title: Administration of Extended Infusion Piperacillin-TazobactamWith the Use of Smart Pump Technology.
abstract: BACKGROUND
  For beta-lactams, the parameter that best predicts bacterial killing is the length of time the antibiotic concentration exceeds the minimum inhibitory concentration (MIC). Studies have demonstrated improved outcomes with extended infusion (4-hour) piperacillin-tazobactam (P-TZ) compared with traditional immediate infusions.
  
  
  OBJECTIVE
  To describe how one institution made the conversion from immediate infusion of P-TZ to a 4-hour extended infusion utilizing an approved automatic therapeutic substitution, staff education, and smart pump technology, and to examine the impact of this conversion on patient length of stay and pharmacy costs.
  
  
  METHODS
  With approval from the Pharmacy and Therapeutics (P&T), Antimicrobial Stewardship, and Medical Executive Committees, the decision was made to automatically convert all P-TZ orders to a standardized 4-hour infusion given every 8 to 12 hours depending on renal function. The medical records of all adult patients receiving P-TZ during 12 months pre implementation and 24 months post implementation of a 4-hour extended infusion of P-TZ were retrospectively analyzed for length of stay and mortality. The cost of P-TZ was also assessed during these time periods.
  
  
  RESULTS
  With the help of smart pump technology, our institution successfully completed a conversion to 4-hour extended infusion P-TZ. Through this conversion, pharmacy expenditure of P-TZ was reduced by 38%; the total cost savings was $387,980.62 for the 24-month postintervention phase. Extended infusion P-TZ reduced hospital length of stay by 0.6 days (P < .05), resulting in an additional cost savings of $1,689,480 for the 24-month postintervention phase. A conservative estimate of total cost savings to the hospital in the first 24 months, including the reduction in P-TZ expenditures, was $2,077,460.
authors: Medication Safety Officer, Sanford Medical Center , Sioux Falls, South Dakota.
authors: Megan L
authors: ML
authors: Maddox
authors: Clinical Nurse Leader, Sanford Medical Center , Sioux Falls, South Dakota .
authors: Erica C
authors: EC
authors: DeBoer
authors: Medication Safety Officer, Sanford Medical Center , Sioux Falls, South Dakota.
authors: Rhonda J
authors: RJ
authors: Hammerquist
keywords: antibiotics; length of stay; piperacillin-tazobactam; smart pump technology