71 Electronic Prescribing Promotes Antimicrobial Stewardship In Surgery: A Closed-Loop Audit

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Lee ◽  
M Kelly ◽  
C Maden ◽  
J McHardy ◽  
D Elfadl
Keyword(s):  
Antimicrobial Stewardship ◽  
Closed Loop ◽  
Antimicrobial Treatment ◽  
Electronic Prescribing ◽  
Local Policy ◽  
Antibiotic Duration ◽  
The Impact ◽  
To Receive ◽  
Appropriate Education ◽  
Audit Standards

Abstract Introduction Antimicrobial resistance is increasing globally. Surgical inpatients are more likely to receive inappropriately broad-spectrum and prolonged antimicrobial treatment, against local policy. Electronic prescribing (e-prescribing) has the potential to promote antimicrobial stewardship. We conducted a closed-loop audit to assess the impact of e-prescribing on surgical inpatient prescriptions. Method Audit standards (from Public Health England) included: (1) documentation of allergy status, prescriber contact information, antimicrobial indication and review/stop dates; and (2) prescription of appropriate antimicrobials for appropriate durations (IV and total). Prospective data collection occurred over 1-week. The interventions included an educational session, a once weekly microbiology round of surgical inpatients and the introduction of e-prescribing (Cerner©). Results Compliance improved significantly between cycle 1 (n = 54 prescriptions) and 2 (n = 59 prescriptions), for: documentation of prescriber contact details (69 vs 100%) and appropriate antimicrobial review/stop dates (17 vs 100%), indications (78 vs 96%), selection (76 vs 90%) and IV and total antibiotic duration (63 vs 93% and 87 vs 100%, respectively); p < 0.05 throughout. Conclusions Audit compliance improved significantly, partly because Cerner© prompts clinicians to input contact details, review dates and indications before prescribing. E-prescribing in combination with appropriate education is likely to promote antimicrobial stewardship and should be considered by other Trusts using paper prescriptions.

scholarly journals 2794. Testing and Treatment in Patients Hospitalized with Suspected Influenza Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S987-S987
Author(s):  
Abhishek Deshpande ◽  
Michael Klompas ◽  
Patricia Bartley ◽  
Pei-Chun Yu ◽  
Sarah Haessler ◽  
...  
Keyword(s):  
Mixed Models ◽  
Antiviral Treatment ◽  
Community Acquired Pneumonia ◽  
Antimicrobial Treatment ◽  
Antibiotic Prescribing ◽  
Minimal Impact ◽  
Antimicrobial Utilization ◽  
Reduced Costs ◽  
The Impact ◽  
To Receive

Abstract Background Influenza is a leading cause of community-acquired pneumonia (CAP). Little is known about the effect of influenza testing on antimicrobial treatment among adult patients hospitalized with CAP. We quantified prevalence of testing and impact of positivity on treatment with antibacterials, antivirals, and outcomes. Methods We included adults admitted with pneumonia in 2010–2015 to 179 US hospitals contributing to the Premier database. Patients had CAP if radiographic evidence of pneumonia and antimicrobial treatment were present on day 1. We assessed influenza testing and compared antimicrobial utilization and outcomes of patients who tested positive vs negative vs not tested. Using mixed logistic regression and gamma generalized linear mixed models, we assessed the impact of influenza testing on inpatient mortality, length of stay (LOS) and cost. Results Among 166,273 patients with CAP, 38,665 (23.2%) were tested for influenza; 11.5% of these tested positive. The influenza testing rate increased from 15.4% in 2010/7–2011/6 to 35.6% in 2014/7–2015/6, ranging from 28.8% during flu season (October–May) to 8.2% in other months. Positive tests were more common during flu season (12.2% vs. 2.8%, P < 0.001). Patients tested for influenza were younger (66.6 vs. 70.3 years), less likely admitted from SNF (5.4% vs. 7.9%), with fewer comorbidities (2.9 vs. 3.3). Of patients tested for influenza, positive patients were younger (66.3 vs. 68.8 years), less likely admitted from SNF (5.2% vs. 6.8%), with more comorbidities (2.9 vs. 2.7) (all comparisons P < 0.001). Patients testing positive more likely received antivirals, were slightly less likely to receive antibacterials (Figure 1), but received shorter antibacterial courses than negative patients (5.3 vs 6.4 days, P < 0.001). Influenza tests were associated with reduced odds of in-hospital mortality compared with no testing (adjusted OR 0.71, 95% CI 0.63–0.81) and positive vs. negative tests with reduced costs (0.95, 0.92–0.99) and LOS (0.97, 0.94–0.99) (Figure 2). Conclusion In a large US inpatient sample hospitalized for pneumonia, only 23.2% of the patients were tested for influenza, but testing varied widely by hospital. A positive influenza test was associated with antiviral treatment but had minimal impact on antibiotic prescribing. Disclosures All authors: No reported disclosures.

scholarly journals Dietitians can improve accuracy of prescribing by interacting with electronic prescribing systems

2019 ◽  
Vol 26 (1) ◽  
pp. e000019 ◽  
Author(s):  
Susan De Waal ◽  
Laurie Lucas ◽  
Simon Ball ◽  
Tanya Pankhurst
Keyword(s):  
Electronic Health Records ◽  
Patient Care ◽  
Multidisciplinary Team ◽  
Electronic Prescribing ◽  
Health Records ◽  
Improve Accuracy ◽  
Before And After ◽  
Improving Accuracy ◽  
The Impact ◽  
To Receive

BackgroundDietitians increasingly interact with electronic health records (EHRs) and use them to alert prescribers to medication inaccuracies.ObjectiveTo understand renal dietitians’ use of electronic prescribing systems and influence on medication accuracy in inpatients. In outpatients to determine whether renal dietitians’ use of the electronic medication recording might improve accuracy.MethodsIn inpatients we studied the impact of dietetic advice on medical prescribing before and after moving from paper recommendations to ePrescribing. In outpatients, when dietitians recommended changes in dialysis units, we assessed the time to patients receiving the new medications. We trained dietitians to use the ePrescribing system and assessed accuracy of medication lists at the start and end of the study period.ResultsInpatients: before the use of EHRs, 25% of proposals were carried out and took an average of 20 days. This rose to 38% using an EHR and took an average of 4 days.Outpatients: in dialysis units dietitians recommend initiating and stopping medications and advise on repeat medications. Most recommendations were during multidisciplinary team (MDT) meetings; the average time to receive medications was 10 days. Drug histories updated by dietitians increased after the start of the study and accuracy of medication lists improved from 2.4 discrepancies/patient to 0.4.ConclusionDietitians can make medication suggestions directly using EHR, delivering more timely change to patient care and improving accuracy of patients’ medication lists. Allowing the whole of the MDT to contribute to the EHR improves data completeness and therefore patient care is likely to be enhanced.

The Governance of Early Education Programs: A Case in Support of Public School Responsibility for Them

1978 ◽  
Vol 3 (3) ◽  
pp. 168-177
Author(s):  
Robert H. Audette ◽  
Robert W. Heiny
Keyword(s):  
Young Children ◽  
Policy Development ◽  
Local Policy ◽  
Public Governance ◽  
Childhood Education ◽  
Educational Structures ◽  
Personal Social Service ◽  
Public Responsibility ◽  
The Impact ◽  
To Receive

The governance of early childhood education is a public responsibility. The need exists for proactive local policy development and program management and for accountability of programs to the purpose of public policy. Public governance of education should be deliberate in order to assure that desired benefits are arranged for all children and their families. Such governance should also be taken cautiously through consideration of issues about (1) education as a personal social service, (2) the impact of educational structures on individuals and families, and (3) the use of preschool programs as a massive human experiment. Alternative ways to govern the education of young children are explored. A clear advantage appears possible for young children when policy decisions are made by persons close to those who are to receive their benefits.

scholarly journals Antimicrobial Stewardship Optimization in the Emergency Department: The Effect of Multiplex Respiratory Pathogen Testing and Targeted Educational Intervention

2020 ◽  
Vol 5 (6) ◽  
pp. 1172-1183
Author(s):  
Thomas J S Durant ◽  
Nejla Zeynep Kubilay ◽  
Jesse Reynolds ◽  
Asim F Tarabar ◽  
Louise M Dembry ◽  
...  
Keyword(s):  
Emergency Department ◽  
Educational Intervention ◽  
Antimicrobial Stewardship ◽  
Antibiotic Prescription ◽  
Antimicrobial Treatment ◽  
The Body ◽  
Respiratory Pathogen ◽  
Prescription Rates ◽  
Tract Infections ◽  
To Receive

Abstract Background Antibacterial agents are often prescribed for patients with suspected respiratory tract infections even though these are most often caused by viruses. In this study, we sought to evaluate the effect of Respiratory Pathogen Panel (RPP) PCR result availability and antimicrobial stewardship education on antibiotic prescription rates in the adult emergency department (ED). Methods We compared rates of antibacterial and oseltamivir prescriptions between 2 nonconsecutive influenza seasons among ED visits, wherein the latter season followed the implementation of a comprehensive educational stewardship campaign. In addition, we sought to elucidate the effect of RPP-PCR on antibiotic prescriptions, with focus on result availability prior to the conclusion of emergency department encounters. Results Antibiotic prescription rates globally decreased by 17.9% in the FS-17/18 cohort compared to FS-14/15 (P &lt; 0.001), while oseltamivir prescription rates stayed the same overall (P = 0.42). Multivariate regression across both cohorts revealed that patients were less likely to receive antibiotics if RPP-PCR results were available before the end of the ED visit or if the RPP-PCR result was positive for influenza. Patients in the educational intervention cohort were also less likely to receive an antibiotic prescription. Conclusion This study provides evidence that RPP-PCR results are most helpful if available prior to the end of the provider-patient interaction. Further, these data suggest that detection of influenza remains an influential result in the context of antimicrobial treatment decision making. In addition, these data contribute to the body of literature which supports comprehensive ASP interventions including leadership and patient engagement.

scholarly journals Evaluating patient attitudes to increased patient engagement with antimicrobial stewardship: a quantitative survey

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Gerry Hughes ◽  
Eilis O’Toole ◽  
Alida Fe Talento ◽  
Aisling O’Leary ◽  
Colm Bergin
Keyword(s):  
Antimicrobial Stewardship ◽  
Public Involvement ◽  
Patient And Public Involvement ◽  
Antimicrobial Treatment ◽  
Irish Hospital ◽  
Asking Questions ◽  
Education Degree ◽  
The Impact ◽  
Hospital Inpatients ◽  
Future Patient

Abstract Background Antimicrobial stewardship (AMS) describes interventions designed to optimize antimicrobial therapy, minimize adverse treatment consequences and reduce the spread of antimicrobial resistance (AMR). Previous research has investigated the patient’s role in healthcare infection prevention but the patient’s role in AMS has not been extensively explored. Objectives To investigate the willingness of hospital inpatients to question staff about prudent antimicrobial use in an Irish hospital and evaluate the impact of patient and public involvement in research (PPI) on this study. Methods A survey was co-designed with the hospital Patient Representative Group (PRG) to evaluate patient willingness to engage with prudent antimicrobial treatment. A random sample of 200 inpatients was selected to self-complete the survey using pen and paper. PRG members provided feedback on their involvement. Results Of the 200 inpatients randomly selected to participate, 120 did not fulfil the inclusion criteria. Of the remaining 80, 67 participated (response 84%). Median respondent age was 58 years, 30% were employed and 30% had a third-level education degree. Over 90% had not heard of AMS while just over 50% had not heard of AMR. Patients preferred asking factual questions rather than challenging ones but did not have a preference in asking questions of doctors compared with nurses. Older patients were less likely to ask questions. PRG members reported an overall positive experience as research collaborators. Conclusions Future patient-centred AMS interventions should empower patients to ask about antimicrobial treatment, in particular the older patient cohort. PPI is a valuable component of patient-centred research.

The impact of a closed-loop electronic prescribing and automated dispensing system on the ward pharmacist's time and activities

2007 ◽  
Vol 15 (2) ◽  
pp. 133-139 ◽  
Author(s):  
Bryony Dean Franklin ◽  
Kara O'Grady ◽  
Parastou Donyai ◽  
Ann Jacklin ◽  
Nick Barber
Keyword(s):  
Closed Loop ◽  
Electronic Prescribing ◽  
The Impact

scholarly journals 1629. Targeted Antimicrobial Use Admission Provides an Actionable Denominator for Antimicrobial Stewardship Programs Evaluating Inpatient Length of Therapy

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S42-S42
Author(s):  
April Dyer ◽  
Elizabeth Dodds Ashley ◽  
Angelina Davis ◽  
Melissa Johnson ◽  
Travis Jones ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Hospital Admissions ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Electronic Prescribing ◽  
Antimicrobial Use ◽  
Number Of Patients ◽  
Length Of Therapy ◽  
The Impact ◽  
Over Time

Abstract Background Actionable, easy to interpret antibiotic use (AU) metrics provide antimicrobial stewardship programs (ASPs) with clear targets. Current aggregate AU metrics lack the ability to discriminate between long courses in a limited number of patients versus short courses in a large number of patients. Methods We developed a novel AU denominator termed “targeted antimicrobial use admission,” defined as an inpatient admission in which a selected agent or group of agents was administered. When used with length of therapy (LOT), it provides the average number of days patients receive the targeted agent(s) during inpatient hospital admissions. To demonstrate the added utility of this metric, we used descriptive statistics to compare it to LOT, LOT/1,000 patient days, LOT/1,000 admissions, and LOT/admission to quantify intravenous (IV) vancomycin use among 25 hospitals in the Duke Antimicrobial Stewardship Outreach Network (DASON) for calendar year 2017. The metric was also used to compare hospitals to one another and track durations at an example hospital over time. Results Total LOT included 128,680 days of IV vancomycin (table). LOT/targeted antimicrobial use admission is the only metric that allows programs to quickly assess agent durations. Conclusion Stewardship programs seeking to shorten durations of therapy can track this metric over time to determine the impact of their ASP efforts (Figure 1). The metric can also be used to compare average durations of IV vancomycin by hospital to determine when and if agent-focused audit and feedback or antibiotic timeouts may be useful (Figure 2). The network mean provides a target for agent-specific de-escalations, in days, for facilities with longer durations. LOT/targeted antimicrobial use admission provides an actionable metric for quantifying antimicrobial durations. This metric is easy to interpret and can feasibly be captured through the electronic prescribing record to aid in selecting ASP strategy. Disclosures All authors: No reported disclosures.

The Impact of Visual Feedback Type on the Mastery of Visuo-Motor Transformations

2012 ◽  
Vol 220 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Sandra Sülzenbrück
Keyword(s):  
Empirical Research ◽  
Visual Feedback ◽  
Closed Loop ◽  
Motor Planning ◽  
Visual Input ◽  
Closed Loop Control ◽  
Loop Control ◽  
Feedback Type ◽  
Effective Use ◽  
The Impact

For the effective use of modern tools, the inherent visuo-motor transformation needs to be mastered. The successful adjustment to and learning of these transformations crucially depends on practice conditions, particularly on the type of visual feedback during practice. Here, a review about empirical research exploring the influence of continuous and terminal visual feedback during practice on the mastery of visuo-motor transformations is provided. Two studies investigating the impact of the type of visual feedback on either direction-dependent visuo-motor gains or the complex visuo-motor transformation of a virtual two-sided lever are presented in more detail. The findings of these studies indicate that the continuous availability of visual feedback supports performance when closed-loop control is possible, but impairs performance when visual input is no longer available. Different approaches to explain these performance differences due to the type of visual feedback during practice are considered. For example, these differences could reflect a process of re-optimization of motor planning in a novel environment or represent effects of the specificity of practice. Furthermore, differences in the allocation of attention during movements with terminal and continuous visual feedback could account for the observed differences.

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