Department of Pharmacy, Connecticut Children's Medical Center, Hartford.
Department of Pharmacy Practice, University of Connecticut, School of Pharmacy, Storrs.
J Pediatric Infect Dis Soc. 2018 May 15;7(2):113-118. doi: 10.1093/jpids/pix015.
A second-sign prospective restriction of select broad-spectrum antimicrobials was fully implemented in January 2015 as a pediatric antimicrobial stewardship program (ASP) initiative to help ensure the most appropriate empiric use of ceftaroline, cefepime, fidaxomicin, linezolid, and vancomycin (intravenous). The objective of this evaluation is to assess the effectiveness of a forced second-sign process in the electronic medical record as a pediatric ASP strategy. We anticipated that the second-sign process for antibiotics would increase the appropriateness of empiric antibiotic use, as defined by preapproved criteria, clinical pathways, national guidelines, and pediatric-specific infectious diseases reference texts, while not causing significant delay in the initial administration of antibiotic therapy.
This was a retrospective before and after intervention chart review conducted from July 2014 to June 2015. The study was conducted at a 187-bed, freestanding teaching children's hospital that included the following: level-1 pediatric trauma center, 18-bed pediatric intensive care unit, and 32-bed neonatal intensive care unit.
A total of 1178 orders were identified, and 389 met inclusion criteria. The vast majority of second-sign orders were for vancomycin (92%), 61% were written for males, and the median age was 6 years old. Appropriateness of second-sign restricted antibiotic use significantly increased after second-sign implementation (84.5% to 92.9%, P = .01). The secondary outcome of time from initial order entry to medication administration was not different between the before and after groups (median time, 184.5 [interquartile range, 110.25-280.75] vs 174 [interquartile range, 104-228] minutes; P = .342).
The use of a second-sign approval process for antimicrobial restriction can lead to increased appropriateness of antibiotic use at a pediatric hospital, without causing a delay in administration.
作为儿科抗菌药物管理计划（ASP）的一项举措，2015 年 1 月全面实施了第二种选择的广谱抗菌药物限制，以帮助确保头孢洛林、头孢吡肟、非达霉素、利奈唑胺和万古霉素（静脉注射）的经验性使用最合理。本评估的目的是评估电子病历中强制的第二种选择过程作为儿科 ASP 策略的有效性。我们预计，抗生素的第二种选择过程将增加经验性抗生素使用的合理性，这些抗生素的使用是根据预先批准的标准、临床途径、国家指南和儿科特定的传染病参考书籍定义的，同时不会导致抗生素治疗的初始给药出现显著延迟。
这是一项回顾性的干预前后图表审查，从 2014 年 7 月到 2015 年 6 月进行。这项研究是在一家拥有 187 张病床的独立教学儿童医院进行的，其中包括：1 级儿科创伤中心、18 张儿科重症监护病房和 32 张新生儿重症监护病房。
共确定了 1178 个订单，其中 389 个符合纳入标准。绝大多数第二种选择的订单是万古霉素（92%），61%是为男性开具的，中位数年龄为 6 岁。第二种选择限制抗生素使用的合理性在第二种选择实施后显著增加（从 84.5%增加到 92.9%，P =.01）。从初始医嘱输入到药物给药的次要结果在前后组之间没有差异（中位数时间，184.5 [四分位距，110.25-280.75] 与 174 [四分位距，104-228] 分钟；P =.342）。
在儿科医院，使用第二种选择的批准程序限制抗生素的使用可以提高抗生素使用的合理性，而不会导致给药延迟。
