Anatomy of a successful stewardship intervention: Improving perioperative prescribing in penicillin-allergic patients
| Autor: | Grant C. Lynde, Merin Kuruvilla, Mary Elizabeth Sexton, Francis A. Wolf, Zanthia Wiley |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Microbiology (medical)
medicine.medical_specialty Cefuroxime Epidemiology business.industry Psychological intervention Cefazolin Pharmacy Perioperative Penicillins Anti-Bacterial Agents Cephalosporins Penicillin Drug Hypersensitivity Infectious Diseases Carbapenems Delayed hypersensitivity Anesthesiology medicine Humans Intensive care medicine business medicine.drug |
| Zdroj: | Infection control and hospital epidemiology. 43(9) |
| ISSN: | 1559-6834 0899-823X |
| Popis: | Objective:To evaluate whether a series of quality improvement interventions to promote safe perioperative use of cephalosporins in penicillin-allergic patients improved use of first-line antibiotics and decreased costs.Design:Before-and-after trial following several educational interventions.Setting:Academic medical center.Patients:This study included patients undergoing a surgical procedure involving receipt of a perioperative antibiotic other than a penicillin or carbapenem between January 1, 2017, and August 31, 2019. Patients with and without a penicillin allergy label in their electronic medical record were compared with respect to the percentage who received a cephalosporin and average antibiotic cost per patient.Methods:A multidisciplinary team from infectious diseases, allergy, anesthesiology, surgery, and pharmacy surveyed anesthesiology providers about their use of perioperative cephalosporins in penicillin-allergic patients. Using findings from that survey, the team designed a decision-support algorithm for safe utilization and provided 2 educational forums to introduce this algorithm, emphasizing the safety of cefazolin or cefuroxime in penicillin-allergic patients without history of a severe delayed hypersensitivity reaction.Results:The percentage of penicillin-allergic patients receiving a perioperative cephalosporin improved from ∼34% to >80% following algorithm implementation and the associated educational interventions. This increase in cephalosporin use was associated with a ∼50% reduction in antibiotic cost per penicillin-allergic patient. No significant adverse reactions were reported.Conclusions:An educational antibiotic stewardship intervention produced a significant change in clinician behavior. A simple intervention can have a significant impact, although further study is needed regarding whether this response is sustained and whether an educational intervention is similarly effective in other healthcare systems. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|