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The use of an IV to PO clinical intervention form to improve antibiotic administration in a community based hospital
Antimicrobials are among the most commonly prescribed medications in acute care settings, with 50% of antimicrobial use deemed inappropriate. Antimicrobial stewardship programs (ASP) aim to optimize antibiotic use in order to improve patient clinical outcomes while minimizing unwanted effects of the...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
British Publishing Group
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4645920/ https://www.ncbi.nlm.nih.gov/pubmed/26734367 http://dx.doi.org/10.1136/bmjquality.u200786.w2247 |
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author | Thompson, Cameron Zahradnik, Michelle Brown, Allison Gina Fleming, Dimitra Law, Madelyn |
author_facet | Thompson, Cameron Zahradnik, Michelle Brown, Allison Gina Fleming, Dimitra Law, Madelyn |
author_sort | Thompson, Cameron |
collection | PubMed |
description | Antimicrobials are among the most commonly prescribed medications in acute care settings, with 50% of antimicrobial use deemed inappropriate. Antimicrobial stewardship programs (ASP) aim to optimize antibiotic use in order to improve patient clinical outcomes while minimizing unwanted effects of therapy including Clostridium difficile infection (CDI) and the emergence of resistant organisms. Antimicrobial Stewardship involves a coordinated set of interventions that ensure patients who require antimicrobial therapy receive the most appropriate agent at the correct dose, by the correct route for the correct duration. This project focused on the appropriate conversion from intravenous (IV) to oral (PO) antibiotics. The purpose of the project was to determine whether antibiotic prescribing patterns improved following the implementation of an IV to PO conversion clinical intervention form. A collaborative approach was used by an interprofessional team to review medical records and design a clinical intervention form that adheres to evidence-based guidelines to promote appropriate conversion for patients on intravenous antibiotics. Education efforts were made to inform health system staff about the goal of the intervention and to gather feedback for the improvement of the clinical intervention form. A five-week pilot intervention period trial was carried out with a specific focus on the fluoroquinolone class of antibiotics, specifically ciprofloxacin, moxifloxacin, and levofloxacin. Data from the intervention phase, including overall antibiotic use, ratio of intravenous:oral antibiotic time and compliance with the clinical intervention form were assessed. The ratio of intravenous to oral fluoroquinolone use changed from 39.4% IV: 60.6% PO before the intervention, to 34.7% IV: 65.3% PO during the intervention, indicating an overall increase in the usage of oral fluoroquinolones during the intervention phase. In patients eligible to receive the clinical intervention form, physician compliance with the form was 50%. IV duration decreased by 42% in patients with physician compliance. Further refinement of this form and the process for implementation will further enhance the conversion of intravenous to oral therapy. Based on these findings and the lessons learned, this process will be considered for further refinements, spread, and sustainability. |
format | Online Article Text |
id | pubmed-4645920 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | British Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-46459202016-01-05 The use of an IV to PO clinical intervention form to improve antibiotic administration in a community based hospital Thompson, Cameron Zahradnik, Michelle Brown, Allison Gina Fleming, Dimitra Law, Madelyn BMJ Qual Improv Rep BMJ Quality Improvement Programme Antimicrobials are among the most commonly prescribed medications in acute care settings, with 50% of antimicrobial use deemed inappropriate. Antimicrobial stewardship programs (ASP) aim to optimize antibiotic use in order to improve patient clinical outcomes while minimizing unwanted effects of therapy including Clostridium difficile infection (CDI) and the emergence of resistant organisms. Antimicrobial Stewardship involves a coordinated set of interventions that ensure patients who require antimicrobial therapy receive the most appropriate agent at the correct dose, by the correct route for the correct duration. This project focused on the appropriate conversion from intravenous (IV) to oral (PO) antibiotics. The purpose of the project was to determine whether antibiotic prescribing patterns improved following the implementation of an IV to PO conversion clinical intervention form. A collaborative approach was used by an interprofessional team to review medical records and design a clinical intervention form that adheres to evidence-based guidelines to promote appropriate conversion for patients on intravenous antibiotics. Education efforts were made to inform health system staff about the goal of the intervention and to gather feedback for the improvement of the clinical intervention form. A five-week pilot intervention period trial was carried out with a specific focus on the fluoroquinolone class of antibiotics, specifically ciprofloxacin, moxifloxacin, and levofloxacin. Data from the intervention phase, including overall antibiotic use, ratio of intravenous:oral antibiotic time and compliance with the clinical intervention form were assessed. The ratio of intravenous to oral fluoroquinolone use changed from 39.4% IV: 60.6% PO before the intervention, to 34.7% IV: 65.3% PO during the intervention, indicating an overall increase in the usage of oral fluoroquinolones during the intervention phase. In patients eligible to receive the clinical intervention form, physician compliance with the form was 50%. IV duration decreased by 42% in patients with physician compliance. Further refinement of this form and the process for implementation will further enhance the conversion of intravenous to oral therapy. Based on these findings and the lessons learned, this process will be considered for further refinements, spread, and sustainability. British Publishing Group 2015-01-28 /pmc/articles/PMC4645920/ /pubmed/26734367 http://dx.doi.org/10.1136/bmjquality.u200786.w2247 Text en © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/http://creativecommons.org/licenses/by-nc/2.0/legalcode |
spellingShingle | BMJ Quality Improvement Programme Thompson, Cameron Zahradnik, Michelle Brown, Allison Gina Fleming, Dimitra Law, Madelyn The use of an IV to PO clinical intervention form to improve antibiotic administration in a community based hospital |
title | The use of an IV to PO clinical intervention form to improve antibiotic administration in a community based hospital |
title_full | The use of an IV to PO clinical intervention form to improve antibiotic administration in a community based hospital |
title_fullStr | The use of an IV to PO clinical intervention form to improve antibiotic administration in a community based hospital |
title_full_unstemmed | The use of an IV to PO clinical intervention form to improve antibiotic administration in a community based hospital |
title_short | The use of an IV to PO clinical intervention form to improve antibiotic administration in a community based hospital |
title_sort | use of an iv to po clinical intervention form to improve antibiotic administration in a community based hospital |
topic | BMJ Quality Improvement Programme |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4645920/ https://www.ncbi.nlm.nih.gov/pubmed/26734367 http://dx.doi.org/10.1136/bmjquality.u200786.w2247 |
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