Effectiveness of an information technology intervention to improve prophylactic antibacterial use in the postoperative period.
BACKGROUND
A 2005 report from the Centers for Medicare and Medicaid Services and the Centers for Disease Control Surgical Infection Prevention program indicated that only 41% of prophylactic antibacterials were correctly stopped within 24 h of the end of surgery. Electronic order sets have shown promise as a means of integrating guideline information with electronic order entry systems and facilitating safer, more effective care.


OBJECTIVE
The aim was to study the effectiveness of a computer-based antibacterial order set on increasing the proportion of patients who have antibacterial wound prophylaxis discontinued in the appropriate time frame.


METHODS
The authors conducted a quasi-experimental interrupted time-series analysis over an 8-month study period with the implementation of a computer-based order system designed to prevent excessive duration of surgical prophylaxis antibacterials.


METHODS
The primary outcome was the proportion of surgeries with antibacterials discontinued in the appropriate time frame. Additionally, we evaluated the percent of surgeries after implementation of the electronic intervention with chart documentation of infection among surgeries where the prescriber indicated the reason for antibacterial therapy was treatment.


RESULTS
The computer-based order intervention significantly improved the proportion of surgeries with timely discontinuation of antibacterials from 38.8% to 55.7% (p < 0.001) in the intervention hospital, while the control hospital remained at 56-57% (p = 0.006 for the difference between treated and control hospitals). In surgeries after intervention implementation where a prescriber indicated the reason for antibacterial therapy was treatment, the prevalence of chart documented infection was only 14%.


CONCLUSIONS
A computer-based electronic order set intervention increased timely discontinuation of postoperative antibacterials.
Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, and Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. khaynes@mail.med.upenn.edu
Kevin
K
Haynes
Darren R
DR
Linkin
Neil O
NO
Fishman
Warren B
WB
Bilker
Brian L
BL
Strom
Eric A
EA
Pifer
Sean
S
Hennessy
D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D020000:Decision Support Systems, Clinical; D004334:Drug Administration Schedule; D004360:Drug Therapy, Computer-Assisted; D019983:Guideline Adherence; D006801:Humans; D057970:Inappropriate Prescribing; D017053:Infection Control; D037141:Mandatory Programs; D050316:Medical Order Entry Systems; D015143:Philadelphia; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000517:prevention & control*; D013997:Time Factors
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