Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.
Children's Hospital Los Angeles, CA, USA.
J Pharm Pract. 2022 Feb;35(1):13-19. doi: 10.1177/0897190020938225. Epub 2020 Jul 9.
BACKGROUND/OBJECTIVES: Antibiotic indication documentation at the time of order entry is mandated by the Joint Commission. Inclusion of indication at order entry may have an impact on the time to administration. Our primary objective was to evaluate agreement between indication selected during order entry and clinical notes. Our secondary objective was to observe if there was a change in time to administration after indications were required during order entry.
Patients ≤18 years old who received ≥1 dose of vancomycin or ceftriaxone during a preintervention period and 3 postintervention periods were included. Indication for use, agreement between order and clinical note, and timing of antibiotic administration were collected.
Most common indication for vancomycin (total: 789) was sepsis (26%, n = 204). Common indications for ceftriaxone (total: 1071) were sepsis (12%, n = 127), perforated appendicitis (12%, n = 125), and urinary tract infection (10%, n = 107). Postintervention, agreement between the indication selected during order entry and indication documented in clinical note for ceftriaxone and vancomycin orders were 41% and 46%, respectively. Median time to administration decreased among patients who received ceftriaxone ( < .01) but had no significant impact on time to administration of vancomycin ( = .49).
Indication for ceftriaxone and vancomycin selected during order entry and reported in clinical notes inconsistently matched. Inclusion of antibiotic indication may impact time to administration.
背景/目的：联合委员会要求在下达医嘱时记录抗生素适应证。在下达医嘱时纳入适应证可能会影响给药时间。我们的主要目标是评估在下达医嘱时选择的适应证与临床记录之间的一致性。我们的次要目标是观察在下达医嘱时需要适应证后，给药时间是否发生变化。
纳入在干预前期间和 3 个干预后期间内接受至少 1 剂万古霉素或头孢曲松的≤18 岁患者。收集适应证使用情况、医嘱和临床记录之间的一致性以及抗生素给药时间。
万古霉素（共 789 例）最常见的适应证是败血症（26%，n=204）。头孢曲松（共 1071 例）的常见适应证是败血症（12%，n=127）、穿孔性阑尾炎（12%，n=125）和尿路感染（10%，n=107）。干预后，在下达医嘱时选择的头孢曲松和万古霉素的适应证与临床记录中记录的适应证之间的一致性分别为 41%和 46%。接受头孢曲松治疗的患者的给药时间中位数有所下降（<.01），但对万古霉素的给药时间没有显著影响（=.49）。
在下达医嘱时选择的头孢曲松和万古霉素适应证与临床记录中的报告不一致。纳入抗生素适应证可能会影响给药时间。
