Antimicrobial prescribing at a university hospital: justified or ‘just in case’. Testing a new scoring system as a key quality indicator

Objective To evaluate the quality of antimicrobial drug prescribing at a university hospital in the Department of Medicine, by using a new scoring system as a quality indicator. Methods Design: a prospective, longitudinal survey, during a 21‐week period. The necessity of antimicrobial treatment of all in‐patients at the Department of Medicine, to whom new antimicrobials were prescribed, was assessed by using a scoring system based on the presence of signs and symptoms of an infection. If the sum's total score was 3 or more, the antimicrobial treatment was deemed justifiable; if the score was less than 3, the antimicrobial treatment was regarded as questionable. Setting: Department of Medicine (279 hospital‐beds) at the University Hospital Center Rijeka, a 1200‐patient‐bed teaching hospital in Croatia. Results Antimicrobials were prescribed to 15% of the total patients. They were given as a treatment to 89% of the patients, and in 67% of the cases, this treatment was administered empirically. According to the scoring system, 29% of the patients did not have a justified indication for antimicrobial treatment. Conclusion The proposed quality indicator (scoring system) that we used is a simple method for the quality assessment of antimicrobial use. It has indicated areas that require in‐depth analysis. Copyright © 2005 John Wiley & Sons, Ltd.