Antimicrobial stewardship & healthcare epidemiology : ASHE · 2022
Effectiveness of an electronic health system-based best-practice advisory to enhance the time to de-escalation of vancomycin for respiratory indications.
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Gibbs Amanda C, Jackson Daniel A, Runjaic Senka, Toncray Vanessa J, Bosch Wendelyn, Mendez Julio C, Epps Kevin L
Аннотация
OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) infection is highly unlikely when nasal-swab results are negative. We evaluated the impact of an electronic prompt regarding MRSA nasal screening on the length of vancomycin therapy for respiratory indications.
DESIGN: Retrospective, single-center cohort study.
SETTING: Tertiary-care academic medical center (Mayo Clinic) in Jacksonville, Florida.
PATIENTS: Eligible patients received empiric treatment with vancomycin for suspected or confirmed respiratory infections from January through April 2019 (preimplementation cohort) and from October 2019 through January 2020 (postimplementation cohort).
INTERVENTION: The electronic health system software was modified to provide a best-practice advisory (BPA) prompt to the pharmacist upon order verification of vancomycin for patients with suspected or confirmed respiratory indications. Pharmacists were prompted to order a MRSA nasal swab if it was not already ordered by the provider.
METHODS: We reviewed patient records to determine the time from vancomycin prescription to de-escalation. The secondary end point was incidence of acute kidney injury.
RESULTS: The study included 120 patients (preimplementation, n = 61; postimplementation, n = 59). Median time to de-escalation was significantly shorter for the postimplementation cohort: 76 hours (interquartile range [IQR], 52-109) versus 42 hours (IQR, 37-61; P = .002). Acute kidney injury occurred in 11 patients (18%) in the preimplementation cohort and in 3 patients (5%) in the postimplementation cohort (P = .01; number needed to treat, 8).
CONCLUSIONS: Implementation of a BPA notification for MRSA nasal screening helped decrease the time to de-escalation of vancomycin.
DESIGN: Retrospective, single-center cohort study.
SETTING: Tertiary-care academic medical center (Mayo Clinic) in Jacksonville, Florida.
PATIENTS: Eligible patients received empiric treatment with vancomycin for suspected or confirmed respiratory infections from January through April 2019 (preimplementation cohort) and from October 2019 through January 2020 (postimplementation cohort).
INTERVENTION: The electronic health system software was modified to provide a best-practice advisory (BPA) prompt to the pharmacist upon order verification of vancomycin for patients with suspected or confirmed respiratory indications. Pharmacists were prompted to order a MRSA nasal swab if it was not already ordered by the provider.
METHODS: We reviewed patient records to determine the time from vancomycin prescription to de-escalation. The secondary end point was incidence of acute kidney injury.
RESULTS: The study included 120 patients (preimplementation, n = 61; postimplementation, n = 59). Median time to de-escalation was significantly shorter for the postimplementation cohort: 76 hours (interquartile range [IQR], 52-109) versus 42 hours (IQR, 37-61; P = .002). Acute kidney injury occurred in 11 patients (18%) in the preimplementation cohort and in 3 patients (5%) in the postimplementation cohort (P = .01; number needed to treat, 8).
CONCLUSIONS: Implementation of a BPA notification for MRSA nasal screening helped decrease the time to de-escalation of vancomycin.