RPIW #92 - Physician Orders with Indications – Establish RQHR’s Prospective Audit and Feedback Process

Home / Physicians News / RPIW #92 - Physician Orders with Indications – Establish RQHR’s Prospective Audit and Feedback Process

RPIW #92 - Physician Orders with Indications – Establish RQHR’s Prospective Audit and Feedback Process

29-Mar-2017

When making quality improvements, it is often difficult to move the dial on practice change.  In October 2016 our targeted audit saw 41% of antimicrobial orders written with an indication included in the order; as of February 2017, it is 72%.  This is a tremendous accomplishment; however, we still need to strive for 100% as we continue to audit the physician’s orders. 

The expectation with this improvement is that every antimicrobial order written in physician orders will also include the indication and duration (this also includes reorders).  Another important point is to ensure that the prescriber’s name is clearly written (to ensure that the correct prescriber is addressed if the signature is not legible).  This helps to ensure best care for our patients as there will be no confusion or time spent mining for information on the current treatment plan.  It is not the intention to replace the information provided in the progress notes. 

 Examples of what a properly recorded order with indication and duration may include: 

  1. March 1/2017 @ 0800: Start Ceftriaxone 1g IV Daily x 7 days for CAP, legible signature (e.g., empiric therapy for community acquired pneumonia)
  2. March 1/2017 @0600: Start Ciprofloxacin 500 mg PO BID x 5 days for UTI, legible signature
    March 2/2017 @1000: Stop Ciprofloxacin – change to Macrobid 100 mg PO BID x 4 days (to complete 5 days of therapy) for UT, legible signature (e.g., change from broad spectrum therapy to narrow spectrum; note: total duration of antimicrobial therapy is taken into account)
  3. March 1/2017 @ 0630: Start Clindamycin 600 mg IV Q8H for osteomyelitis, legible signature
    March 4/2017 @ 0800: Stop Clindamyin – change to Cefazolin 2G IV Q8H for osteomyelitis, legible signature
    March 8/2017 @ 0800: Continue Cefazolin 2G IV Q8H x 5 weeks for osteomyelitis, legible signature
    (e.g., change from sub-optimal therapy to optimized antibiotic therapy; note: duration is clarified on March 8 order to specify total duration, indication is included for clarity)

Thank you for your continued support with improving and providing Better Teams …Health…Value and Better Care for our Patients.  

As this information is aggregate, you may contact the Antimicrobial Stewardship Program to know where you are directly in regards to your contribution to the 72%. 

antimicrobial.stewardship@rqhealth.ca or call 306-766-3520.