Evaluation of a Second-Sign Process for Antimicrobial Prior Authorization
| Autor: | Aimee M. Dassner, Jennifer E Girotto |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty Neonatal intensive care unit Adolescent Cefepime 030106 microbiology 030501 epidemiology Computer security computer.software_genre Antimicrobial Stewardship 03 medical and health sciences Anti-Infective Agents Interquartile range medicine Electronic Health Records Humans Antimicrobial stewardship Fidaxomicin Prior authorization Child Prescription Drug Overuse Retrospective Studies Pediatric intensive care unit business.industry Infant General Medicine Hospitals Pediatric medicine.disease Connecticut Infectious Diseases Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Female 0305 other medical science business computer medicine.drug Pediatric trauma |
| Zdroj: | Journal of the Pediatric Infectious Diseases Society. 7:113-118 |
| ISSN: | 2048-7207 2048-7193 |
| DOI: | 10.1093/jpids/pix015 |
| Popis: | Background A second-sign prospective restriction of select broad-spectrum antimicrobials was fully implemented in January 2015 as a pediatric antimicrobial stewardship program (ASP) initiative to help ensure the most appropriate empiric use of ceftaroline, cefepime, fidaxomicin, linezolid, and vancomycin (intravenous). The objective of this evaluation is to assess the effectiveness of a forced second-sign process in the electronic medical record as a pediatric ASP strategy. We anticipated that the second-sign process for antibiotics would increase the appropriateness of empiric antibiotic use, as defined by preapproved criteria, clinical pathways, national guidelines, and pediatric-specific infectious diseases reference texts, while not causing significant delay in the initial administration of antibiotic therapy. Methods This was a retrospective before and after intervention chart review conducted from July 2014 to June 2015. The study was conducted at a 187-bed, freestanding teaching children's hospital that included the following: level-1 pediatric trauma center, 18-bed pediatric intensive care unit, and 32-bed neonatal intensive care unit. Results A total of 1178 orders were identified, and 389 met inclusion criteria. The vast majority of second-sign orders were for vancomycin (92%), 61% were written for males, and the median age was 6 years old. Appropriateness of second-sign restricted antibiotic use significantly increased after second-sign implementation (84.5% to 92.9%, P = .01). The secondary outcome of time from initial order entry to medication administration was not different between the before and after groups (median time, 184.5 [interquartile range, 110.25-280.75] vs 174 [interquartile range, 104-228] minutes; P = .342). Conclusions The use of a second-sign approval process for antimicrobial restriction can lead to increased appropriateness of antibiotic use at a pediatric hospital, without causing a delay in administration. |
| Databáze: | OpenAIRE |
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