| Autor: |
Shojania, Kaveh G1, Yokoe, Deborah1, Platt, Richard1, Fiskio, Julie1, Ma'luf, Nell1, Bates, David W1, Shojania, K G2 (AUTHOR), Yokoe, D (AUTHOR), Platt, R (AUTHOR), Fiskio, J (AUTHOR), Ma'luf, N (AUTHOR), Bates, D W (AUTHOR) |
| Zdroj: |
Journal of the American Medical Informatics Association. Nov1998, Vol. 5 Issue 6, p554-562. 9p. 2 Black and White Photographs, 6 Charts, 2 Graphs. |
| Abstrakt: |
Background: Vancomycin-resistant enterococci represent an increasingly important cause of nosocomial infections. Minimizing vancomycin use represents a key strategy in preventing the spread of these infections.Objective: To determine whether a structured ordering intervention using computerized physician order entry that requires use of a guideline could reduce intravenous vancomycin use.Design: Randomized controlled trial assessing frequency and duration of vancomycin therapy by physicians.Participants and Setting: Three hundred ninety-six physicians and 1,798 patients in a tertiary-care teaching hospital.Intervention: Computer screen displaying, at the time of physician order entry, an adaptation of the Centers for Disease Control and Prevention guidelines for appropriate vancomycin use.Main Outcome Measures: The frequency of initiation and renewal of vancomycin therapy as well the duration of therapy prescribed on a per prescriber basis.Results: Compared with the control group, intervention physicians wrote 32 percent fewer orders (11.3 versus 16.7 orders per physician; P = 0.04) and had 28 percent fewer patients for whom they either initiated or renewed an order for vancomycin (7.4 versus 10.3 orders per physician; P = 0.02). In addition, the duration of vancomycin therapy attributable to physicians in the intervention group was 36 percent lower than the duration of therapy prescribed by control physicians (26.5 versus 41.2 days; P = 0.05). Analysis of pharmacy data confirmed a decrease in the overall hospital use of intravenous vancomycin during the study period.Conclusion: Implementation of a computerized guideline using physician order entry decreased vancomycin use. Computerized guidelines represent a promising tool for changing prescribing practices. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Library, Information Science & Technology Abstracts |
| Externí odkaz: |
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