Antibiotics play an important role in modern medicine. The discovery and use of antibiotics have led to medical breakthroughs, such as infection prevention after surgery. Furthermore, antibiotics have made remarkable contributions to the control of infectious diseases[13]. As a result, human life expectancy has increased substantially in the second half of the last century. However, antibiotic resistance is a rapidly growing problem. Resistance to widely used β-lactam antibiotics has substantially increased, and treatment of ceftriaxone- and fluoroquinolone-resistant gonorrhoea has become a challenge[2]. Moreover, vancomycin, a last line of defence, can no longer completely eradicate Enterococcus faecalis[14]. Although the spread of antibiotic-resistant bacteria threatens human health, research on new antibiotics is slow. For economic reasons, large pharmaceutical companies are turning to the research and development of drugs for chronic diseases[15]; this fact indicates that we are currently entering the post-antibiotic era. The loss of antibiotics in clinical treatment implies that common bacterial infections may lead to increased mortality rates in humans.
Fortunately, the link between antibiotic use and resistance has been recognised[16]. Prospective reviews and interventions in antibiotic prescription are considered necessary measures in most healthcare systems. Antibiotic prescription management and monitoring, with the participation of clinical pharmacists, can effectively reduce the use of antibiotics and financial waste[15, 17, 18]. The use of electronic prescriptions has also improved the effectiveness of antibiotic management. In addition, studies have found that different multi-antibiotic management regimens can achieve better control than a single program[19]. However, it is still necessary to explore other ways to manage antibiotic use.
In this study, we established a monthly evaluation system using random sampling and retrospective analysis of antibiotic prescriptions in the outpatient and emergency departments. In contrast with prospective reviews and interventions by clinical pharmacists, the monthly evaluation system responds to the execution or review of antibiotic prescriptions. The monthly evaluation system supplements the prospective review and intervention systems. Its main function is to compensate for human negligence in prescription review and, more importantly, to optimise the qualified prescription. This was demonstrated by the change in the proportion of antibiotics prescribed throughout this study, particularly the reduced irrational prescription rate. Although the prescriptions approved by clinical pharmacists are qualified and have good curative effects, there is still room for improvement in the management of antibiotics, owing to the differences in experiences and habits of physicians. In this study, the evaluation team evaluated prescription samples, which were then reviewed by the team leader. As a result of these two rounds of review, the evaluation errors were minimised. The subsequent publishing of the results was one of the key aspects of the system. A study has suggested that the disclosure of institutional assessment scores could eventually change clinical practice[20]. Similarly, our results suggest that disclosing the evaluation results of physicians’ antibiotic prescriptions can also improve the level of antibiotic management by physicians and pharmacists. The publication includes unreasonable prescriptions and the evaluation team’s suggestions for improvement. This serves as feedback to the relevant physicians and pharmacists and as a warning to other physicians. Any objection to the publication can be reported to the evaluation expert panel by the physician, who can then apply for a re-evaluation. As the final step in our study, the expert group ensured the accuracy of evaluations and improved the operational level of the evaluation team by assessing the annual improvement in the initial response-to-evaluation consistency rate. More importantly, the change in antibiotic use did not affect disease treatment during the time in which the system was implemented. There was no significant change in the rate of patient complaints about treatment outcomes.
However, there were limitations to the system. It did not achieve the same results for antibiotic prescription management in the emergency department as in the outpatient department. There was a decrease in the proportion of single antibiotics prescribed in the emergency department, and there was a significant increase in the proportion of two-dose antibiotics prescribed (Table 1B). These results may be attributed to the fact that most patients in the emergency department are in critical condition and are administered extensive antimicrobial therapy for their survival. In future, we hope to study and improve the antimicrobial-prescribing situation in the emergency department.
In conclusion, we established a monthly evaluation system to assess antibiotic prescriptions, with three rounds of evaluation and a public feedback system. We verified the effectiveness of the system on clinical antibiotic use management and improved the professionalism of medical staff, including evaluation team members. At present, the system is running efficiently. However, owing to the impact of coronavirus disease 2019 in 2020, the number of patients has increased dramatically. This study only intercepted the system data from July 2016 to June 2019 for verification to exclude pandemic-related factors. Detailed research is needed to develop more effective management systems for antibiotic use.