Dutcher Lauren, Yeager Alyssa, Gitelman Yevgeniy, Morgan Steven, Laude Jillian Dougherty, Binkley Shawn, Binkley Amanda, Cimino Christo, McDonnell Lindsay, Saw Stephen, Cluzet Valerie, Lautenbach Ebbing, Hamilton Keith W
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Infect Prev Pract. 2020 Apr 30;2(2):100062. doi: 10.1016/j.infpip.2020.100062. eCollection 2020 Jun.
Automatic stop orders (ASOs) for antimicrobials have been recommended as a component of antimicrobial stewardship programs, but may result in unintentional treatment interruption due to failure of providers to re-order an antimicrobial medication. We examined the impact of a multifaceted intervention designed to reduce the potential harms of interrupting antimicrobial treatment due to ASOs.
An intervention was implemented that included pharmacist review of expiring antimicrobials as well as provider education to encourage use of a long-term antimicrobial order set for commonly used prophylactic antimicrobials. Pharmacist interventions and antimicrobial re-ordering was recorded. Percent of missed doses of a commonly used prophylactic antimicrobial, single strength co-trimoxazole, was compared pre- and post-intervention using a chi-squared test.
From November 1, 2015 to November 30, 2016, there were 401 individual pharmacist interventions for antimicrobial ASOs, resulting in 295 instances of antimicrobial re-ordering. The total percent of presumed missed single strength co-trimoxazole doses was reduced from 8.4% to 6.2% post-intervention (<0.001).
This study found that a targeted intervention was associated with a reduction in unintended antimicrobial treatment interruption related to ASOs.
抗菌药物自动停药医嘱（ASOs）已被推荐作为抗菌药物管理计划的一部分，但由于医护人员未能重新开具抗菌药物处方，可能会导致无意的治疗中断。我们研究了一项多方面干预措施的影响，该措施旨在减少因ASOs导致的抗菌治疗中断的潜在危害。
实施了一项干预措施，包括药剂师对即将过期的抗菌药物进行审查，以及对医护人员进行教育，鼓励他们使用常用预防性抗菌药物的长期抗菌医嘱集。记录药剂师的干预措施和抗菌药物重新开具情况。使用卡方检验比较干预前后常用预防性抗菌药物单剂量复方新诺明漏服剂量的百分比。
2015年11月1日至2016年11月30日，药剂师针对抗菌药物ASOs进行了401次个体干预，导致295次抗菌药物重新开具。干预后，假定的单剂量复方新诺明漏服总百分比从8.4%降至6.2%（<0.001）。
本研究发现，有针对性的干预措施与减少与ASOs相关的无意抗菌治疗中断有关。
