Quality and cost improvement in neonatal prescribing through clinical audit

Jayesh Bhatt (Specialist Paediatric Registrar, at the Regional Neonatal Intensive Care Unit, Royal Hallamshire Hospital, Sheffield, UK)
Christine Nye (Neonatal Pharmacist, at the Regional Neonatal Intensive Care Unit, Royal Hallamshire Hospital, Sheffield, UK)
Vincent Kirkbride (Consultant Neonatologist and Director of Neonatal Services, at the Regional Neonatal Intensive Care Unit, Royal Hallamshire Hospital, Sheffield, UK)

Clinical Governance: An International Journal

ISSN: 1477-7274

Publication date: 1 December 2004

Abstract

Gentamicin is one of the most frequently used antibiotics in neonatal units and there are many regimes in use based on weight and/or gestational age (GA). Direct costs include prescription and therapeutic drug monitoring (TDM). A retrospective audit (loop 1) identified 48 per cent trough and 51 per cent peak levels outside the desirable range (trough: ≤2; peak: 5‐10 mg/L). A prospective re‐audit (loop 2) showed improved results (15 per cent and 29 per cent), which improved further (11 per cent and 26 per cent) in loop 3. For loops 1, 2, and 3 the mean (±SD) trough levels were 2.16 (±1.04), 1.30 (± 0.63) and 1.23 (±0.62) respectively and peak levels were 5.05 (±1.87), 6.64 (±2.48), and 6.2 (±1.81) respectively. Cost savings occurred as the number of doses required was reduced by one‐third to 50 per cent, depending upon the infant characteristics. Furthermore, in 27 per cent of cases, gentamicin was discontinued before TDM was necessary. By completing the audit cycle improved quality of therapeutic care has been achieved, with more accurate drug monitoring targets achieved and reduced drug costs.

Keywords

Citation

Bhatt, J., Nye, C. and Kirkbride, V. (2004), "Quality and cost improvement in neonatal prescribing through clinical audit", Clinical Governance: An International Journal, Vol. 9 No. 4, pp. 232-236. https://doi.org/10.1108/14777270410566643

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Emerald Group Publishing Limited

Copyright © 2004, Emerald Group Publishing Limited

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