# The relationship of prescriber training level to restricted antibiotic prescribing appropriateness at a tertiary academic hospital: a retrospective study

## TL;DR

This study found no difference in appropriate antibiotic prescribing between trainees and staff at a hospital, but prescriptions on weekends were less likely to be appropriate.

## Contribution

The study provides new evidence on prescriber training level and antibiotic prescribing appropriateness in a tertiary hospital setting.

## Key findings

- Prescriptions written by medical trainees were not more or less appropriate than those by staff.
- Weekend prescriptions had reduced odds of being appropriate.
- Antibiotic prescribing appropriateness improved over time, including during and after the COVID-19 pandemic.

## Abstract

This study aimed to compare appropriateness of restricted antimicrobial prescriptions, as assessed by antimicrobial stewardship program (ASP) prospective audit and feedback (PAF), between those ordered by medical trainees versus staff. Secondary objectives were to determine whether certain timing factors and other independent variables impacted prescription appropriateness.

Single center, retrospective cohort study.

The University of Alberta Hospital a 700-bed tertiary care hospital in Edmonton, Canada.

Prescriptions of six health-authority restricted antibiotics subject to ASP PAF between 2018 and 2023. Cases were excluded if prescriber role or prescription dates or times were unavailable.

Data from a local ASP quality improvement database was extracted. Multiple logistic regression analysis was completed with adjusted odds ratios (aOR) reported.

A total of 3,687 restricted antibiotic prescriptions subjected to PAF were included in this study, of which 1,163 (31.5%) were assessed as not appropriately prescribed. Prescriptions written by medical trainees did not have higher odds of appropriateness compared to staff (aOR 1.09 [95% CI 0.94–1.28], P = .25). Weekend prescriptions had a reduced odds of being appropriate (aOR 0.71 [0.60–0.84], P < .0001). Through the course of the Coronavirus Disease 2019 (COVID-19) pandemic, appropriateness improved from 56.2% (prepandemic), 71.5% (peri-pandemic) to 76.9% (postpandemic).

No differences were noted in restricted antibiotic prescription appropriateness between medical trainees and staff. Weekend prescriptions were less likely to be appropriate. Improved appropriateness over time may be multifactorial, including implementation of ASP preceding the pandemic. Further studies examining timing factors associated with appropriateness are needed.