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Earlier switching from intravenous to oral antibiotics owing to electronic reminders


Beeler, Patrick E; Kuster, Stefan P; Eschmann, Emmanuel; Weber, Rainer; Blaser, Jürg (2015). Earlier switching from intravenous to oral antibiotics owing to electronic reminders. International Journal of Antimicrobial Agents, 46(4):428-433.

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) and in the control group (17 units). A total of 22863 i.v. antibiotic therapies were analysed; 6082 (26.6%) were switched to p.o.
THERAPY: In the intervention group, 757 courses of i.v. antibiotics were administered for a mean±standard deviation duration of 5.4±8.1 days before switching to p.o. antibiotics in the baseline period, and 794 courses for 4.5±5.5 days in the intervention period (P=0.004), corresponding to a 17.5% reduction of i.v. administration time. In contrast, in the control group the duration increased; 2240 i.v. antibiotics were administered for a mean duration of 4.0±5.9 days in the baseline period, and 2291 for 4.3±5.8 days in the intervention period (P=0.03). Electronic reminders fostered earlier i.v.-to-p.o. switches, thereby reducing the duration of initial i.v. therapies by nearly a day.

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) and in the control group (17 units). A total of 22863 i.v. antibiotic therapies were analysed; 6082 (26.6%) were switched to p.o.
THERAPY: In the intervention group, 757 courses of i.v. antibiotics were administered for a mean±standard deviation duration of 5.4±8.1 days before switching to p.o. antibiotics in the baseline period, and 794 courses for 4.5±5.5 days in the intervention period (P=0.004), corresponding to a 17.5% reduction of i.v. administration time. In contrast, in the control group the duration increased; 2240 i.v. antibiotics were administered for a mean duration of 4.0±5.9 days in the baseline period, and 2291 for 4.3±5.8 days in the intervention period (P=0.03). Electronic reminders fostered earlier i.v.-to-p.o. switches, thereby reducing the duration of initial i.v. therapies by nearly a day.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
04 Faculty of Medicine > Center for Medical Research
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:October 2015
Deposited On:23 Nov 2015 14:27
Last Modified:22 Jul 2016 00:00
Publisher:Elsevier
ISSN:0924-8579
Publisher DOI:https://doi.org/10.1016/j.ijantimicag.2015.06.013
PubMed ID:26293470
Permanent URL: https://doi.org/10.5167/uzh-114672

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