Pharmacy Practice Department, Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana, United States.
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States.
Appl Clin Inform. 2019 Mar;10(2):229-236. doi: 10.1055/s-0039-1683877. Epub 2019 Apr 3.
To maximize resources, the antimicrobial stewardship program at a pediatric tertiary care hospital made pediatric dosing specific guidance within the electronic health record available to all hospitals within the health system.
The objective of this study was to compare the appropriateness of antibiotic dosing before and after the implementation of an electronic intravenous (IV) antibiotic order set.
This was a retrospective cohort study evaluating orders from patients younger than 18 years who received cefepime, piperacillin-tazobactam, tobramycin, or gentamicin at 12 health-system hospitals. Antibiotic dosing regimens and order set use were evaluated in patients who received the specified antibiotics during the 6-month time frame prior to and following electronic order set availability at each hospital.
In the before and after implementation periods, 360 and 387 total antibiotic orders were included, respectively. Most orders were gentamicin (55.8% in the before implementation period and 54.5% in the after implementation period) followed by piperacillin-tazobactam (22.5% in the before period and 22.2% in the after period). Overall, 663 orders were classified as appropriate (88.8%). Appropriateness was similar in the before or after implementation periods (87.8 vs. 89.7%, = 0.415). There was a significant difference in appropriateness if a blank order versus the electronic IV antibiotic order set was used (82.8 vs. 90.5%; = 0.024).
No difference in antibiotic appropriateness overall was found in the before and after implementation periods. However, when specifically compared with the appropriateness of dosing when blank order forms were used, dosing was more appropriate when electronic antibiotic order sets were used.
为了最大化资源利用，一家儿科三级保健医院的抗菌药物管理项目在电子病历中为整个医疗系统内的所有医院提供了儿科用药具体指导。
本研究旨在比较电子静脉（IV）抗生素医嘱集实施前后抗生素剂量的适宜性。
这是一项回顾性队列研究，评估了在 12 家医疗系统医院中，年龄小于 18 岁的患者接受头孢吡肟、哌拉西林他唑巴坦、妥布霉素或庆大霉素治疗时的医嘱。在每个医院的电子医嘱集可用之前和之后的 6 个月时间内，评估接受指定抗生素治疗的患者的抗生素剂量方案和医嘱集使用情况。
在实施前后期间，分别纳入了 360 和 387 份总抗生素医嘱。大多数医嘱为庆大霉素（实施前为 55.8%，实施后为 54.5%），其次是哌拉西林他唑巴坦（实施前为 22.5%，实施后为 22.2%）。总体而言，663 份医嘱被归类为适宜（88.8%）。实施前后的适宜性相似（87.8% vs. 89.7%， = 0.415）。如果使用空白医嘱与电子 IV 抗生素医嘱集，适宜性有显著差异（82.8% vs. 90.5%； = 0.024）。
在实施前后期间，总体上未发现抗生素适宜性的差异。然而，当具体比较空白医嘱与电子抗生素医嘱集的用药适宜性时，电子抗生素医嘱集的使用使用药更适宜。
