Evaluation of empiric appropriateness of discharge antibiotic prescriptions from an academic medical center emergency department
AbstractAddressing antimicrobial resistance has been a challenge for emergency departments (EDs) due to unclear diagnoses and the fast-paced environment. This study evaluated the appropriateness of empiric antibiotic prescriptions written upon discharge for emergency department patients and describes medication errors found in a random sample of 1000 prescriptions written over a one-year period. The investigators were trained in error identification, operational definitions, coding, and other information included in content analysis procedures. Coding for the final data set was based on majority rule, and descriptive statistics addressed the study objectives. Discharge prescription error rate out of 1000 prescriptions was 22.2%. Pediatric prescriptions had a within-group error rate of 33.3%, and adult prescriptions had a within-group error rate of 19.7%. The most common error type was due to dosing below the recommended range (19.8%). ED residents wrote the highest percentage of prescriptions (65.4%). Non-ED attending physicians had the highest within-group error rate of 31.0%. Antibiotics with the highest within-class error rate were amoxicillin, levofloxacin, and nitrofurantoin. Prescription errors made with antibiotics written upon discharge in the ED were common. Antimicrobial resistance is a growing problem that could be improved by optimizing antibiotic prescription dosing and implementing antibiotic stewardship activities in the emergency department.
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