title: Effect of closed-loop order processing on the time to initial antimicrobial therapy.
abstract: OBJECTIVE
  The results of a study comparing the average time to initiation of i.v. antimicrobial therapy with closed-versus open-loop order entry and processing are reported.
  
  
  METHODS
  A retrospective cohort study was performed to compare order-to-administration times for initial doses of i.v. antimicrobials before and after a closed-loop order-processing system including computerized prescriber order entry (CPOE) was implemented at a large medical center. A total of 741 i.v. antimicrobial administrations to adult patients during designated five-month preimplementation and postimplementation study periods were assessed. Drug-use reports generated by the pharmacy database were used to identify order-entry times, and medication administration records were reviewed to determine times of i.v. antimicrobial administration.
  
  
  RESULTS
  The mean ± S.D. order-to-administration times before and after the implementation of the CPOE system and closed-loop order processing were 3.18 ± 2.60 and 2.00 ± 1.89 hours, respectively, a reduction of 1.18 hours (p < 0.0001). Closed-loop order processing was associated with significant reductions in the average time to initiation of i.v. therapy in all patient care areas evaluated (cardiology, general medicine, and oncology). The study results suggest that CPOE-based closed-loop order processing can play an important role in achieving compliance with current practice guidelines calling for increased efforts to ensure the prompt initiation of i.v. antimicrobials for severe infections (e.g., sepsis, meningitis).
  
  
  CONCLUSIONS
  Implementation of a closed-loop order-processing system resulted in a significant decrease in order-to-administration times for i.v. antimicrobial therapy.
authors.affiliation: Department of Pharmacy Services, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mail Code CR 9-4, Portland, OR 97239, USA. panosh@ohsu.edu
authors.forename: Nicole
authors.initials: N
authors.lastname: Panosh
authors.forename: Richardd
authors.initials: R
authors.lastname: Rew
authors.forename: Michelle
authors.initials: M
authors.lastname: Sharpe
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D015142:Baltimore; D006801:Humans; D050316:Medical Order Entry Systems / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000379:methods / Q000458:organization & administration* / Q000639:trends; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000890:Anti-Infective Agents