Greater Glasgow and Clyde Medicines

Antibiotic Prescribing in Acute: Key Messages February 2017

Missed doses of antibiotics leads to a reduced concentration in the blood with subsequent reduced efficacy. This not only adversely impacts the patient response but also promotes emergence of resistance.

A missed dose study, in one NHSGGC hospital, reported the following findings:

  • 76 doses of antibiotics were missed in total (n=1693, 4.5%)
  • Almost a quarter of patients missed at least one antibiotic dose (32/134, 23.9%)
  • Almost a third of missed doses had no reason documented (25/76, 32.9%)
  • Almost a fifth of missed doses were due to no IV access (13/76, 17.1%)

Key messages for prescribers

  • Antibiotics, initiated outwith the normal medicine round, may require a stat dose to be prescribed in the 'once only' section of the Kardex. In such cases the urgency should be highlighted to nursing staff.
  • Inform nursing staff if a patient's antibiotic regimen is changed e.g. a change from IV to oral therapy.
  • Discuss missed antibiotic doses with the nurse in charge.

Key messages for nursing staff

  • Always sign the Kardex following the administration of an antibiotic.
  • If the antibiotic is not available on the ward, contact pharmacy and request an urgent supply.
  • Discuss alternative therapy with the prescriber for the following patients: no IV access, nil by mouth, fasting, vomiting or unable to swallow.
  • If the patient is unavailable, administer the dose as soon as the patient returns to the ward.
  • It is acceptable practice to waken patients to administer their antibiotic dose.
  • Discuss missed antibiotic doses with the nurse in charge.