title: Antimicrobials in acute exacerbations of chronic obstructive pulmonary disease - An analysis of the time to next exacerbation before and after the implementation of standing orders.
abstract: OBJECTIVE
  To compare the mean time to next exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) before and after the implementation of standing orders.
  
  
  METHODS
  Tertiary care hospital, Halifax, Nova Scotia, Canada.
  
  
  METHODS
  The records of 150 patients were analyzed, 76 were in the preimplementation group, 74 in the postimplementation group.
  
  
  METHODS
  The management and outcomes of patients admitted with an acute exacerbation of COPD before and after the implementation of standing orders were compared.
  
  
  METHODS
  A retrospective chart review.
  
  
  RESULTS
  THERE WAS NO DIFFERENCE IN THE MEAN TIME TO NEXT EXACERBATION BETWEEN TREATMENT GROUPS (PREIMPLEMENTATION GROUP: 310 days, postimplementation group: 289 days, P=0.53). Antibiotics were used in 90% of the cases (preimplementation group: 87%, postimplementation group: 93%). The postimplementation group had a 20% increase in the use of first-line agents over the preimplementation group. Overall, first-line agents represented only 37% of the antibiotic courses.
  
  
  CONCLUSIONS
  The implementation of standing orders encouraged the use of first-line agents but did not influence subsequent symptom resolution, length of hospital stay, or the infection-free interval in patients with acute exacerbations of COPD.
authors.affiliation: Department of Pharmacy, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia.
authors.forename: Rob D
authors.initials: RD
authors.lastname: Goddard
authors.forename: Shelly A
authors.initials: SA
authors.lastname: McNeil
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Slayter
authors.forename: R Andrew
authors.initials: RA
authors.lastname: McIvor