title: Effect of adding piperacillin-tazobactam to automated dispensing cabinets on promptness of first-dose antibiotics in hospitalized patients.
abstract: OBJECTIVE
  Significant improvements in order-to-administration times for critical first doses of i.v. antibiotic therapy through the use of automated dispensing cabinets (ADCs) are reported.
  
  
  METHODS
  In a retrospective pre-post analysis conducted at a large academic medical center, pharmacy and medical records were reviewed to evaluate average times to administration of first doses of i.v. piperacillin-tazobactam therapy during designated periods before and after the addition of selected i.v. antibiotics to ADCs on patient care units. Inpatients who received a specified i.v. piperacillin-tazobactam formulation were included in the analysis. The primary endpoint was the total time from prescribing to administration; the impact of ADC use on other time intervals (e.g., from scanning of orders to administration, from pharmacist verification and release of orders to administration) was also evaluated.
  
  
  RESULTS
  A total of 121 subjects were included in the preimplementation (n = 65) and postimplementation (n = 56) samples. There was a significant 1.7-hour reduction in the mean ± S.D. order-to-administration time (from 4.5 ± 4.1 to 2.9 ± 2.5 hours, p = 0.009) for piperacillin-tazobactam first doses with the use of ADCs. Subgroup analyses showed significant reductions in the mean ± S.D. scan-to-administration time (from 3.3 ± 3.4 to 1.7 ± 1.5 hours, p = 0.001) and release-to-administration time (from 2.4 ± 2.4 to 1.4 ± 1.5 hours, p = 0.034).
  
  
  CONCLUSIONS
  The addition of a piperacillin-tazobactam product and other commonly used i.v. antibiotics to ADCs was associated with a significantly reduced order-to-administration time for piperacillin-tazobactam first doses. This change was accounted for by a significant reduction in the time between order entry and drug administration.
authors.affiliation: Amy Lo, Pharm.D., is Postgraduate Year 1 (PGY1) Resident in Pharmacy Practice, Acute Care, University of Southern California, Los Angeles. Juanqi "Nikki" Zhu, Pharm.D., is PGY1 Acute Care Pharmacy Resident, Western University of Health Sciences, Pomona, CA. Mark Richman, M.D., is Physician, Department of Medicine; and Julianne Joo, Pharm.D., BCPS, is Clinical Pharmacist, Department of Pharmacy, Olive View-UCLA Medical Center, Sylmar, CA. Patrick Chan, Pharm.D., Ph.D., is Assistant Professor of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences.
authors.forename: Amy
authors.initials: A
authors.lastname: Lo
authors.affiliation: Amy Lo, Pharm.D., is Postgraduate Year 1 (PGY1) Resident in Pharmacy Practice, Acute Care, University of Southern California, Los Angeles. Juanqi "Nikki" Zhu, Pharm.D., is PGY1 Acute Care Pharmacy Resident, Western University of Health Sciences, Pomona, CA. Mark Richman, M.D., is Physician, Department of Medicine; and Julianne Joo, Pharm.D., BCPS, is Clinical Pharmacist, Department of Pharmacy, Olive View-UCLA Medical Center, Sylmar, CA. Patrick Chan, Pharm.D., Ph.D., is Assistant Professor of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences.
authors.forename: Juanqi Nikki
authors.initials: JN
authors.lastname: Zhu
authors.affiliation: Amy Lo, Pharm.D., is Postgraduate Year 1 (PGY1) Resident in Pharmacy Practice, Acute Care, University of Southern California, Los Angeles. Juanqi "Nikki" Zhu, Pharm.D., is PGY1 Acute Care Pharmacy Resident, Western University of Health Sciences, Pomona, CA. Mark Richman, M.D., is Physician, Department of Medicine; and Julianne Joo, Pharm.D., BCPS, is Clinical Pharmacist, Department of Pharmacy, Olive View-UCLA Medical Center, Sylmar, CA. Patrick Chan, Pharm.D., Ph.D., is Assistant Professor of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences.
authors.forename: Mark
authors.initials: M
authors.lastname: Richman
authors.affiliation: Amy Lo, Pharm.D., is Postgraduate Year 1 (PGY1) Resident in Pharmacy Practice, Acute Care, University of Southern California, Los Angeles. Juanqi "Nikki" Zhu, Pharm.D., is PGY1 Acute Care Pharmacy Resident, Western University of Health Sciences, Pomona, CA. Mark Richman, M.D., is Physician, Department of Medicine; and Julianne Joo, Pharm.D., BCPS, is Clinical Pharmacist, Department of Pharmacy, Olive View-UCLA Medical Center, Sylmar, CA. Patrick Chan, Pharm.D., Ph.D., is Assistant Professor of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences.
authors.forename: Julianne
authors.initials: J
authors.lastname: Joo
authors.affiliation: Amy Lo, Pharm.D., is Postgraduate Year 1 (PGY1) Resident in Pharmacy Practice, Acute Care, University of Southern California, Los Angeles. Juanqi "Nikki" Zhu, Pharm.D., is PGY1 Acute Care Pharmacy Resident, Western University of Health Sciences, Pomona, CA. Mark Richman, M.D., is Physician, Department of Medicine; and Julianne Joo, Pharm.D., BCPS, is Clinical Pharmacist, Department of Pharmacy, Olive View-UCLA Medical Center, Sylmar, CA. Patrick Chan, Pharm.D., Ph.D., is Assistant Professor of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences. chanp@westernu.edu.
authors.forename: Patrick
authors.initials: P
authors.lastname: Chan
mesh_terms: D000046:Academic Medical Centers; D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001331:Automation; D005260:Female; D006801:Humans; D008297:Male; D008510:Medication Systems, Hospital; D008875:Middle Aged; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010595:Pharmacists / Q000458:organization & administration; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010878:Piperacillin / Q000008:administration & dosage / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin