|I am a junior doctor currently in my second year working at East Surrey hospital. I am passionate about improving patient care through quality improvement and digital health. |
During my first year at Croydon Hospital, I and a colleague Dr Joe Hogan co-developed the Antibiotic Calculation and Monitoring System, with the aim to tackling the widespread dosing errors of intravenous antibiotics.
The Antibiotic Calculation and Monitoring System, is a computer-based application developed to automate the process of calculating dosing regimens for commonly prescribed antibiotics: gentamicin, amikacin, vancomycin and teicoplanin.
Dosing these commonly prescribed antibiotics is not as straightforward as, say, penicillin because you have to adjust the dosing regimen for the patient’s weight, obesity, renal function and the indication. However, failure to follow the guidelines risks overdosing the patient, leading to toxic effects, or underdosing, which is not effective in treating the infection.
There is a wealth of literature evidence that both over-and underdosing these antibiotics is associated with significant patient mortality. Many doctors will be familiar with the difficulties prescribing these antibiotics, but our audit aimed to quantify the extent of the problem. Our team gathered all the information on thousands of antibiotics prescribed over a one-year period. Results highlighted widespread prescription errors.
Out of over 6000 gentamicin prescriptions, for example, 61% were prescribed incorrectly, with 17% categorised as serious under- or overdoses. There have been similar results in other trusts.
To tackle widespread errors, our app allows one to simply input all the relevant patient information (such as age, weight, sex, renal function) and the dose calculation and adjustments are done automatically.
Pilot studies in both Croydon Hospital and East Surrey Hospital have demonstrated faster and accurate prescribing, with superior results to Cerner’s and Microguide’s generic calculators.
For Croydon Hospital, the application was calculated to save the trust over £4000 per year in junior doctor time calculating and prescribing dosing regimens, and over £1500 per year by preventing drug waste.
This potential saving of £5500 saving does not include costs associated with benefits in length of stay, patient side-effects, savings in pharmacy time, recovery time from infection/sepsis and mortality.
The calculator reached the finals of the 2019 Health Tech Awards, and has been featured in an interview by the Health Tech Newspaper: http://www.thehtnco.uk/2019/10/17/interview-series-arron-thind-junior-doctor-east-surrey-hospital/.
Furthermore, the app is in the process of being uploaded onto Croydon Hospital’s network, and discussions are currently in process with East Surrey Hospital. Our ambition is to roll the Antibiotic app across all NHS hospitals by the end of next year. Please help us spread awareness of our apps.
If you require further information please contact me asap and I will be more than happy to help.
Dr Arron Thind [email protected]