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Lack of weight recording in patients being administered narrow therapeutic index antibiotics: a prospective cross-sectional study
  1. Esmita Charani1,
  2. Myriam Gharbi1,
  3. Mary Hickson2,
  4. Shokri Othman3,
  5. Aisha Alfituri3,
  6. Gary Frost4,
  7. Alison Holmes1
  1. 1Faculty of Medicine, The National Centre for Infection prevention and Management, Imperial College London, London, UK
  2. 2Therapy Services, Imperial College Healthcare NHS Trust, London, UK
  3. 3National Institute of Health Research/Wellcome Trust Imperial Clinical Research Facility Imperial College Healthcare NHS Trust, London, UK
  4. 4Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
  1. Correspondence to Dr Esmita Charani; e.charani{at}imperial.ac.uk

Abstract

Objectives Patient weight is a key measure for safe medication management and monitoring of patients. Here we report the recording of patient's body weight on admission in three hospitals in West London and its relationship with the prescription of antibiotic drugs where it is essential to have the body weight of the patient.

Methods A prospective cross-sectional study was conducted in three teaching hospitals in West London. Data were collected during March 2011–September 2011 and July 2012–August 2012, from adult admissions units, medical and surgical wards. Data from each ward were collected on a single day to provide a point prevalence data on weight recording. Patient medication charts, nursing and medical notes were reviewed for evidence of weight and height recording together with all the medication prescribed for the patients. An observational study collecting data on the weight recording process was conducted on two randomly selected wards to add context to the data.

Results Data were collected on 1012 patients. Weight was not recorded for 46% (474) of patients. Eighty-nine patients were prescribed a narrow therapeutic antibiotic, in 39% (35/89) of these weight was not recorded for the patient. Intravenous vancomycin was the most commonly prescribed antibiotic requiring therapeutic monitoring. In total 61 patients were receiving intravenous vancomycin and of these 44% (27/61) did not have their weight recorded. In the observational study, the most frequently identified barrier to weight not being recorded was interruptions to the admission process.

Conclusions Despite the clinical importance of body weight measurement it is poorly recorded in hospitalised patients, due to interruptions to the workflow and heavy staff workloads. In antibiotics a correct, recent patient weight is required for accurate dosing and to keep drugs within the narrow therapeutic index, to ensure efficacy of prescribing and reduce toxicity.

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