Prescribing Good Practice

Hospital Antibiotic Prudent Prescribing Indicator (HAPPI) audits of the standards below will be carried out regularly.

Documentation Prescribing standards
Inpatient drug chart 1. Allergy status documented on drug chart
2. Review date or stop date recorded for all prescribed antibiotics
Medical notes 3. Indication or provisional diagnosis documented for all antibiotics on their start date
4. Choice of antibiotic(s) according to UHS guideline or documented valid justification* for off-guideline choice
5. Duration of intravenous antibiotic(s) <48h or within guideline-recommended IV duration
6. Total duration of antibiotic course(s) <7days or within guideline-recommended duration
* Justfication may include: culture and sensitivity report; risk of resistant pathogen (healthcare contact, co-morbidity, prior antibiotic exposure, travel history); recommendation by named medical microbiologist / ID doctor; treatment failure of guideline agents; contra-indication to guideline agent(s).
Effective antibiotic prescribing - Royal College of Physicians Top Ten Tips 2011
  • Institute antibiotic treatment immediately in patients with life-threatening infection.
  • Prescribe in accordance with local policies and guidelines, avoiding broad spectrum agents.
  • Document in clinical notes indication(s) for antibiotic prescription.
  • Send appropriate specimens to the microbiology lab draining pus and removing foreign bodies if indicated.
  • Use antimicrobial susceptibility data to de-escalate/substitute/add agents and to switch from intravenous to oral therapy.
  • Prescribe the shortest antibiotic course likely to be effective.
  • Always select agents to minimise collateral damage (ie selection of multi-resistant bacteria/Clostridium difficile).
  • Monitor antibiotic drug levels when relevant (eg. Vancomycin).
  • Use single dose antibiotic prophylaxis wherever possible.
  • Consult your local infection experts.