Neonatal Research Institute, SHARP Mary Birch Hospital for Women and Newborns, 3003 Health Center Drive, San Diego, CA, 92123, USA.
UC San Diego Health, Department of Pharmacy, 200 West Arbor Drive, San Diego, CA, 92103, USA.
J Med Syst. 2017 Nov 9;41(12):202. doi: 10.1007/s10916-017-0856-7.
Chorioamnionitis is an intra-amniotic infection with serious maternal and neonatal complications. Clinical studies suggest antibiotic administration before delivery reduces the risk of complications compared to after delivery. Our center implemented a standardized intrapartum gentamicin computerized provider order entry and dosage form dispensing system intended to improve treatment initiation efficiency in hospitalized obstetric patients. The primary objective of this retrospective study was to determine if these system changes were associated with decreased time from gentamicin ordering to administration in patients with chorioamnionitis. A secondary objective was to compare clinical outcomes before and after system changes. Classification and regression tree (CART) analyses was applied to identify key predictors. Results demonstrated a trend towards reduced time to administration in the post-implementation group. Clinical outcomes were not altered. CART analysis revealed that post-implementation assignment and length of membrane rupture predicted shorter time to gentamicin initiation. This study suggests that the specific system changes we implemented were safe and improved efficiency, but additional changes are needed to have a clinically significant impact.
绒毛膜羊膜炎是一种羊膜内感染，可导致严重的母婴并发症。临床研究表明，与分娩后使用相比，分娩前使用抗生素可降低并发症风险。我们中心实施了一种标准化的产时庆大霉素计算机医嘱录入和剂型配发系统，旨在提高住院产科患者的治疗起始效率。本回顾性研究的主要目的是确定这些系统改变是否与绒毛膜羊膜炎患者的庆大霉素给药时间从医嘱到给药的缩短有关。次要目的是比较系统改变前后的临床结果。分类和回归树（CART）分析用于识别关键预测因素。结果表明，实施后组的给药时间呈缩短趋势。临床结果没有改变。CART 分析显示，实施后分组和胎膜破裂时间长短预测了庆大霉素起始时间的缩短。本研究表明，我们实施的特定系统改变是安全且提高了效率，但需要进一步改变才能产生临床显著影响。
