Thompson Cameron, Zahradnik Michelle, Brown Allison, Gina Fleming Dimitra, Law Madelyn
Brock University, Canada.
BMJ Qual Improv Rep. 2015 Jan 28;4(1). doi: 10.1136/bmjquality.u200786.w2247. eCollection 2015.
Antimicrobials are among the most commonly prescribed medications in acute care settings, with 50% of antimicrobial use deemed inappropriate. Antimicrobial stewardship programs (ASP) aim to optimize antibiotic use in order to improve patient clinical outcomes while minimizing unwanted effects of therapy including Clostridium difficile infection (CDI) and the emergence of resistant organisms. Antimicrobial Stewardship involves a coordinated set of interventions that ensure patients who require antimicrobial therapy receive the most appropriate agent at the correct dose, by the correct route for the correct duration. This project focused on the appropriate conversion from intravenous (IV) to oral (PO) antibiotics. The purpose of the project was to determine whether antibiotic prescribing patterns improved following the implementation of an IV to PO conversion clinical intervention form. A collaborative approach was used by an interprofessional team to review medical records and design a clinical intervention form that adheres to evidence-based guidelines to promote appropriate conversion for patients on intravenous antibiotics. Education efforts were made to inform health system staff about the goal of the intervention and to gather feedback for the improvement of the clinical intervention form. A five-week pilot intervention period trial was carried out with a specific focus on the fluoroquinolone class of antibiotics, specifically ciprofloxacin, moxifloxacin, and levofloxacin. Data from the intervention phase, including overall antibiotic use, ratio of intravenous:oral antibiotic time and compliance with the clinical intervention form were assessed. The ratio of intravenous to oral fluoroquinolone use changed from 39.4% IV: 60.6% PO before the intervention, to 34.7% IV: 65.3% PO during the intervention, indicating an overall increase in the usage of oral fluoroquinolones during the intervention phase. In patients eligible to receive the clinical intervention form, physician compliance with the form was 50%. IV duration decreased by 42% in patients with physician compliance. Further refinement of this form and the process for implementation will further enhance the conversion of intravenous to oral therapy. Based on these findings and the lessons learned, this process will be considered for further refinements, spread, and sustainability.
抗菌药物是急性护理环境中最常用的处方药之一，其中50%的抗菌药物使用被认为是不恰当的。抗菌药物管理计划（ASP）旨在优化抗生素的使用，以改善患者的临床结局，同时将治疗的不良影响降至最低，包括艰难梭菌感染（CDI）和耐药菌的出现。抗菌药物管理涉及一系列协调的干预措施，以确保需要抗菌治疗的患者以正确的剂量、通过正确的途径、在正确的疗程内接受最合适的药物。该项目专注于从静脉注射（IV）抗生素到口服（PO）抗生素的适当转换。该项目的目的是确定实施静脉转口服转换临床干预表后抗生素处方模式是否得到改善。一个跨专业团队采用协作方法审查病历，并设计一份符合循证指南的临床干预表，以促进静脉用抗生素患者的适当转换。开展了教育工作，向卫生系统工作人员通报干预目标，并收集反馈意见以改进临床干预表。针对氟喹诺酮类抗生素，特别是环丙沙星、莫西沙星和左氧氟沙星，进行了为期五周的试点干预期试验。评估了干预阶段的数据，包括总体抗生素使用情况、静脉注射与口服抗生素使用时间的比例以及对临床干预表的依从性。静脉注射与口服氟喹诺酮类药物的使用比例从干预前的39.4%静脉注射：60.6%口服，变为干预期间的34.7%静脉注射：65.3%口服，表明干预阶段口服氟喹诺酮类药物的使用总体增加。在符合条件接受临床干预表的患者中，医生对该表的依从率为50%。医生依从的患者静脉用药时间减少了42%。对该表及实施过程的进一步完善将进一步提高静脉注射到口服治疗的转换率。基于这些发现和经验教训，将考虑对这一过程进行进一步完善、推广和持续应用。
