Oral quinolones in hospitalized patients: an evaluation of a computerized decision support intervention*

Abstract

. Objective. To determine whether a computerized decision support system could increase the proportion of oral quinolone antibiotic orders placed for hospitalized patients. Design. Prospective, interrupted time‐series analysis. Setting. University hospital in the south‐eastern United States. Subjects. Inpatient quinolone orders placed from 1 February 2001 to 31 January 2003. Intervention. A web‐based intervention was deployed as part of an existing order entry system at a university hospital on 5 February 2002. Based on an automated query of active medication and diet orders, some users ordering intravenous quinolones were presented with a suggestion to consider choosing an oral formulation. Main outcome measure. The proportion of inpatient quinolone orders placed for oral formulations before and after deployment of the intervention. Results. There were a total of 15 194 quinolone orders during the study period, of which 8962 (59%) were for oral forms. Orders for oral quinolones increased from 4202 (56%) before the intervention to 4760 (62%) after, without a change in total orders. In the time‐series analysis, there was an overall 5.6% increase (95% CI 2.8–8.4%; P < 0.001) in weekly oral quinolone orders due to the intervention, with the greatest effect on nonintensive care medical units. Conclusions. A web‐based intervention was able to increase oral quinolone orders in hospitalized patients. This is one of the first studies to demonstrate a significant effect of a computerized intervention on dosing route within an antibiotic class. This model could be applied to other antibiotics or other drug classes with good oral bioavailability.

Earlier switching from intravenous to oral antibiotics owing to electronic reminders

“…(14) performed a before-and-after study without control group, and analysed the PO use of levofloxacin and ciprofloxacin when displaying electronic notifications. The use of PO levofloxacin and PO ciprofloxacin increased following the intervention (14). The studies by Fischer et al (23) and Hulgan et al (14) implemented sophisticated algorithms that searched the electronic patient charts for PO orders or structured data on oral diets in order to avoid alerts in patients who are unable to swallow.…”

“…suggested switches to equivalent oral agents (13). Other investigators presented a sophisticated algorithm that recommended the oral administration route for quinolones in some patients, and successfully increased the use of PO administration of levofloxacin and ciprofloxacin (14). Shojania et al (15) displayed guidelines at the time of computerized physician order entry and thereby reduced the duration of IV vancomycin.…”

Automated medication error studies with audit supplementation were effectively designed and analyzed by time series

“…Because multiple measurement points are needed, time series designs require either large observation periods or large populations that allow small time increments, provided that the effect can be observed within a short time window. However, selection of endpoints with large enough baseline frequency rates or the use of combined endpoint allow time series analysis in quality improvement studies in single institutions over periods as short as 1 or 2 years [18,[19][20][21][22][23][24][25][26][27].…”

Analysis of computer alerts suggesting oral medication use during computerized order entry of i.v. medications

“…medications. [4][5][6] Effective i.v.-to-oral conversion may Purpose. Compliance with computer alerts suggesting oral medication use during computerized order entry of i.v.…”