A Retrospective Audit of Indication and Duration Documentation in Relation to Antimicrobial Prescribing in Residential Care

Compared to other countries in Europe, Ireland has one of the highest prescribing rates for antimicrobials. Antimicrobial resistance is a worldwide concern, a threat to human health and a contributor to financial burden on the healthcare system. The aim of this audit was to retrospectively investigate the level of adherence to HSE guidelines on the documentation of indication and duration for antimicrobials prescribed in residential care for older adults over the age of 65 in four extended care units. This clinical audit was measured against two HSE standards for antimicrobial prescribing documentation. Residential care prescription charts were retrospectively reviewed over a period of one week in June 2024. Where an antimicrobial prescription was identified, documentation of indication and duration of use at the time of prescribing was assessed. Details were collected and recorded on the HSE NCCA Excel Template for Clinical Audits. A total of 55/84 residents (65.5%) had at least one antimicrobial prescribed. There were 136 antimicrobial prescriptions in total (63.24% had an indication documented; 66.18% had a duration documented, 55.88% had both indication and duration documented). Oral/enteral prescriptions (n = 49) had the highest average combined % adherence to HSE standards for indication and duration documentation (88.90%) compared to topical (n = 80; 49.5%), parenteral (n = 6; 75%) or PV route prescriptions (n = 1; 50%). No prophylactic prescriptions (n = 32) had indication or duration recorded (0% adherence). Antimicrobials should be prescribed with a clear therapeutic indication and appropriate duration documented on the prescription. Areas of good practice included prescriptions for oral/enteral routes and for active infections. Potential areas of improvement included topical, prophylaxis and stat dose prescriptions. Medical, nursing and pharmacy teams should be made aware of the importance of indication and duration documentation at time of antimicrobial prescribing, and to follow-up any omissions.