Meng Fei Cheah

Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia

Effectiveness of Pharmacist-Led Audit-and-Feedback Intervention in Promoting Appropriate Third-Generation Cephalosporin Use at a Tertiary Public Hospital in Malaysia

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    Abstract

    Objective: This study aimed to determine the effectiveness of a pharmacist-led audit-and-feedback intervention in promoting the appropriate prescribing of third-generation cephalosporins and timely culture and sensitivity (C&S) testing in patients admitted to a neurosurgical ward. Method: This quasi-experimental study was conducted from July 2019 to August 2020 in a tertiary public hospital in Malaysia. In the pre-intervention phase, seventy patients who have received treatment with third-generation cephalosporins were examined by a ward pharmacist. The use of a cephalosporin was deemed to be appropriate only if it was in line with either the National Antimicrobial Guidelines 2019 or the recommendations made by the Antimicrobial Stewardship team. The availability of C&S test performed before the first dose of cephalosporin was also studied. As an intervention, the findings were presented and discussed in a 2-hour feedback session. Subsequently, the post-intervention audit was performed in the same manner as in the pre-intervention phase. The primary outcome measures were the proportion of cases with appropriate use of cephalosporin and timely C&S testing. The variables were analysed descriptively. Pearson’s chi-square test was used to assess the differences in appropriateness of antibiotics use and C&S testing, in the pre- and post-intervention cohorts. Result: Seventy cases were studied in the pre- and another seventy in post-intervention phases. The proportion of cases with appropriate use of third-generation cephalosporin increased significantly from 77.1% (54 / 70) to 95.8% (67 / 70) following the intervention (p = 0.001). The proportion of cases with a C&S test performed timely also increased significantly from 38.6% (27 / 70) to 58.6% (41 / 70) (p = 0.018). Conclusion: The pharmacist-led audit-and-feedback intervention was effective in improving the appropriateness of the prescribing of third-generation cephalosporins and timely culture and sensitivity testing, indicating the antimicrobial stewardship strategy had produced a positive outcome.