Automated dispensing cabinet alert improves compliance with obtaining blood cultures before antibiotic administration for patients admitted with pneumonia.

BACKGROUND

A Centers for Medicare & Medicaid Services (CMS) pneumonia quality measures with particular impact on the emergency department (ED) is blood cultures prior to antibiotic administration for patients admitted with pneumonia. A study was conducted to measure the impact of an automated dispensing cabinet (ADC) alert on improving compliance with the quality measure of obtaining blood cultures prior to giving antibiotics for patients admitted with pneumonia and who have blood cultures ordered.

METHODS

The pre-post study involved ED adult patient with an admitting diagnosis of pneumonia from October 2007 through September 2008. The intervention consisted of a series of questions in the ED medication ADC regarding blood culture orders and antibiotic administration. Patients with an admitting diagnosis of pneumonia were identified through a search of the ED electronic health record (EHR). The proportion of patients in whom blood cultures were obtained prior to antibiotic administration in the pre- (October 2007-March 2008) and postintervention (April 2008-September 2008) periods were compared. The chi-square test was used to test for statistical significance.

RESULTS

Some 951 patients with pneumonia were identified during the study period, 426 pre- and 525 postintervention. Compliance with obtaining blood cultures prior to antibiotic administration was 84% (205/245, 95% confidence interval [CI]: 79%-88%) and 95% (275/291, 95% CI: 92%-97%) in the pre and postintervention periods, respectively (p <. 001).

CONCLUSIONS

In this population of patients with pneumonia, a series of questions in an ADC improved compliance with the quality measure regarding the obtaining of blood cultures prior to administering antibiotics to patients in whom blood cultures are requested.