Agwu Allison L, Lee Carlton K K, Jain Sanjay K, Murray Kara L, Topolski Jason, Miller Robert E, Townsend Timothy, Lehmann Christoph U
Divisions of Pediatric Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Clin Infect Dis. 2008 Sep 15;47(6):747-53. doi: 10.1086/591133.
Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program.
A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated.
After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy.
The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World Wide Web-based antimicrobial approval program, will effectively enhance antimicrobial stewardship programs.
抗菌药物管理计划旨在减少医院内抗菌药物的不当使用。在约翰霍普金斯儿童医疗与外科中心（马里兰州巴尔的摩），我们实施了一项基于万维网的抗菌药物限制计划，以解决现有限制计划存在的问题。
一项用户调查确定了改进现有抗菌药物限制计划的机会，并随后在一家拥有175张床位的三级护理儿科教学医院设计、实施并评估了一项基于万维网的抗菌药物限制计划。该计划提供自动化临床决策支持，便于审批，并加强了开方者、药剂师和儿科传染病研究员之间的实时沟通。审批状态、持续时间和理由；缺失请求通知；以及即将到期的审批都存储在一个可通过安全内部网站访问的数据库中。在该计划实施前后，对用户满意度、漏服和/或延迟服药报告、抗菌药物配药时间和成本进行了评估。
该计划实施后，与限制使用抗菌药物相关的预计年度成本降低了370,069美元，配药剂量数量减少了11.6%。开方者和药剂师的用户满意度分别从22%提高到68%和从13%提高到69%。开方者报告的漏服和延迟服药数量分别减少了21%和32%，药剂师报告的延迟审批数量减少了37%；测量的配药时间没有变化（P = 0.24）。此外，药房记录的与限制使用抗菌药物相关的电话减少了40%。
基于万维网的抗菌药物审批计划改善了沟通，提高了抗菌药物管理效率，提高了用户满意度，并节省了大量成本。像这种基于万维网的抗菌药物审批计划这样的综合工具将有效地加强抗菌药物管理计划。
