Table 1

Classifying the literature on antimicrobial indication documentation

Strategies for indication documentation

  • Mandatory indication: indication is required to proceed with ordering antimicrobial

  • Prompted indication: prescriber is reminded to include indication when ordering antimicrobial

  • Accountable justification: prescriber is prompted to provide a justification for certain potentially inappropriate prescribing situations

  • Indication-based prescribing: antimicrobial options are presented based on prescriber-selected indication

Types of studies evaluating indication documentation
Measuring indication documentation Interventions to improve indication documentation Measuring outcomes of indication documentation Identifying barriers and enablers to indication documentation
Prevalence
How often do prescribers include an indication? Where indication is included (prescription vs medical record). (n=52)
Accuracy
Comparing indication documentation to a ‘gold standard’. (n=14)
Clarity
Evaluating the interpretability, sufficiency or specificity of the indication (eg, cystitis vs urinary tract infection). (n=7)		Multi-modal approaches including audit and feedback and education to improve indication documentation (n=33)

  • Appropriateness of prescribing (eg, guideline concordant antibiotic selection) (n=10)

  • Antimicrobial utilisation (eg, prescribing rate or antibiotic days of therapy) (n=7)

  • Economic outcome (ie, cost-effectiveness) (n=1)

  • Adherence to restriction criteria (n=1)

  • Patient outcome (ie, clinical success) (n=1)

 Barriers
Factors that may reduce the uptake of indication documentation (eg, time consumption, uncertainty in diagnosis, logistics requirements).
Enablers
Factors that may increase the uptake of indication documentation (eg, prescribers’ motivation to improve communication, reduce errors, technological support).
(n=10)