An electronic trigger tool to optimise intravenous to oral antibiotic switch: a controlled, interrupted time series study
Publication year
2017Source
Antimicrobial Resistance and Infection Control, 6, (2017), pp. 81ISSN
Publication type
Article / Letter to editor
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Organization
Internal Medicine
Intensive Care
Journal title
Antimicrobial Resistance and Infection Control
Volume
vol. 6
Page start
p. 81
Subject
Radboudumc 4: lnfectious Diseases and Global Health RIHS: Radboud Institute for Health Sciences; Radboudumc 4: lnfectious Diseases and Global Health RIMLS: Radboud Institute for Molecular Life Sciences; Intensive Care - Radboud University Medical Center; Internal Medicine - Radboud University Medical CenterAbstract
BACKGROUND: Timely switch from intravenous (iv) antibiotics to oral therapy is a key component of antimicrobial stewardship programs in order to improve patient safety, promote early discharge and reduce costs. We have introduced a time-efficient and easily implementable intervention that relies on a computerized trigger tool, which identifies patients who are candidates for an iv to oral antibiotic switch. METHODS: The intervention was introduced on all internal medicine wards in a teaching hospital. Patients were automatically identified by an electronic trigger tool when parenteral antibiotics were used for >48 h and clinical or pharmacological data did not preclude switch therapy. A weekly educational session was introduced to alert the physicians on the intervention wards. The intervention wards were compared with control wards, which included all other hospital wards. An interrupted time-series analysis was performed to compare the pre-intervention period with the post-intervention period using '% of i.v. prescriptions >72 h' and 'median duration of iv therapy per prescription' as outcomes. We performed a detailed prospective evaluation on a subset of 244 prescriptions to evaluate the efficacy and appropriateness of the intervention. RESULTS: The number of intravenous prescriptions longer than 72 h was reduced by 19% in the intervention group (n = 1519) (p < 0.01) and the median duration of iv antibiotics was reduced with 0.8 days (p = <0.05). Compared to the control group (n = 4366) the intervention was responsible for an additional decrease of 13% (p < 0.05) in prolonged prescriptions. The detailed prospective evaluation of a subgroup of patients showed that adherence to the electronic reminder was 72%. CONCLUSIONS: An electronic trigger tool combined with a weekly educational session was effective in reducing the duration of intravenous antimicrobial therapy.
This item appears in the following Collection(s)
- Academic publications [245263]
- Electronic publications [132551]
- Faculty of Medical Sciences [93208]
- Open Access publications [106200]
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