A prescription that says 'seven days' is interpreted from whenever the reader thinks day one was, and in a patient who had doses in theatre, in recovery, on the ward and then at home, nobody agrees. A prescription that says 'stop after the dose on 25 September' cannot be misread.
The failure this prevents is not dramatic, which is why it persists. Courses drift by two or three days at each handover, and the drift is always in the same direction — longer. Nobody stops an antibiotic early on a Friday; several people extend one.
This costs nothing and takes no extra time at the point of prescribing. It is worth doing on every antibiotic that has a defined course, and it matters most in exactly the situations where a trial has shortened the recommended duration, because a shortened course that drifts is no longer the course that was tested.
- Put a calendar stop date on every antibiotic with a defined course, on the chart and in the discharge letter
- State whether doses given before or during surgery count towards the course
- Name who is responsible for stopping it — the ward team, the GP, or the patient
- At handover, review antibiotics against their stop dates rather than against their indications
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