Effect of prescription proposal using the electronic medical record by ward pharmacists for proper use of antimicrobial prophylaxis for surgery

Abstract

“Guidelines for proper use of prophylactic antimicrobial for surgery” published in 2016 recommends the selection, dose interval and dosage of prophylactic antimicrobial according to patient characteristics for each surgical procedure. In our hospital, prophylactic antimicrobial had been set by the clinical path, but the adjustment of interval and dosage according to renal function or weight had been left to surgeons. Since January 2018, the ward pharmacists have started the electronic patient record–based prescription suggestion in collaboration with surgeons and operating room nurses for the purpose of improving the appropriate use of prophylactic antimicrobial. Appropriate use ratio of prophylactic antimicrobial before/after the intervention was significantly improved. The ratio was the following: all groups: 62.0％/87.4％ (P＜0.001), renal impairment group: 34.0％/86.3％(P＜0.001), overweight group: 20％/92.3％(P=0.001). It has been shown that the ward pharmacist’s intervention improved the appropriate use ratio of dose interval and dosage of prophylactic antimicrobial. Our intervention may lead to reduction in the incidence of surgical site infection and prevention of adverse events by antimicrobial.