title: Implementation of a Prolonged Infusion Guideline for Time-Dependent Antimicrobial Agents at a Tertiary Academic Medical Center.
abstract: Administration of time-dependent beta-lactam antibiotic as a prolonged infusion may maximize the pharmacodynamic target of time above the minimum inhibitory concentration. We describe the implementation of a prolonged infusion at a tertiary academic medical center, and a 1-year compliance analysis with the guideline. After performing a thorough literature search, a guideline was developed by members of the Department of Infectious Diseases and Department of Pharmacy. Approval and endorsement of the guideline was obtained by the Antimicrobial Subcommittee and Pharmacy and Therapeutics Committee. Physical champions were instrumental in the implementation of the guideline institution-wide. We then performed a 1-year retrospective analysis of guideline compliance from January 1, 2011 to December 31, 2011. Noncompliant administrations were obtained from smart infusion pumps. The total number of doses administered was taken from pharmacy information resources. In total, nearly 85,000 time-dependent doses were administered. Compliance with the prolonged infusion guideline was 89%. Rates of compliance did not significantly differ between medications (P = 0.555). Obtaining support from key stakeholders in collateral services and institutional leadership was vital for the success of this guideline. Compliance with the guideline 1 year after implementation was high. Implementation of a prolonged infusion guideline is feasible with institutional support and motivation.
authors.affiliation: 1Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA; and 2Department of Pharmacy Services, Yale-New Haven Hospital, New Haven, CT.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hohlfelder
authors.forename: David W
authors.initials: DW
authors.lastname: Kubiak
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Degrado
authors.forename: David P
authors.initials: DP
authors.lastname: Reardon
authors.forename: Paul M
authors.initials: PM
authors.lastname: Szumita
mesh_terms: D000046:Academic Medical Centers; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019983:Guideline Adherence; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous; D008826:Microbial Sensitivity Tests; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013997:Time Factors; D047090:beta-Lactams / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams