Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, and Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
Department of Pharmacy, Duke University Hospital, Durham, NC.
Am J Health Syst Pharm. 2020 Feb 7;77(4):282-287. doi: 10.1093/ajhp/zxz318.
To assess the accuracy of antibiotic indication documentation provided during order entry and prescriber perceptions of the requirement to specify indications.
Patients who received 1 of 6 selected antibiotics from May 1 through June 30, 2017, were identified. Records of 30 randomly selected patients who received each study antibiotic were retrospectively reviewed. The primary endpoint was indication accuracy, defined as agreement of the indication entered during order entry with that documented in progress notes at the time of order entry. Secondary endpoints included correlation of entered indication and final diagnosis for empiric antibiotics. A brief survey was emailed to prescribers to assess the burden and perceptions of requiring an indication during order entry.
Four thousand five hundred twenty-four patients received 1 or more doses of a study antibiotic. For the 180 patients selected for evaluation, 89.4% of indications were accurate. Indications for antibiotics ordered for prophylaxis were more likely to be inaccurate than those for empiric or definitive antibiotics (accuracy rates of 46%, 94%, and 92%, respectively, p < 0.05). For empiric antibiotics, 78.5% of indications documented at order entry matched the final diagnosis. Two hundred fifty-four of 863 prescribers (29%) responded to the survey request. Most respondents felt that documenting the indication took no more than 20 seconds, was a "minor nuisance" or "occasionally burdensome," and had no impact on their consideration of antibiotic appropriateness.
With the exception of prophylaxis, the indications documented during order entry were sufficiently accurate to assist antimicrobial stewardship efforts. Although indication documentation was perceived as a minor burden, surveyed prescribers indicated it had only a minimal beneficial effect on antibiotic prescribing.
评估在医嘱输入过程中提供的抗生素用药指征文档的准确性，以及医师对于指定用药指征的看法。
2017 年 5 月 1 日至 6 月 30 日期间，选取接受了 6 种选定抗生素之一的患者。回顾性分析随机抽取的 30 名接受每种研究抗生素治疗患者的记录。主要终点是指征准确性，定义为医嘱输入期间输入的指征与医嘱输入时的病程记录中的指征相符。次要终点包括输入的指征与经验性抗生素的最终诊断的相关性。向医师发送了一份简短的调查，以评估在医嘱输入时指定指征的负担和看法。
4524 例患者接受了一种或多种研究抗生素治疗。对于入选的 180 例患者，89.4%的指征是准确的。用于预防的抗生素的用药指征比经验性或确定性抗生素更有可能不准确（准确性分别为 46%、94%和 92%，p<0.05）。对于经验性抗生素，78.5%的医嘱输入时记录的指征与最终诊断相符。863 名医师中有 254 名（29%）回复了调查请求。大多数受访者认为记录指征不超过 20 秒，是“轻微的麻烦”或“偶尔麻烦”，并且对他们考虑抗生素的适当性没有影响。
除了预防用药，医嘱输入时记录的指征足够准确，可以辅助抗菌药物管理。尽管指征记录被认为是一个小负担，但调查的医师表示，这对处方抗生素的影响很小。
