Audit of Physicians’ Adherence to a Preprinted Order Set for Community-Acquired Pneumonia

Autor: Barbara L Falkner, Carol Gee, Dana L. Cole, Abu A Hamour, Curt T Fowkes, Tammy Bluemink
Jazyk: angličtina
Rok vydání: 2010
Předmět:
Popis: Background: Community-acquired pneumonia is the seventh leading cause of death in Canada. Previous studies have shown reductions in both mortality rate and length of hospital stay with the use of guidelineconcordant empiric therapy and standardized preprinted orders. Objectives: The primary objective was to determine adherence to the preprinted order for community-acquired pneumonia at the University Hospital of Northern British Columbia (UHNBC). The study also had the following secondary objectives: to assess the appropriateness of prescribing of levofloxacin in relation to institutional recommendations; to determine adherence with recent guidelines from the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) for the treatment of community-acquired pneumonia; and to determine allcause mortality, duration of IV antibiotic therapy, and length of stay for the various regimens reviewed. Methods: A retrospective observational chart review was conducted of patients with community-acquired pneumonia who were admitted between November 2007 and February 2008. Exclusion criteria were designed to eliminate patients who did not have this condition. Descriptive statistics were used to assess adherence with the preprinted order. Secondary outcomes were analyzed with the Pearson χ 2 test, t tests, and analysis of variance. Results: In total, the charts for 113 patients were reviewed, and 58 patients were included in the study. The preprinted order for communityacquired pneumonia was used for 25 (43%) of the 58 patients; however, for only 4 (7%) of these admissions were all sections of the preprinted order used correctly. No statistically significant differences in length of stay were found for any of the antibiotic combinations assessed. However, the proportion of patients treated according to the IDSA-ATS guidelines was significantly greater when the preprinted order was used ( p = 0.012). In addition, use of the preprinted order encouraged assessment of the patient's pneumococcal vaccination status (9 [25%] of 25 patients versus 3 [9%] of 33 patients) and utilization of the pneumonia severity index (13 [52%] of 25 patients versus 0 [0%] of 33 patients). Conclusion: The preprinted order for community-acquired pneumonia at UHNBC was not being utilized to its fullest. However, when it was used, it increased guideline-concordant empiric therapy and encouraged assessment of patients' pneumococcal vaccination status and pneumonia severity index. RESUME Contexte : La pneumonie extra-hospitaliere est la septieme principale cause de mortalite au Canada. Des etudes ont montre que le taux de mortalite et la duree de l'hospitalisation diminuaient avec l'emploi d'un traitement empirique conforme aux lignes directrices et l'utilisation d'ordonnances preimprimees standardisees. Objectifs : Le principal objectif etait de determiner le taux d'observance a une ordonnance preimprimee actuellement utilisee au University Hospital of Northern British Columbia pour la prise en charge de la pneumonie extra-hospitaliere. L'etude comportait aussi les objectifs secondaires suivants : evaluer la pertinence de la prescription de la levofloxacine relativement aux recommandations de l'etablissement; determiner l'observance des recentes lignes directrices de l'Infectious Diseases Society of America (IDSA) et de l'American Thoracic Society (ATS) dans la prise en charge de la pneumonie extra-hospitaliere; et rendre compte des deces toutes causes confondues, de la duree de l'antibiotherapie intraveineuse et de la duree de l'hospitalisation pour les divers schemas examines. Methodes : On a effectue une analyse d'observation retrospective des dossiers medicaux des patients atteints de pneumonie extra-hospitaliere qui ont ete hospitalises entre novembre 2007 et fevrier 2008. Les criteres d'exclusion ont ete concus pour eliminer les cas non atteints de cette maladie. Des statistiques descriptives ont ete calculees pour evaluer l'observance de l'ordonnance preimprimee. Les parametres d'evaluation secondaires ont ete analyses a l'aide du test du chi carre de Pearson, des tests de t et de l'analyse de variance. Resultats : Au total, les dossiers medicaux de 113 patients ont ete analyses et 58 inclus dans l'etude. L'ordonnance preimprimee pour la prise en charge de la pneumonie extra-hospitaliere a ete utilisee chez 25 (43 %) des 58 patients; cependant, toutes les sections de l'ordonnance preimprimee n'ont ete remplies correctement que pour seulement 4 (7 %) de ces patients hospitalises. Aucune difference statistiquement significative n'a ete observee dans la duree de l'hospitalisation pour toutes les combinaisons d'antibiotiques analysees. En revanche, la proportion de patients traites conformement aux lignes directrices de l'IDSA-ATS etait considerablement plus elevee lorsque l'ordonnance preimprimee etait utilisee (p = 0,012). De plus, le recours a celle-ci a favorise l'evaluation de l'etat vaccinal antipneumococcique des patients (9 [25 %] des 25 patients contre 3 [9 %] des 33 patients) et l'utilisation de l'indice de gravite de la pneumonie (13 [52 %] des 25 patients contre 0 [0%] des 33 patients). Conclusion : L'ordonnance preimprimee pour la prise en charge de la pneumonie extra-hospitaliere n'etait pas utilisee a son plein potentiel au University Hospital of Northern British Columbia. Cependant, lorsqu'elle etait utilisee, elle a accru l'observance du traitement empirique aux lignes directrices et favorise l'evaluation de l'etat vaccinal antipneumococcique des patients et l'utilisation de l'indice de gravite de la pneumonie.
Databáze: OpenAIRE
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