Pharmacy-implemented guidelines on switching from intravenous to oral antibiotics: an intervention study
Background: A high proportion of medical in-patients in the UK receive intravenous (IV) antibiotic therapy. This may be inappropriate in non-severe infections, or unnecessarily prolonged. Aim: To assess the impact of guideline implementation on IV antibiotic prescribing in medical admissions to a ge...
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| Veröffentlicht in: | QJM : An International Journal of Medicine 2005-10, Vol.98 (10), p.745-752 |
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| container_title | QJM : An International Journal of Medicine |
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| creator | McLaughlin, C.M. Bodasing, N. Boyter, A.C. Fenelon, C. Fox, J.G. Seaton, R.A. |
| description | Background: A high proportion of medical in-patients in the UK receive intravenous (IV) antibiotic therapy. This may be inappropriate in non-severe infections, or unnecessarily prolonged. Aim: To assess the impact of guideline implementation on IV antibiotic prescribing in medical admissions to a general hospital. Design: Observational intervention study. Methods: Data relating to infection and antibiotic therapy were collected for 4 weeks pre-intervention (group 1) and 4 weeks post intervention (group 2). Six months later, data were collected for a further 4 weeks following a second intervention (group 3). Interventions consisted of pharmacy-led implementation of guidelines incorporating criteria for IV therapy and switching to the oral route. The second intervention also included pharmacy-initiated feedback on prescribing. The main outcome measures were IV antibiotic duration, and appropriateness of the IV route and switching. Results: Of 2365 admissions, 757 (32%) had 806 treated episodes. IV therapy was used in 40%, 46% and 36% (groups 1, 2 and 3, respectively) and was appropriate in 92% vs. 100% (group 1 vs. 2). In groups 2 and 3, oral switch timing was appropriate in 90% and 88%, vs. 17% in group 1 (p |
| doi_str_mv | 10.1093/qjmed/hci114 |
| format | Article |
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This may be inappropriate in non-severe infections, or unnecessarily prolonged. Aim: To assess the impact of guideline implementation on IV antibiotic prescribing in medical admissions to a general hospital. Design: Observational intervention study. Methods: Data relating to infection and antibiotic therapy were collected for 4 weeks pre-intervention (group 1) and 4 weeks post intervention (group 2). Six months later, data were collected for a further 4 weeks following a second intervention (group 3). Interventions consisted of pharmacy-led implementation of guidelines incorporating criteria for IV therapy and switching to the oral route. The second intervention also included pharmacy-initiated feedback on prescribing. The main outcome measures were IV antibiotic duration, and appropriateness of the IV route and switching. Results: Of 2365 admissions, 757 (32%) had 806 treated episodes. IV therapy was used in 40%, 46% and 36% (groups 1, 2 and 3, respectively) and was appropriate in 92% vs. 100% (group 1 vs. 2). In groups 2 and 3, oral switch timing was appropriate in 90% and 88%, vs. 17% in group 1 (p<0.001). Between groups 1 and 2, median duration of IV therapy was reduced from 3 to 2 days (p = 0.01). More patients in group 2 received appropriate exclusively IV therapy (65% vs. 96%, p<0.01). Duration of stay in IV-treated patients reduced from 13 to 10 days in groups 2 and 3 (p = 0.047). IV antibiotic expenditure reduced by 13% per patient admitted between groups 1 and 2. Discussion: Pharmacy-led introduction of antibiotic guidelines appears to result in clinically appropriate reductions in IV therapy.</description><identifier>ISSN: 1460-2725</identifier><identifier>EISSN: 1460-2393</identifier><identifier>DOI: 10.1093/qjmed/hci114</identifier><identifier>PMID: 16126741</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Administration, Oral ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - administration & dosage ; Antibacterial agents ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Biological and medical sciences ; Community-Acquired Infections - drug therapy ; Female ; General aspects ; Humans ; Infusions, Intravenous ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Pharmacy Service, Hospital - standards ; Pilot Projects ; Practice Guidelines as Topic - standards ; Professional Role</subject><ispartof>QJM : An International Journal of Medicine, 2005-10, Vol.98 (10), p.745-752</ispartof><rights>2005 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Oct 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c450t-a451133d83befa84b96b4d8aa744dc06d33e2eb44c07ad70ba22bb7c81b5d3c73</citedby><cites>FETCH-LOGICAL-c450t-a451133d83befa84b96b4d8aa744dc06d33e2eb44c07ad70ba22bb7c81b5d3c73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17157113$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16126741$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McLaughlin, C.M.</creatorcontrib><creatorcontrib>Bodasing, N.</creatorcontrib><creatorcontrib>Boyter, A.C.</creatorcontrib><creatorcontrib>Fenelon, C.</creatorcontrib><creatorcontrib>Fox, J.G.</creatorcontrib><creatorcontrib>Seaton, R.A.</creatorcontrib><title>Pharmacy-implemented guidelines on switching from intravenous to oral antibiotics: an intervention study</title><title>QJM : An International Journal of Medicine</title><addtitle>QJM</addtitle><description>Background: A high proportion of medical in-patients in the UK receive intravenous (IV) antibiotic therapy. This may be inappropriate in non-severe infections, or unnecessarily prolonged. Aim: To assess the impact of guideline implementation on IV antibiotic prescribing in medical admissions to a general hospital. Design: Observational intervention study. Methods: Data relating to infection and antibiotic therapy were collected for 4 weeks pre-intervention (group 1) and 4 weeks post intervention (group 2). Six months later, data were collected for a further 4 weeks following a second intervention (group 3). Interventions consisted of pharmacy-led implementation of guidelines incorporating criteria for IV therapy and switching to the oral route. The second intervention also included pharmacy-initiated feedback on prescribing. The main outcome measures were IV antibiotic duration, and appropriateness of the IV route and switching. Results: Of 2365 admissions, 757 (32%) had 806 treated episodes. IV therapy was used in 40%, 46% and 36% (groups 1, 2 and 3, respectively) and was appropriate in 92% vs. 100% (group 1 vs. 2). In groups 2 and 3, oral switch timing was appropriate in 90% and 88%, vs. 17% in group 1 (p<0.001). Between groups 1 and 2, median duration of IV therapy was reduced from 3 to 2 days (p = 0.01). More patients in group 2 received appropriate exclusively IV therapy (65% vs. 96%, p<0.01). Duration of stay in IV-treated patients reduced from 13 to 10 days in groups 2 and 3 (p = 0.047). IV antibiotic expenditure reduced by 13% per patient admitted between groups 1 and 2. Discussion: Pharmacy-led introduction of antibiotic guidelines appears to result in clinically appropriate reductions in IV therapy.</description><subject>Administration, Oral</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Antibacterial agents</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Biological and medical sciences</subject><subject>Community-Acquired Infections - drug therapy</subject><subject>Female</subject><subject>General aspects</subject><subject>Humans</subject><subject>Infusions, Intravenous</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pharmacology. Drug treatments</subject><subject>Pharmacy Service, Hospital - standards</subject><subject>Pilot Projects</subject><subject>Practice Guidelines as Topic - standards</subject><subject>Professional Role</subject><issn>1460-2725</issn><issn>1460-2393</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0E1v1DAQBmALgWhZuHFGERI9NdRfiZPeaEW3SJVAVUGIizX-SNdLYm9tB7r_vgm7FImT7fHj0fhF6DXB7wlu2cnderDmZKUdIfwJOiS8xiVlLXv6dy9odYBepLTGGHPBm-fogNSE1oKTQ7T6soI4gN6Wbtj0drA-W1Pcjs7Y3nmbiuCL9NtlvXL-tuhiGArnc4Rf1ocxFTkUIUJfgM9OuZCdTqfTYTY2Tia7-X0ezfYletZBn-yr_bpAXy8-3pxfllefl5_OP1yVmlc4l8ArQhgzDVO2g4artlbcNACCc6NxbRiz1CrONRZgBFZAqVJCN0RVhmnBFuho13cTw91oU5aDS9r2PXg7TSzrpmobJtgE3_4H12GMfppNUtpOQdXt3O14h3QMKUXbyU10A8StJFjO8cs_8ctd_BN_s-85qrn8iPd5T-DdHkDS0HcRvHbpnxOkEvP_F6jcOZeyvX-8h_hT1oKJSl5-_yGba7o84_ybXLIHIPmgaQ</recordid><startdate>20051001</startdate><enddate>20051001</enddate><creator>McLaughlin, C.M.</creator><creator>Bodasing, N.</creator><creator>Boyter, A.C.</creator><creator>Fenelon, C.</creator><creator>Fox, J.G.</creator><creator>Seaton, R.A.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20051001</creationdate><title>Pharmacy-implemented guidelines on switching from intravenous to oral antibiotics: an intervention study</title><author>McLaughlin, C.M. ; Bodasing, N. ; Boyter, A.C. ; Fenelon, C. ; Fox, J.G. ; Seaton, R.A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c450t-a451133d83befa84b96b4d8aa744dc06d33e2eb44c07ad70ba22bb7c81b5d3c73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Administration, Oral</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Antibacterial agents</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Biological and medical sciences</topic><topic>Community-Acquired Infections - drug therapy</topic><topic>Female</topic><topic>General aspects</topic><topic>Humans</topic><topic>Infusions, Intravenous</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pharmacology. Drug treatments</topic><topic>Pharmacy Service, Hospital - standards</topic><topic>Pilot Projects</topic><topic>Practice Guidelines as Topic - standards</topic><topic>Professional Role</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McLaughlin, C.M.</creatorcontrib><creatorcontrib>Bodasing, N.</creatorcontrib><creatorcontrib>Boyter, A.C.</creatorcontrib><creatorcontrib>Fenelon, C.</creatorcontrib><creatorcontrib>Fox, J.G.</creatorcontrib><creatorcontrib>Seaton, R.A.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>QJM : An International Journal of Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McLaughlin, C.M.</au><au>Bodasing, N.</au><au>Boyter, A.C.</au><au>Fenelon, C.</au><au>Fox, J.G.</au><au>Seaton, R.A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pharmacy-implemented guidelines on switching from intravenous to oral antibiotics: an intervention study</atitle><jtitle>QJM : An International Journal of Medicine</jtitle><addtitle>QJM</addtitle><date>2005-10-01</date><risdate>2005</risdate><volume>98</volume><issue>10</issue><spage>745</spage><epage>752</epage><pages>745-752</pages><issn>1460-2725</issn><eissn>1460-2393</eissn><abstract>Background: A high proportion of medical in-patients in the UK receive intravenous (IV) antibiotic therapy. This may be inappropriate in non-severe infections, or unnecessarily prolonged. Aim: To assess the impact of guideline implementation on IV antibiotic prescribing in medical admissions to a general hospital. Design: Observational intervention study. Methods: Data relating to infection and antibiotic therapy were collected for 4 weeks pre-intervention (group 1) and 4 weeks post intervention (group 2). Six months later, data were collected for a further 4 weeks following a second intervention (group 3). Interventions consisted of pharmacy-led implementation of guidelines incorporating criteria for IV therapy and switching to the oral route. The second intervention also included pharmacy-initiated feedback on prescribing. The main outcome measures were IV antibiotic duration, and appropriateness of the IV route and switching. Results: Of 2365 admissions, 757 (32%) had 806 treated episodes. IV therapy was used in 40%, 46% and 36% (groups 1, 2 and 3, respectively) and was appropriate in 92% vs. 100% (group 1 vs. 2). In groups 2 and 3, oral switch timing was appropriate in 90% and 88%, vs. 17% in group 1 (p<0.001). Between groups 1 and 2, median duration of IV therapy was reduced from 3 to 2 days (p = 0.01). More patients in group 2 received appropriate exclusively IV therapy (65% vs. 96%, p<0.01). Duration of stay in IV-treated patients reduced from 13 to 10 days in groups 2 and 3 (p = 0.047). IV antibiotic expenditure reduced by 13% per patient admitted between groups 1 and 2. Discussion: Pharmacy-led introduction of antibiotic guidelines appears to result in clinically appropriate reductions in IV therapy.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>16126741</pmid><doi>10.1093/qjmed/hci114</doi><tpages>8</tpages></addata></record> |
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| subjects | Administration, Oral Adolescent Adult Aged Aged, 80 and over Anti-Bacterial Agents - administration & dosage Antibacterial agents Antibiotics. Antiinfectious agents. Antiparasitic agents Biological and medical sciences Community-Acquired Infections - drug therapy Female General aspects Humans Infusions, Intravenous Male Medical sciences Middle Aged Pharmacology. Drug treatments Pharmacy Service, Hospital - standards Pilot Projects Practice Guidelines as Topic - standards Professional Role |
| title | Pharmacy-implemented guidelines on switching from intravenous to oral antibiotics: an intervention study |
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