4 ways to limit inappropriate antibiotic prescribing

Inappropriate antibiotic prescribing is of increasing concern with at least 23,000 Americans dying from antibiotic-resistant bacteria each year.

Jeffrey A. Linder, MD, associate professor of medicine in the general internal medicine division at Boston-based Brigham and Women's Hospital, lays out four strategies to limit improper antibiotic prescribing in an American Medical Association blog post.

1. Put up letters. Adorn your organization's walls with "commitment letters" which give staff member information about antibiotics' side effects and why they may not be effective when fighting viral infections. When Dr. Linder and his colleagues put up letters at five outpatient primary care clinics for 12 weeks, the facilities slashed their inappropriate antibiotic prescribing rates by 9.8 percent. Facilities that did not implement a letter approach had a rise in inappropriate antibiotic prescribing rates, up from 42.8 percent to 52.7 percent.

2. Peer comparison. Dr. Linder and his colleagues ranked physicians' antibiotic prescribing habits and sent an email to the physicians that were deemed "top performers," meaning they had the lowest rates of inappropriate orders. Physicians that were characterized as "bottom performers" received individual emails that told them they were not a "top performer."

3. Have alerts on EHR systems. When a provider tries to order an antibiotic that is improper for a specific diagnosis, have EHR alerts that say, "antibiotics are not generally indicated" for that diagnosis. The alert can then list other over-the-counter and prescription medications for the patient.

4. Have providers justify their order. When an alert tells a physician that antibiotics are not typically indicated, have that provider explicitly justify their reasoning for that order. Have the warning say, "If you do not enter anything in this box, no justification for prescribing the antibiotic will be added to the patient's medical record."

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