Do guidelines and protocols improve teicoplanin prescribing?

Context

Teicoplanin prescribing practices were inconsistent and prone to unnoticed errors before the introduction of Electronic Prescribing and Medicines Administration (EPMA). This issue was compounded by the absence of formal prescribing guidelines.

Problem

The transition to EPMA did not substantially reduce teicoplanin prescribing errors, primarily due to the complex dosing regimen (different target dose, renal function, weight, and the need to prescribe three loading doses followed by a daily maintenance dose). Additionally, lack of clear prescribing guidelines meant that prescribers and pharmacists had no reference to check against.

Intervention

New guidelines and EPMA protocols were promoted through teaching sessions for pharmacists and learning at lunch sessions for junior doctors, which were carried out at regular intervals to reach a wider audience. Written materials such as posters, screensavers and patient safety bulletins were produced and distributed by email.

Strategy for change

Following the approval of the teicoplanin guidelines in August 2023, the implementation period was initiated, using the communication methods described above. A validated survey to assess the effectiveness of the changes applied was conducted to obtain junior doctors’ feedback.

Measurement for improvement

The Trust’s reporting system (DATIX) was used to analyse and monitor teicoplanin prescribing errors before and after EPMA implementation, as well as before and after the introduction of the guidelines and protocols. A total of 22 DATIX events were recorded from 2021 to 2023, with varying error types.

The yearly breakdown is as follows:

• 2021: 5 DATIXs were reported (5 missed doses)
• 2022: 8 DATIXs were reported (1 missed dose, 4 wrong doses, 1 adverse event, 2 other),
• 2023: 9 DATIXs were reported (3 wrong doses, 1 allergy, 1 delayed prescribing, 2 pharmacy, 2 OPAT incidents).

Effects of changes

The introduction of EPMA resulted in a 20% increase in reported DATIX events related to teicoplanin, potentially indicating improved reporting practices and providing more details of the various clinical risks. The survey revealed that 70% of junior doctors were unaware of the antimicrobial protocols on EPMA, and 50% had never used them. However, 80% found the drug guidance notes and the e-prescribing platform to be useful or easy to use.

Conclusion

While the rate of incorrect dosing incidents has not significantly decreased, this may be due to the newness of the guidelines and the need for further uptake. The increase in DATIX reporting likely reflects enhanced reporting with EPMA. Future efforts should focus on promoting the guidelines, improving the searchability of protocols, developing quick reference guides, exploring alternative communication channels, and enhancing feedback mechanisms for electronic antimicrobial prescribing.

The authors are aware that reporting bias has potentially impacted the results in this report and more work is needed to monitor teicoplanin prescribing in a more systematic way, such as through regular reports from EPMA.

Additional authors: Fernando Fuertes Garcia, Clinical Pharmacist EPMA and Inflammatory Bowel Disease (IBD) Lead; Barnsley Hospital NHS Foundation Trust 

This study did not require ethics approval.

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.