Oral quinolones in hospitalized patients: an evaluation of a computerized decision support intervention.
OBJECTIVE
To determine whether a computerized decision support system could increase the proportion of oral quinolone antibiotic orders placed for hospitalized patients.


METHODS
Prospective, interrupted time-series analysis.


METHODS
University hospital in the south-eastern United States.


METHODS
Inpatient quinolone orders placed from 1 February 2001 to 31 January 2003.


METHODS
A web-based intervention was deployed as part of an existing order entry system at a university hospital on 5 February 2002. Based on an automated query of active medication and diet orders, some users ordering intravenous quinolones were presented with a suggestion to consider choosing an oral formulation.


METHODS
The proportion of inpatient quinolone orders placed for oral formulations before and after deployment of the intervention.


RESULTS
There were a total of 15 194 quinolone orders during the study period, of which 8962 (59%) were for oral forms. Orders for oral quinolones increased from 4202 (56%) before the intervention to 4760 (62%) after, without a change in total orders. In the time-series analysis, there was an overall 5.6% increase (95% CI 2.8-8.4%; P < 0.001) in weekly oral quinolone orders due to the intervention, with the greatest effect on nonintensive care medical units.


CONCLUSIONS
A web-based intervention was able to increase oral quinolone orders in hospitalized patients. This is one of the first studies to demonstrate a significant effect of a computerized intervention on dosing route within an antibiotic class. This model could be applied to other antibiotics or other drug classes with good oral bioavailability.
Hulgan
T
T
Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, 345 24th Avenue N, Suite 105, Nashville, TN 37203, USA. todd.hulgan@vanderbilt.edu
Rosenbloom
S T
ST
Hargrove
F
F
Talbert
D A
DA
Arbogast
P G
PG
Bansal
P
P
Miller
R A
RA
Kernodle
D S
DS
D000284:Administration, Oral; D002939:Ciprofloxacin / Q000008:administration & dosage; D003365:Costs and Cost Analysis; D020000:Decision Support Systems, Clinical / Q000191:economics; D024841:Fluoroquinolones / Q000008:administration & dosage* / Q000191:economics; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D007275:Injections, Intravenous; D015242:Ofloxacin / Q000008:administration & dosage; D011446:Prospective Studies; D015363:Quinolones / Q000008:administration & dosage*
D024841:Fluoroquinolones; D015363:Quinolones; D002939:Ciprofloxacin; D015242:Ofloxacin