Gunn Lundy R, Tunney Robert, Kelly Kimberly
Appl Clin Inform. 2018 Jan;9(1):149-155. doi: 10.1055/s-0038-1626726. Epub 2018 Feb 28.
Medication alert overrides remain persistently high over the past decade, influenced by factors such as "alert fatigue" and lack of provider acceptance.
We compared the aggregate rate of fluoroquinolone (FQ) prescribing for the treatment of acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections (UTIs) in adult inpatients prior to (historical control group) and after (prospective intervention group) implementation of a program requiring indication when ordering FQ antibiotics in combination with a nonmodal best-practice alert regarding the latest U.S. Food and Drug Administration (FDA) recommendations. We then compared rates of prescribing among provider type, severity of infection, and patient age.
Qualified orders were defined as new FQ orders for acute sinusitis, acute bronchitis, and uncomplicated UTI for adult inpatients between July 2016 through September 2016 (control) or November 2016 through January 2017 (intervention). The primary endpoint was a provider-initiated FQ order for a target indication. Secondary endpoints included FQ orders by provider type and patient age. Rates of FQ use among the target indications were compared between groups by chi-square test of independence with Yates' correction in the analysis of the primary endpoint and Fisher's exact test for secondary endpoints.
FQ prescribing for acute bronchitis, and uncomplicated UTI occurred at a rate of 86/350 (24.6%) and 62/394 (15.7%) in the control and experimental groups, respectively ( = 0.0035). No patients receiving FQ qualified for a diagnosis of acute sinusitis.
A program combining FQ restriction in combination with nonmodal messaging may have decreased the rate of prescribing for acute bronchitis and uncomplicated UTI, although the contributions of each individual element could not be rigorously assessed.
在过去十年中，受“警报疲劳”和医护人员接受度不足等因素影响，用药警报的 override 率一直居高不下。
我们比较了在实施一项要求开具氟喹诺酮（FQ）抗生素时需注明适应症并结合美国食品药品监督管理局（FDA）最新建议的非模式化最佳实践警报程序之前（历史对照组）和之后（前瞻性干预组），成年住院患者中用于治疗急性鼻窦炎、急性支气管炎和单纯性尿路感染（UTI）的 FQ 处方总率。然后我们比较了不同医护人员类型、感染严重程度和患者年龄的处方率。
合格医嘱定义为 2016 年 7 月至 2016 年 9 月（对照组）或 2016 年 11 月至 2017 年 1 月（干预组）期间成年住院患者新开具的用于急性鼻窦炎、急性支气管炎和单纯性 UTI 的 FQ 医嘱。主要终点是医护人员针对目标适应症开具的 FQ 医嘱。次要终点包括按医护人员类型和患者年龄划分的 FQ 医嘱。在主要终点分析中，通过独立性卡方检验并进行 Yates 校正，在次要终点分析中通过 Fisher 精确检验比较两组目标适应症中 FQ 的使用比率。
对照组和实验组中，用于急性支气管炎和单纯性 UTI 的 FQ 处方率分别为 86/350（24.6%）和 62/394（15.7%）（P = 0.0035）。没有接受 FQ 治疗的患者符合急性鼻窦炎的诊断标准。
一项将 FQ 限制与非模式化信息相结合的计划可能降低了急性支气管炎和单纯性 UTI 的处方率，尽管无法严格评估每个单独要素的贡献。
