scholarly journals 148. Implementation of Restriction Criteria within an Electronic Medical Record and Its Impact on Carbapenem Prescribing

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S186-S186
Author(s):  
Mandana Naderi ◽  
Kimberly Welker ◽  
Gary Chan ◽  
David Nix
Keyword(s):  
Health System ◽  
Retrospective Cohort ◽  
Interrupted Time Series ◽  
Antibiotic Prescribing ◽  
Interrupted Time Series Analysis ◽  
Prescribing Practices ◽  
Post Intervention ◽  
Days Of Therapy ◽  
History Of ◽  
Selection For

Abstract Background Carbapenem restriction criteria (CRC) were developed by our health system to conserve the prescribing of these broad-spectrum agents. The purpose of this study was to compare pre and post EMR implementation of adherence to the system-approved CRC and if there was an association with decreased utilization of carbapenems. Methods A retrospective cohort review from January 2018 to June 2020 was performed via the Cerner EMR at 3 community hospitals in Arizona (AZ) and California (CA) to determine if CRC was appropriate at time of carbapenem initiation. Admitted patients > 18 years prescribed meropenem or ertapenem and received at least one dose were included. Health System approved CRC are shown in Table 2. Results A total of 160 patients were analyzed, including 60 pre-EMR CRC intervention and 100 post intervention. Forty-five patients (28%) had a documented history of ESBL infection as shown in Table 1. Figure 1 shows carbapenem utilization over the study period. An interrupted time series analysis was performed for both AZ and CA. After correcting for pre-intervention trends, AZ days of therapy (DOT) decreased by 6.2 DOT per 1000 patient days within 1 month post intervention (23%, p< 0.0001); the model predicted a further drop of 0.6 DOT per 1000 patient days per month over the 6 months post intervention. The CA DOT decreased by 1.2 DOT per 1000 patient days 1 month post intervention (17%, p= 0.28), with a predicted further drop of 0.28 DOT per 1000 patient days per month over the 6-month period post intervention. Post implementation retrospective review as described in Table 2 aligned with EMR restriction criteria selection for 68% of patients; interfacility differences occurred with 96% of CA reviews supported by criteria and 59% of AZ reviews supported by criteria (p= 0.0025). Conclusion This analysis supports that implementation of an EMR tool is an effective intervention to decrease unnecessary carbapenem use at the time of prescribing. The ESBL rate was similar pre and post intervention which may indicate that decreases in DOT were not due to a difference in MDRO rate. This study also highlights the different baseline antibiotic prescribing practices that may exist between facilities. Disclosures All Authors: No reported disclosures

scholarly journals Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 914
Author(s):  
Varidhi Nauriyal ◽  
Shankar Man Rai ◽  
Rajesh Dhoj Joshi ◽  
Buddhi Bahadur Thapa ◽  
Linda Kaljee ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Program Implementation ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Post Intervention ◽  
Middle Income ◽  
Burn Care ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Henry Ford

Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT/1000 PD) of penicillin (p = 0.02), aminoglycoside (p < 0.001), and cephalosporin (p = 0.04). Increases in DOT/1000 PD at post-intervention were significant for metronidazole (p < 0.001), quinolone (p = 0.01), and other antibiotics (p < 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (p < 0.001) and Pokhara Academy of Health Sciences (p = 0.02), but not at Kathmandu Model Hospital (p = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (t = 3.56; p < 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (p < 0.001), de-escalation (p < 0.001), accurate documentation (p < 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (p < 0.001) and after diagnoses (p < 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal.

scholarly journals Impact of Removal of Automatic 7-Day Stop Orders for Inpatient Antimicrobials

2020 ◽  
Vol 41 (S1) ◽  
pp. s264-s265
Author(s):  
Afia Adu-Gyamfi ◽  
Keith Hamilton ◽  
Leigh Cressman ◽  
Ebbing Lautenbach ◽  
Lauren Dutcher
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Treatment Interruptions ◽  
Days Of Therapy ◽  
Quasi Experimental ◽  
The Impact

Background: Automatic discontinuation of antimicrobial orders after a prespecified duration of therapy has been adopted as a strategy for reducing excess days of therapy (DOT) as part of antimicrobial stewardship efforts. Automatic stop orders have been shown to decrease antimicrobial DOT. However, inadvertent treatment interruptions may occur as a result, potentially contributing to adverse patient outcomes. To evaluate the effects of this practice, we examined the impact of the removal of an electronic 7-day ASO program on hospitalized patients. Methods: We performed a quasi-experimental study on inpatients in 3 acute-care academic hospitals. In the preintervention period (automatic stop orders present; January 1, 2016, to February 28, 2017), we had an electronic dashboard to identify and intervene on unintentionally missed doses. In the postintervention period (April 1, 2017, to March 31, 2018), the automatic stop orders were removed. We compared the primary outcome, DOT per 1,000 patient days (PD) per month, for patients in the automatic stop orders present and absent periods. The Wilcoxon rank-sum test was used to compare median monthly DOT/1,000 PD. Interrupted time series analysis (Prais-Winsten model) was used to compared trends in antibiotic DOT/1,000 PD and the immediate impact of the automatic stop order removal. Manual chart review on a subset of 300 patients, equally divided between the 2 periods, was performed to assess for unintentionally missed doses. Results: In the automatic stop order period, a monthly median of 644.5 antibiotic DOT/1,000 PD were administered, compared to 686.2 DOT/1,000 PD in the period without automatic stop orders (P < .001) (Fig. 1). Using interrupted time series analysis, there was a nonsignificant increase by 46.7 DOT/1,000 PD (95% CI, 40.8 to 134.3) in the month immediately following removal of automatic stop orders (P = .28) (Fig. 2). Even though the slope representing monthly change in DOT/1,000 PD increased in the period without automatic stop orders compared to the period with automatic stop orders, it was not statistically significant (P = .41). Manual chart abstraction revealed that in the period with automatic stop orders, 9 of 150 patients had 17 unintentionally missed days of therapy, whereas none (of 150 patients) in the period without automatic stop orders did. Conclusions: Following removal of the automatic stop orders, there was an overall increase in antibiotic use, although the change in monthly trend of antibiotic use was not significantly different. Even with a dashboard to identify missed doses, there was still a risk of unintentionally missed doses in the period with automatic stop orders. Therefore, this risk should be weighed against the modest difference in antibiotic utilization garnered from automatic stop orders.Funding: NoneDisclosures: None

Impact of Legislation on Opioid Prescribing following Hysterectomy and Hysteroscopy in Arizona and Florida

2021 ◽  
pp. 1-9
Author(s):  
Aakriti R. Carrubba ◽  
Amy E. Glasgow ◽  
Elizabeth B. Habermann ◽  
Amanda P. Stanton ◽  
Megan N. Wasson ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Cohort Analysis ◽  
Oral Morphine ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Before And After ◽  
Legislative Changes

<b><i>Objectives:</i></b> This study aimed to determine the oral morphine equivalents (OMEs) prescribed and refill rates following hysterectomy and hysteroscopy in the setting of opioid prescribing practice changes in 2 states. <b><i>Design:</i></b> This is a retrospective cohort analysis consisting of 2,916 patients undergoing hysterectomy or hysteroscopy between July 2016 and September 2019 at 2 affiliated academic hospitals in states that underwent legislative changes in opioid prescribing in 2018. <b><i>Methods:</i></b> Participants were identified using the Current Procedural Terminology procedure codes in Arizona and Florida. Hysterectomy was chosen as the most invasive gynecologic procedure, while hysteroscopy was chosen as the least invasive. Medical records were abstracted to find opioid prescriptions from 90 days before surgery to 30 days after discharge. Patients with opioid use between 90 and 7 days before surgery were excluded. Prescriptions were converted to OMEs and were calculated per quarter year. Statistical analysis included Wilcoxon rank sum <i>t</i> tests for OMEs and χ<sup>2</sup> <i>t</i> tests for refill rates. Interrupted time-series analysis was used to determine significant change in OMEs before and after legislative change. Statistical analysis was performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). <b><i>Results:</i></b> In Arizona, 1,067 hysterectomies were performed; 459 (43%) vaginal, 561 (52.6%) laparoscopic/robotic, and 47 (4.4%) abdominal. There were 530 hysteroscopies. Overall median OMEs decreased from 225 prior to July 2018 to 75 after July 2018 (<i>p</i> &#x3c; 0.0001). The opioid refill rate remained unchanged at 7.4% (<i>p</i> = 0.966). In Florida, there were 769 hysterectomies; 241 (31.3%) vaginal, 476 (61.9%) laparoscopic/robotic, and 52 (6.8%) abdominal. There were 549 hysteroscopies. Overall median OMEs decreased from 150 prior to July 2018 to 0 after July 2018 (<i>p</i> &#x3c; 0.0001). The opioid refill rate was similar (7.8% before July 2018 and 7.3% after July 2018; <i>p</i> = 0.739). <b><i>Limitations:</i></b> Limitations include involvement of a single hospital institution with a total of 10 fellowship-trained surgeons and biases inherent to retrospective study design. <b><i>Conclusions:</i></b> Legislative and provider-led changes coincided with decreases in opioid prescribing after 2018 in both states without increasing rates of refills and showed actual data reflected in the medical record. Gynecologists must actively participate in safe prescribing practices to decrease opioid dependence and misuse.

Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis

2021 ◽  
pp. bmjqs-2021-013110
Author(s):  
Sanjay Mahant ◽  
Jun Guan ◽  
Jessie Zhang ◽  
Sima Gandhi ◽  
Evan Jon Propst ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Health System ◽  
Interrupted Time Series ◽  
Improve Quality ◽  
Interrupted Time Series Analysis ◽  
Quality Improvement Programme ◽  
Improvement Programme

BackgroundTonsillectomy is among the most common and cumulatively expensive surgical procedures in children, with known variations in quality of care. However, evidence on health system interventions to improve quality of care is limited. The Quality-Based Procedures (QBP) programme in Ontario, Canada, introduced fixed episode hospital payment per tonsillectomy and disseminated a perioperative care pathway. We determined the association of this payment and quality improvement programme with tonsillectomy quality of care.MethodsInterrupted time series analysis of children undergoing elective tonsillectomy at community and children’s hospitals in Ontario in the QBP period (1 April 2014 to 31 December 2018) and the pre-QBP period (1 January 2009 to 31 January 2014) using health administrative data. We compared the age-standardised and sex-standardised rates for all-cause tonsillectomy-related revisits within 30 days, opioid prescription fills within 30 days and index tonsillectomy inpatient admission.Results111 411 children underwent tonsillectomy: 51 967 in the QBP period and 59 444 in the pre-QBP period (annual median number of hospitals, 86 (range 77–93)). Following QBP programme implementation, revisit rates decreased for all-cause tonsillectomy-related revisits (0.48 to −0.18 revisits per 1000 tonsillectomies per month; difference −0.66 revisits per 1000 tonsillectomies per month (95% CI −0.97 to −0.34); p<0.0001). Codeine prescription fill rate continued to decrease but at a slower rate (−4.81 to −0.11 prescriptions per 1000 tonsillectomies per month; difference 4.69 (95% CI 3.60 to 5.79) prescriptions per 1000 tonsillectomies per month; p<0.0001). The index tonsillectomy inpatient admission rate decreased (1.12 to 0.23 admissions per 1000 tonsillectomies per month; difference −0.89 (95% CI −1.33 to −0.44) admissions per 1000 tonsillectomies per month; p<0.0001).ConclusionsThe payment and quality improvement programme was associated with several improvements in quality of care. These findings may inform jurisdictions planning health system interventions to improve quality of care for tonsillectomy and other paediatric procedures.

The Impact of the Change in Payment System for German Psychiatric Clinics on Treatment Success: An Interrupted Time Series Analysis

2019 ◽  
Vol 82 (06) ◽  
pp. 559-567
Author(s):  
Christina Niedermeier ◽  
Andrea Barrera ◽  
Eva Esteban ◽  
Ivana Ivandic ◽  
Carla Sabariego
Keyword(s):  
Time Series ◽  
Negative Impact ◽  
Treatment Success ◽  
Interrupted Time Series ◽  
Sensitivity Analyses ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Intervention Point ◽  
The Impact ◽  
New System

Abstract Background In Germany a new reimbursement system for psychiatric clinics was proposed in 2009 based on the § 17d KHG Psych-Entgeltsystem. The system can be voluntary implemented by clinics since 2013 but therapists are frequently afraid it might affect treatment negatively. Objectives To evaluate whether the new system has a negative impact on treatment success by analysing routinely collected data in a Bavarian clinic. Material and methods Aggregated data of 1760 patients treated in the years 2007–2016 was analysed with segmented regression analysis of interrupted time series to assess the effects of the system on treatment success, operationalized with three outcome variables. A negative change in level after a lag period was hypothesized. The robustness of results was tested by sensitivity analyses. Results The percentage of patients with treatment success tends to increase after the new system but no significant change in level was observed. The sensitivity analyses corroborate results for 2 outcomes but when the intervention point was shifted, the positive change in level for the third outcome became significant. Conclusions Our initial hypothesis is not supported. However, the sensitivity analyses disclosed uncertainties and our study has limitations, such as a short observation time post intervention. Results are not generalizable as data of a single clinic was analysed. Nevertheless, we show the importance of collecting and analysing routine data to assess the impact of policy changes on patient outcomes.

scholarly journals Effects of the implementation of a hand hygiene education program among ICU professionals: an interrupted time-series analysis

2019 ◽  
Vol 45 (5) ◽  
Author(s):  
Diana Marcela Prieto Romero ◽  
Maycon Moura Reboredo ◽  
Edimar Pedrosa Gomes ◽  
Cristina Martins Coelho ◽  
Maria Aparecida Stroppa de Paula ◽  
...  
Keyword(s):  
Time Series ◽  
Hand Hygiene ◽  
Education Program ◽  
Hand Hygiene Compliance ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Intervention Phase ◽  
Hygiene Compliance ◽  
Hygiene Education

ABSTRACT Objective: To evaluate the effects that a hand hygiene education program has on the compliance of health professionals in an ICU. Methods: This was a quasi-experimental study with an interrupted time-series design, conducted over a 12-month period: the 5 months preceding the implementation of a hand hygiene education program (baseline period); the 2 months of the intensive (intervention) phase of the program; and the first 5 months thereafter (post-intervention phase). Hand hygiene compliance was monitored by one of the researchers, unbeknownst to the ICU team. The primary outcome measure was the variation in the rate of hand hygiene compliance. We also evaluated the duration of mechanical ventilation (MV), as well as the incidence of ventilator-associated pneumonia (VAP) at 28 days and 60 days, together with mortality at 28 days and 60 days. Results: On the basis of 959 observations, we found a significant increase in hand hygiene compliance rates-from 31.5% at baseline to 65.8% during the intervention phase and 83.8% during the post-intervention phase, corresponding to prevalence ratios of 2.09 and 2.66, respectively, in comparison with the baseline rate (p < 0.001). Despite that improvement, there were no significant changes in duration of MV, VAP incidence (at 28 or 60 days), or mortality (at 28 or 60 days). Conclusions: Our findings indicate that a hand hygiene education program can increase hand hygiene compliance among ICU professionals, although it appears to have no impact on VAP incidence, duration of MV, or mortality.

scholarly journals Inpatient antibiotic utilization in the Veterans’ Health Administration during the coronavirus disease 2019 (COVID-19) pandemic

2020 ◽  
pp. 1-3 ◽  
Author(s):  
Thomas D. Dieringer ◽  
Daisuke Furukawa ◽  
Christopher J. Graber ◽  
Vanessa W. Stevens ◽  
Makoto M. Jones ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Veterans Health Administration ◽  
Antibiotic Prescribing ◽  
Veterans Health ◽  
Health Administration ◽  
Prescribing Practices ◽  
Antibiotic Utilization ◽  
Days Of Therapy

Abstract Antibiotic prescribing practices across the Veterans’ Health Administration (VA) experienced significant shifts during the coronavirus disease 2019 (COVID-19) pandemic. From 2015 to 2019, antibiotic use between January and May decreased from 638 to 602 days of therapy (DOT) per 1,000 days present (DP), while the corresponding months in 2020 saw antibiotic utilization rise to 628 DOT per 1,000 DP.

The development and implementation of a discharge checklist for psychiatric inpatients: a pilot study

2018 ◽  
Vol 26 (3) ◽  
pp. 259-262 ◽  
Author(s):  
Yasmin Khanbhai ◽  
Michael Nance ◽  
David Smith
Keyword(s):  
Pilot Study ◽  
Discharge Planning ◽  
Psychiatric Inpatients ◽  
Interrupted Time Series ◽  
High Rate ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Readmission Rates ◽  
Implementation Period ◽  
Quasi Experimental

Objectives: Readmission rates are a routinely used measure of patient and service outcomes, potentially improved by discharge planning. This pilot study aimed to develop a discharge checklist for psychiatric inpatients, exploring its feasibility, applicability, and impact on readmission rates. Methods: The study used a quasi-experimental, pre–post intervention design. The checklist was designed from an evidence-based literature review, and introduced for a three-month period, comparing 28-day readmission rates with the previous three months using interrupted time series analysis. Results: Checklists were completed for 80% of patients in the trial period, with 100% completion of checklist items. Demographic and clinical details for pre- and post-intervention groups were closely aligned. There was a small, but statistically non-significant, reduction in readmission rates. Conclusions: There was a high rate of checklist completion. The lack of significant reductions in readmission rates supports more development of the checklist application and design before a longer implementation period and re-evaluation.

scholarly journals The impact of China’s lockdown policy on the incidence of CoVID-19: An Interrupted time series analysis

2020 ◽  
Author(s):  
Mooketsi Molefi ◽  
John Tlhakanelo ◽  
Thabo Phologolo ◽  
Shimeles G. Hamda ◽  
Tiny Masupe ◽  
...  
Keyword(s):  
Time Series ◽  
Linear Trend ◽  
Effective Means ◽  
Interrupted Time Series ◽  
Ordinary Least Squares ◽  
World Health ◽  
Least Squares Regression ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
The Impact

Abstract BackgroundPolicy changes are often necessary to contain the detrimental impact of epidemics such as the coronavirus disease (COVID-19). China imposed strict restrictions on movement on January 23rd, 2020.Interrupted time series methods were used to study the impact of the lockdown on the incidence of COVID-19. MethodsThe number of cases of COVID-19 reported daily from January 12thto March 30th, 2020 were extracted from the World Health Organization (WHO) COVID-19 dashboard ArcGIS® and matched to China’s projected population of 1 408 526 449 for 2020 in order to estimate daily incidences. Data were plotted to reflect daily incidences as data points in the series. A deferred interruption point of 6thFebruary was used to allow a 14-day period of diffusion. The magnitude of change and linear trend analyses were evaluated using the itsafunction with ordinary least-squares regression coefficients in Stata® yielding Newey-West standard errors.ResultsSeventy-eight (78) daily incidence points were used for the analysis, with 11(14.10%) before the intervention. There was a daily increase of 163 cases (β=1.16*10-07, p=0.00) in the pre-intervention period. Although there was no statistically significant drop in the number of cases reported daily in the immediate period following 6thFebruary 2020 when compared to the counterfactual (p=0.832), there was a 241 decrease (β=-1.71*10-07, p=0.00) in cases reported daily when comparing the pre-intervention and post-intervention periods. A deceleration of 78(47%) cases reported daily. ConclusionThe lockdown policy managed to significantly decrease the incidence of CoVID-19 in China. Lockdown provides an effective means of curtailing the incidence of COVID-19.

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