Implementation of indication-based antibiotic order sentences improves antibiotic use in emergency departments

Authors

Lisa Vuong, Henry Ford Health
Rachel M. Kenney, Henry Ford HealthFollow
Julie M. Thomson, Henry Ford HealthFollow
Darius J. Faison, Henry Ford Health
Brian M. Church, Henry Ford HealthFollow
Robert McCollom, Henry Ford HealthFollow
Satheesh Gunaga, Henry Ford HealthFollow
Megan M. Cahill, Henry Ford HealthFollow
Michelle A. Slezak, Henry Ford HealthFollow
Susan L. Davis, Henry Ford HealthFollow
Michael P. Veve, Henry Ford HealthFollow

Recommended Citation

Pharmacy Vuong L, Kenney RM, Thomson JM, Faison DJ, Church BM, McCollom R, Gunaga S, Cahill MM, Slezak MA, Davis SL, and Veve MP. Implementation of indication-based antibiotic order sentences improves antibiotic use in emergency departments. Am J Emerg Med 2023; 69:5-10.

Document Type

Article

Publication Date

3-29-2023

Publication Title

The American journal of emergency medicine

Abstract

INTRODUCTION: Prior data have suggested that suboptimal antibiotic prescribing in the emergency department (ED) is common for uncomplicated lower respiratory tract infections (LRTI), urinary tract infections (UTI), and acute bacterial skin and skin structure infections (ABSSSI). The objective of this study was to measure the effect of indication-based antibiotic order sentences (AOS) on optimal antibiotic prescribing in the ED.

METHODS: This was an IRB-approved quasi-experiment of adults prescribed antibiotics in EDs for uncomplicated LRTI, UTI, or ABSSSI from January to June 2019 (pre-implementation) and September to December 2021 (post-implementation). AOS implementation occurred in July 2021. AOS are lean process, electronic discharge prescriptions retrievable by name or indication within the discharge order field. The primary outcome was optimal prescribing, defined as correct antibiotic selection, dose, and duration per local and national guidelines. Descriptive and bivariate statistics were performed; multivariable logistic regression was used to determine variables associated with optimal prescribing.

RESULTS: A total of 294 patients were included: 147 pre-group and 147 post-group. Overall optimal prescribing improved from 12 (8%) to 34 (23%) (P < 0.001). Individual components of optimal prescribing were optimal selection at 90 (61%) vs 117 (80%) (P < 0.001), optimal dose at 99 (67%) vs 115 (78%) (P = 0.036), and optimal duration at 38 (26%) vs 50 (34%) (P = 0.13) for pre- and post-group, respectively. AOS was independently associated with optimal prescribing after multivariable logistic regression analysis (adjOR, 3.6; 95%CI,1.7-7.2). A post-hoc analysis showed low uptake of AOS by ED prescribers.

CONCLUSIONS: AOS are an efficient and promising strategy to enhance antimicrobial stewardship in the ED.

PubMed ID

37027958

Volume

69

First Page

5

Last Page

10