible from every patient's bedside using wireless terminals, ensuring the availability of the rule base at the time and place of prescription.