Background Documenting an indication when prescribing antimicrobials is considered best practice; however, a better understanding of the evidence is needed to support broader implementation of this practice.
Objectives We performed a scoping review to evaluate antimicrobial indication documentation as it pertains to its implementation, prevalence, accuracy and impact on clinical and utilisation outcomes in all patient populations.
Eligibility criteria Published and unpublished literature evaluating the documentation of an indication for antimicrobial prescribing.
Sources of evidence A search was conducted in MEDLINE, Embase, CINAHL and International Pharmaceutical Abstracts in addition to a review of the grey literature.
Charting and analysis Screening and extraction was performed by two independent reviewers. Studies were categorised inductively and results were presented descriptively.
Results We identified 123 peer-reviewed articles and grey literature documents for inclusion. Most studies took place in a hospital setting (109, 89%). The median prevalence of antimicrobial indication documentation was 75% (range 4%–100%). Studies evaluating the impact of indication documentation on prescribing and patient outcomes most commonly examined appropriateness and identified a benefit to prescribing or patient outcomes in 17 of 19 studies. Qualitative studies evaluating healthcare worker perspectives (n=10) noted the common barriers and facilitators to this practice.
Conclusion There is growing interest in the importance of documenting an indication when prescribing antimicrobials. While antimicrobial indication documentation is not uniformly implemented, several studies have shown that multipronged approaches can be used to improve this practice. Emerging evidence demonstrates that antimicrobial indication documentation is associated with improved prescribing and patient outcomes both in community and hospital settings. But setting-specific and larger trials are needed to provide a more robust evidence base for this practice.
- medication safety
- antibiotic management
- general practice
- healthcare quality improvement
- implementation science
Data availability statement
Data are available on reasonable request.
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Contributors SS, VL and BJL contributed to conceptualisation of the project. All authors contributed to methodology. SS, VL, ES and BJL contributed to data curation. BL performed the formal analysis. SS and BJL wrote the original draft. All authors contributed to review and editing of manuscript. BJL is the guarantor of this study.
Funding This scoping review was carried out as part of the authors’ routine work.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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