Promoting Rational Prescribing by Emergency Department Junior Medical Officers

Aim: To promote rational antibiotic and analgesic prescribing by junior medical officers (JMOs) for non‐inpatients attending an emergency department (ED). Method: JMOs were surveyed to determine factors influencing prescribing in the ED and the approach to management of commonly encountered conditions that might require antibiotics or analgesics. The ED was supplied with a prescription pad that included a summary ‘clinical condition’ page to be completed by the prescribing medical officer. A panel comprising an emergency physician, clinical pharmacologist, microbiologist, general practitioner, senior medical registrar, emergency department clinical pharmacist and a JMO reviewed all IMO‐completed summary clinical condition pages with the corresponding analgesic and/or antibiotic prescriptions that were written over a three‐week period. The appropriateness of each prescription was rated following a consensus approach from ‘1’: ‘appropriate’ to ‘4’: ‘inappropriate’. A two‐week educational campaign followed the data collection period and included promotion of guidelines for appropriate analgesic and antibiotic prescribing in the ED and ‘in‐service’ discussions and lectures to all medical staff. The prescription review and survey were repeated to assess the effects of the education and review of prescribing practices. Feedback was given to the JMOs detailing number of antibiotic and analgesic prescriptions and appropriateness before and after education. Results: One hundred and thirty‐four ‘non‐inpatient’ prescriptions were collected before education and 90 afterwards. The majority of prescriptions were graded ‘1’ before and after education with a reduction in prescriptions graded ‘4’ after the education. Antibiotic prescribing improved more markedly than analgesic prescribing. Although there was a trend towards improvement in prescribing of antibiotics this did not reach statistical significance, probably due to the small sample size. A surrogate marker of improvement was that the use of guidelines increased during the study. The JMOs supported the program very enthusiastically. Conclusion: A method has been developed to educate JMOs on therapeutics in the ED that led to a trend in improvement in prescribing of antibiotics but little change in analgesic prescribing. The program was very well accepted by the JMOs.