Earlier switching from intravenous to oral antibiotics owing to electronic reminders

Abstract

Paper-based interventions have been shown to stimulate switching from intravenous (i.v.) to oral (p.o.) antibiotic therapies. Shorter i.v. durations are associated with a lower risk of iatrogenic infections as well as reduced workload and costs. The purpose of this study was to determine whether automated electronic reminders are able to promote earlier switching. In this controlled before-and-after study, an algorithm identified patients who were eligible for i.v.-to-p.o. switch 60h after starting i.v. antimicrobials. Reminders offering guidance on the re-assessment of initial i.v. therapy were displayed within the electronic health records in 12 units during the intervention period (year 2012). In contrast, no reminders were visible during the baseline period (2011)

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

“…Beeler et al [ 14 ] performed a prospective, controlled trial using an electronic reminder to stimulate iv-oral switch. Their study resulted in a decrease of total iv duration of 17.5% in the intervention group, and a switch-rate of 26.6%.…”

“…This enables antimicrobial stewardship teams to focus on other stewardship activities. The implementation of more sophisticated electronic health record systems (EHRS), which provide electronic alerts, could contribute to an additional reduction of workload [ 14 , 15 ].…”

Characteristics of the antibiotic regimen that affect antimicrobial resistance in urinary pathogens

“…Our results should trigger research to examine the influence of this switch on the selection of antimicrobial resistance. A recent investigation in Switzerland has shown that in acute care practice such a switch, leads to a two-step broad spectrum selection pressure, with an oral exposure of predominantly amoxicillin clavulanic acid, and to a lesser extent fluoroquinolones or clindamycine [ 4 ]. This impact on resistance in pathogens and commensals thus is substantial and we therefor plea to examine this in defined case control settings and larger at the population level.…”

“…An antimicrobial therapy consists of a specific product, synergies with other agents, its route of administration (formulation), a dose, a treatment interval, treatment duration, and they all can have an effect on the selection of antimicrobial resistance (AMR) [ 4 , 5 ]. A vast amount of studies has been focusing on synergies, the ideal dose (pharmacokinetic/pharmacodynamic parameters [ 6 ]), treatment interval and the impact of duration on resistance [ 7 ], to maintain clinical efficacy while minimizing resistance.…”

Negligible impact of highly patient-specific decision support for potassium-increasing drug-drug interactions – a cluster-randomised controlled trial

“…In fact, it has been shown that with a high number of automated CDS messages the likelihood of overriding increases ('alert fatigue'), which bears the risk that providers miss critical notifications [6]. To improve the acceptance and effectiveness of CDS notifications, various approaches have been proposed: -focusing on high-priority DDIs [7] -displaying context information in notifications such as current laboratory values [8] -patient data-driven filtering/suppressing of improper notifications [9] -displaying notifications at the right time, when adverse event becomes likelier [10] -removing notifications when the triggering conditions are no longer met [11] Whereas CDS interventions usually feature only a few of these approaches, we designed a concept hereafter described that combined all features (a-e) to reduce the number of CDS notifications and thereby minimise alert fatigue.…”