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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...

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Autores principales: Thompson, Cameron, Zahradnik, Michelle, Brown, Allison, Gina Fleming, Dimitra, Law, Madelyn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: British Publishing Group 2015
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.
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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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