Improving the timeliness of meticillin-resistant Staphylococcus aureus antimicrobial decolonization therapy administration: a descriptive account

Abstract

SummaryBackgroundIt is important to ensure that the timely administration of appropriate antimicrobial decolonization therapy occurs when patients are identified as meticillin-resistant Staphylococcus aureus (MRSA)-colonized. Computerized Provider Order Entry (CPOE) with embedded Clinical Decision Support (CDS) may help to facilitate this.AimTo investigate changes in the average time from patient admission to administration of MRSA decolonization antimicrobial therapy in the context of various national and local infection control interventions, including the use of CPOE.MethodsData concerning the time of admission and of administration of patients' first MRSA decolonization antimicrobials were extracted from a locally developed CPOE system (Prescribing Investigation and Communications System: PICS) which was introduced at a large university teaching hospital in the UK in 1998. Data were extracted retrospectively from January 2006 to March 2012.FindingsA variety of relevant local and national interventions occurred from 2006 to 2012. Notably, the automatic charting of MRSA decolonization antimicrobial therapy was introduced in December 2007. There was a significant decline of 15.0% per year (95% confidence interval: 11.1–18.7%; P < 0.001) in the time taken from admission to administration of MRSA decolonization antimicrobial therapy during the study period.ConclusionsNumerous factors may have contributed to the observed reductions in the time from admission to administration of MRSA decolonization antimicrobials, including the implementation of specific features within a CPOE system. By rapidly attending to positive MRSA colonizations there is decreased potential for MRSA to spread, which may help to reduce the prevalence of MRSA colonizations within hospitals and improve patient outcomes.

Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review

“…Most evidence came from specialty settings (such as intensive care, emergency medicine and paediatrics); and from high‐risk patient groups (e.g. those at risk for or with infections); and from tertiary care …”

“…We found that most work has been conducted in relation to CPOE and CDS systems, focusing on interventions that targeted individual prescribers through prompts and reminders …”

“…In relation to practitioner performance, the studies reported improved turnaround time for first dose of antibiotic, improved selection of antibiotics (e.g. in line with local protocols), optimal dosing, improved adherence to guidelines/protocols, and a decrease in the total number of antibiotics prescribed .…”

Tracing and Preventing Infections

“…Limitation of spread of infection depends on rapid and effective microbiological diagnostics, as in MRSA screening with responses within a few hours [50,51].…”

Investigating the ways in which health information technology can promote antimicrobial stewardship: a conceptual overview

“…The interoperability and automation of health information technology systems aim to minimise the time from the diagnostic order to the patient receiving the first dose. 26 During prescription preparation, health information technology can support pharmacists through a process of controls: checking whether the prescription is appropriate for the indication and the patient as well as facilitating contraindication checks such as allergies, drug interactions and conditions such as renal impairment which may necessitate a modification of the antibiotic dose. Electronic health record and ePrescribing systems can also support nurses during the administration of medication through reminders for timely administration as well as alerts for missed and delayed doses.…”