title: The effects of an electronic order set on vancomycin dosing in the ED.
abstract: OBJECTIVE
  The objective of the study was to assess the impact of a computer physician order entry (CPOE) electronic order set on appropriate vancomycin dosing in the emergency department (ED).
  
  
  METHODS
  We conducted a retrospective study examining ED dosing of vancomycin before and after the implementation of an electronic weight-based vancomycin order set. Preimplementation and postimplementation patient records were analyzed between the dates of June 1st and August 31st 2010 for the pre-CPOE group and January 1st to March 31st 2013 for the post-CPOE group.
  
  
  METHODS
  χ(2) analysis, Fisher exact test, and t tests were performed with a 2-sided P value <.05 denoting statistical significance, where appropriate.
  
  
  RESULTS
  A total of 597 patients were included in the study, with 220 in the pre-CPOE group and 377 in the post-CPOE group. The use of the electronic order set resulted in a 21.9% increase (P < .05) in appropriate dosing with 67.4% (254/377) of post-CPOE vancomycin doses considered appropriate vs 45.5% (100/220) in the pre-CPOE group. In critically ill patients, there was a 16.3% increase in appropriate dosing with 44.7% (38/85) in the post-CPOE group compared with 28.4% (19/67) in the pre-CPOE group.
  
  
  CONCLUSIONS
  The implementation of an electronic order set increased the percentage of ED patients receiving appropriate initial vancomycin doses. The impact of increasing compliance to vancomycin guidelines is in accordance with stewardship principles that promote optimization of antimicrobial dosing based on individual patient characteristics. More studies are needed to assess the relationship between appropriate vancomycin loading doses in the ED and therapeutic outcomes.
authors.affiliation: Emergency Department, Lakeland Regional Medical Center, Lakeland, FL. Electronic address: brad.hall@lrmc.com.
authors.forename: A Brad
authors.initials: AB
authors.lastname: Hall
authors.affiliation: Critical Care, Lakeland Regional Medical Center, Lakeland, FL.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Montero
authors.affiliation: Pharmacy Department, Lakeland Regional Medical Center, Lakeland, FL.
authors.forename: Jessica
authors.initials: J
authors.lastname: Cobian
authors.affiliation: Emergency Department, Lakeland Regional Medical Center, Lakeland, FL.
authors.forename: Tim
authors.initials: T
authors.lastname: Regan
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016638:Critical Illness; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control; D008875:Middle Aged; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin