Department of Anesthesiology and Critical Care, Johns Hopkins University, Baltimore, Maryland, USA.
J Hosp Med. 2010 Jan;5(1):E41-5. doi: 10.1002/jhm.561.
In-hospital antimicrobial approval policies are designed to curb the indiscriminant use of antimicrobials. These policies usually require written forms and/or direct requests to an Infectious Disease specialist (or surrogate) prior to release of the antimicrobial. We hypothesized that the approval processes at our institution results in delayed antimicrobial administration.
We performed a retrospective cohort study examining the time from order to administration for 25 different antimicrobials ordered "stat." Antimicrobials were classified as restricted (required approval) or unrestricted. We compared these 2 classes to each other both during the daytime (8 AM to 10 PM), when approval is required for restricted antimicrobials, and at night when the first dose of all antimicrobials is exempted. We defined a delay in administration when the medication was given >1 hour from time of order. We separately examined delays of >2 hours.
A higher percentage of >1-hour delays occurred when the antimicrobial was restricted (odds ratio [OR] = 1.49; 95% confidence interval [CI] = 1.23-1.82). Similar results were seen for >2-hour delays (OR = 1.78; 95% CI = 1.39-2.21). During the exempt-from-restriction time period (10 PM to 8 AM), there was no difference between these 2 classes of antimicrobials. Results were unchanged by adjustment for service (medicine vs. surgery vs. other), patient characteristics (age, sex, race), or by weekday vs. weekend.
Statistically significant delays in stat antimicrobial administration occur in our institution when antimicrobials require preapproval. These findings illustrate the importance of considering clinical efficiency when restrictions are put in place for time-sensitive therapies such as antimicrobials.
住院期间的抗菌药物审批政策旨在遏制抗菌药物的滥用。这些政策通常要求在发放抗菌药物之前填写书面表格和/或直接向传染病专家（或代理人）提出申请。我们假设，我们机构的审批流程会导致抗菌药物的延迟使用。
我们进行了一项回顾性队列研究，检查了 25 种不同的“即刻”抗菌药物从医嘱到给药的时间。将抗菌药物分为限制（需要审批）和非限制两类。我们比较了这两类药物在白天（8 点至 10 点）和夜间（所有抗菌药物的第一剂免除审批）的情况。当药物给药时间比医嘱时间延迟超过 1 小时时，我们定义为给药延迟。我们分别检查了延迟超过 2 小时的情况。
当抗菌药物受到限制时，超过 1 小时的延迟比例更高（优势比 [OR] = 1.49；95%置信区间 [CI] = 1.23-1.82）。对于超过 2 小时的延迟，也出现了类似的结果（OR = 1.78；95% CI = 1.39-2.21）。在免除限制的时间段（晚上 10 点至早上 8 点），这两类抗菌药物之间没有差异。调整服务（内科、外科、其他）、患者特征（年龄、性别、种族）或工作日与周末后，结果保持不变。
当抗菌药物需要预先审批时，我们机构会出现显著的即刻抗菌药物给药延迟。这些发现表明，在对抗菌药物等时间敏感的治疗方法实施限制时，需要考虑临床效率。
