Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline
| Autor: | David A. Khan, Kristin S. Alvarez, Wenjing Wei, Justin R. Chen, Scott A. Tarver |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
clinical decision support
medicine.medical_specialty medicine.drug_class Antibiotics Pharmacist skin test Aztreonam Clinical decision support system 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine stewardship medicine polycyclic compounds Major Article Antimicrobial stewardship 030212 general & internal medicine penicillin allergy business.industry Guideline Antimicrobial Penicillin Infectious Diseases 030228 respiratory system Oncology chemistry Emergency medicine business medicine.drug aztreonam |
| Zdroj: | Open Forum Infectious Diseases |
| ISSN: | 2328-8957 |
| Popis: | Background Patients reporting penicillin allergy often receive unnecessary and costly broad-spectrum alternatives such as aztreonam with negative consequences. Penicillin allergy testing improves antimicrobial therapy but is not broadly used in hospitals due to insufficient testing resources and short-term expenses. We describe a clinical decision support (CDS) tool promoting pharmacist-administered penicillin allergy testing in patients receiving aztreonam and its benefits toward antimicrobial stewardship and costs. Methods A CDS tool was incorporated into the electronic medical record, directing providers to order penicillin allergy testing for patients receiving aztreonam. An allergy-trained pharmacist reviewed orders placed through this new guideline and performed skin testing and oral challenges to determine whether these patients could safely take penicillin. Data on tests performed, antibiotic utilization, and cost-savings were compared with patients tested outside the new guideline as part of our institution’s standard stewardship program. Results The guideline significantly increased penicillin allergy testing among patients receiving aztreonam from 24% to 85% (P < .001) while reducing the median delay between admission and testing completion from 3.31 to 1.05 days (P = 0.008). Patients tested under the guideline saw a 58% increase in penicillin exposure (P = .046). Institutional aztreonam administration declined from 2.54 to 1.47 administrations per 1000 patient-days (P = .016). Average antibiotic costs per patient tested before and after CDS decreased from $1265.81 to $592.08 USD, a 53% savings. Conclusions Targeting penicillin allergy testing to patients on aztreonam yields therapeutic and economic benefits during a single admission. This provides a cost-effective model for inpatient testing. |
| Databáze: | OpenAIRE |
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