title: Implementation of an extended-infusion piperacillin-tazobactam program at an urban teaching hospital.
abstract: OBJECTIVE
  The development and implementation of an extended-infusion piperacillin-tazobactam program at an urban teaching hospital are described.
  
  
  CONCLUSIONS
  A multidisciplinary team was formed to address the feasibility of converting from the standard 30-minute infusion to an extended infusion of piperacillin- tazobactam. Before hospitalwide implementation, feasibility studies were performed in a subset of patients to identify potential barriers to program implementation. On the day of hospitalwide conversion, the orderables for piperacillin-tazobactam were reprogrammed in the computerized prescriber-order-entry system to allow separate options for the 30-minute infusion (for pediatric patients) and the extended-infusion regimen. After selecting the orderable for the extended-infusion regimen, an electronic message appeared to remind prescribers of the rationale for this change and recommended indications for piperacillin-tazobactam. Program success was prospectively evaluated on 11 weekdays after hospitalwide conversion for all 96 adult inpatients receiving piperacillin-tazobactam. Of the 194 piperacillin-tazobactam doses observed, 90% were appropriate, with compliance increasing to 100% by the end of the observation period. There was near-complete cessation of the every-6-hour dosage interval and a marked increase in the every-8-hour and every-12-hour dosage intervals. The number of piperacillin-tazobactam doses per 1000 patient-days significantly decreased during the postimplementation period. During the postimplementation period, pharmacy expenditures related to piperacillin-tazobactam decreased by 18% and the total number of grams of piperacillin-tazobactam purchased decreased by 24%.
  
  
  CONCLUSIONS
  A hospitalwide program for the administration of extended-infusion piperacillin-tazobactam was safely and successfully implemented using a multi-disciplinary approach in an urban teaching hospital.
authors.affiliation: Department of Pharmacy, John H. Stroger Jr. Hospital of Cook County, 1901 West Harrison Street, Chicago, IL 60612, USA. rxamplas@uicalumni.org
authors.forename: Renee C
authors.initials: RC
authors.lastname: Xamplas
authors.forename: Gail S
authors.initials: GS
authors.lastname: Itokazu
authors.forename: Robert C
authors.initials: RC
authors.lastname: Glowacki
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Grasso
authors.forename: Clay
authors.initials: C
authors.lastname: Caquelin
authors.forename: David N
authors.initials: DN
authors.lastname: Schwartz
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D003422:Critical Care; D006784:Hospitals, Teaching; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous; D019300:Medical Errors; D010348:Patient Care Team; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D010878:Piperacillin / Q000008:administration & dosage / Q000191:economics; D000077725:Piperacillin, Tazobactam Drug Combination; D011446:Prospective Studies; D011785:Quality Assurance, Health Care
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin