An electronic trigger tool to optimise intravenous to oral antibiotic switch: a controlled, interrupted time series study

Abstract

BackgroundTimely switch from intravenous (iv) antibiotics to oral therapy is a key component of antimicrobial stewardship programs in order to improve patient safety, promote early discharge and reduce costs. We have introduced a time-efficient and easily implementable intervention that relies on a computerized trigger tool, which identifies patients who are candidates for an iv to oral antibiotic switch.MethodsThe intervention was introduced on all internal medicine wards in a teaching hospital. Patients were automatically identified by an electronic trigger tool when parenteral antibiotics were used for >48 h and clinical or pharmacological data did not preclude switch therapy. A weekly educational session was introduced to alert the physicians on the intervention wards. The intervention wards were compared with control wards, which included all other hospital wards. An interrupted time-series analysis was performed to compare the pre-intervention period with the post-intervention period using ‘% of i.v. prescriptions >72 h’ and ‘median duration of iv therapy per prescription’ as outcomes. We performed a detailed prospective evaluation on a subset of 244 prescriptions to evaluate the efficacy and appropriateness of the intervention.ResultsThe number of intravenous prescriptions longer than 72 h was reduced by 19% in the intervention group (n = 1519) (p < 0.01) and the median duration of iv antibiotics was reduced with 0.8 days (p = <0.05). Compared to the control group (n = 4366) the intervention was responsible for an additional decrease of 13% (p < 0.05) in prolonged prescriptions.The detailed prospective evaluation of a subgroup of patients showed that adherence to the electronic reminder was 72%.ConclusionsAn electronic trigger tool combined with a weekly educational session was effective in reducing the duration of intravenous antimicrobial therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-017-0239-3) contains supplementary material, which is available to authorized users.

Mechanisms affecting the implementation of a national antimicrobial stewardship programme; multi-professional perspectives explained using Normalisation Process Theory

“…This could fracture the workability of AMS beyond initial prescribing, with key aspects 'falling between the gaps', particularly in relation to review of antibiotic use. This difficulty has been recognised elsewhere and additional mechanisms to trigger review have been advocated(31,32).Particular tensions were found in our study between AMS principles and heightened concerns around sepsis. Broom and colleagues(33) also found that perceived immediate clinical risks for individuals tend to dominate doctor's prescribing decisions over longer term population health risk.…”

Picking the low‐hanging fruit: Why not choose oral antibiotics for skin and soft‐tissue infections in the emergency department

“…Shared decision‐making is a core consideration of the modern clinician, but patients can also be misinformed about inpatient management being somehow superior . This can impair the judicious use of antimicrobials …”

Mechanisms affecting the implementation of a national antimicrobial stewardship programme; multi-professional perspectives explained using normalisation process theory

“…This could fracture the workability of AMS beyond initial prescribing, with key aspects 'falling between the gaps', particularly in relation to review of antibiotic use. This difficulty has been recognised elsewhere and additional mechanisms to trigger review have been advocated [31,32]. Particular tensions were found in our study between AMS principles and heightened concerns around sepsis.…”