Assessment of an intervention aimed at early discontinuation of intravenous antimicrobial therapy in a Brazilian University hospital

Bonella, Gislaine; Fontes, Astrídia Marília de Souza; Jorge, Miguel Tanús; Silveira, Alexandre Barcelos Morais da

doi:10.1016/j.bjid.2016.07.002

Cited by 4 publications

(4 citation statements)

References 30 publications

(32 reference statements)

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“…The length of time to readmission varied between studies, ranging from 14 to 90 days of the intervention. Six papers reported readmission rates due to all causes 9 , 20 , 22 , 25 , 28 , 31 whilst one reported those only related directly to the infection. 14 …”

Section: Resultsmentioning

confidence: 99%

“…There was some consistency in the methodology used to measure LOS with 10/12 papers reporting total duration of inpatient hospital stay and the remaining 2 determining ‘infection-related length of stay’. 11 , 25 Divergence was observed in the reporting of DOT, with three studies reporting total DOT and seven reporting this outcome as a rate using one of four denominators: 100 patient days, 21 1000 patient days, 13 , 25 , 28 , 31 1000 at-risk patient days 12 and 1000 occupied bed days. 11 Three studies investigated the antibiotic consumption reported in all cases as antibiotic expenditure.…”

Section: Resultsmentioning

confidence: 99%

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Antimicrobial stewardship using electronic prescribing systems in hospital settings: a scoping review of interventions and outcome measures

Jenkins

Pontefract

Cresswell

et al. 2022

JAC-Antimicrobial Resistance

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Objectives To identify interventions implemented in hospital electronic prescribing systems and the outcome measures used to monitor their impact. Methods We systematically searched CINAHL, EMBASE, Google Scholar and Medline using keywords in three strands: (i) population: hospital inpatient or emergency department; (ii) intervention: electronic prescribing functionality; and (iii) outcome: antimicrobial stewardship. The interventions were grouped into six themes: alerts, order sets, restriction of access, mandated documentation, embedded guidelines and automatic prescription stop. The outcome measures were organized into those that measure the quality or quantity of prescribing or clinical decision support (CDS) activity. The impact of each intervention reported was grouped into a positive, negative or no change. Results A total of 28 studies were eligible for inclusion. There were 28 different interventions grouped into the six themes. Alerts visible to the practitioner in the electronic health record (EHR) were most frequently implemented (n = 11/28). Twenty different outcome measures were identified, divided into quality (n = 13/20) and quantity outcomes (n = 4/20) and CDS activity (n = 3/20). One-third of outcomes reported across the 28 studies showed positive change (34.4%, n = 42/122) and 61.4% (n = 75/122) showed no change. Conclusions The most frequently implemented interventions were alerts, the majority of which were to influence behaviour or decision-making of the practitioner within the EHR. Quality outcomes were most frequently selected by researchers. The review supports previous research that larger well-designed randomized studies are needed to investigate the impact of interventions on AMS and outcome measures to be standardized.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Antimicrobial stewardship using electronic prescribing systems in hospital settings: a scoping review of interventions and outcome measures

Jenkins

Pontefract

Cresswell

et al. 2022

JAC-Antimicrobial Resistance

View full text Add to dashboard Cite

show abstract

“…In our study, apart from the large number of reported errors reaching patients, many other errors were detected in reports from nurses and pharmacists, signaling that interventions to improve such barriers would also be valuable to prevent errors from reaching patients. In this sense, in addition to implementing measures to avoid errors, interventions to safely intercept them are also beneficial [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Prescribing errors are pointed as a major concern in published studies on some hospitals in Brazil, as they occur in 43.5% to 44.5% of handwritten, mixed and pre-typed prescriptions [ 11 , 12 ] and in 8.0% of electronic prescriptions [ 13 ]. Inadequate prescriptions of antimicrobials for prophylaxis [ 14 ] and infection treatments [ 15 , 16 ] have also been identified.…”

Section: Introductionmentioning

confidence: 99%

Prescribing errors in a Brazilian teaching hospital: Causes and underlying factors from the perspective of junior doctors

et al. 2023

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Introduction In university hospital settings most prescriptions are written by junior doctors, who are more likely to make prescribing errors than experienced doctors. Prescribing errors can cause serious harm to patients and drug harm differs among low, middle and high-income countries. In Brazil, few studies have investigated the causes of these errors. Our aim was to explore medication prescribing errors in a teaching hospital, their causes, and underlying factors from the perspective of junior doctors. Method Qualitative, descriptive and exploratory study that used a semi-structured individual interview with questions related to the planning and execution of prescriptions. It was conducted with 34 junior doctors who graduated from twelve different universities located in six Brazilian states. The data were analyzed according to the Reason’s Accident Causation model. Results Among the 105 errors reported, medication omission stood out. Most errors resulted from unsafe acts during execution, followed by mistakes and violations. Many errors reached the patients; unsafe acts of rule violations and slips accounted for the majority. Work overload and time pressure were the most frequently reported causes. Difficulties faced by the National Health System and organizational problems were identified as latent conditions. Conclusion The results reaffirm international findings about the severity of prescribing errors and the multifactorial aspect of their causes. Unlike other studies, we found a large number of violations, which, from the interviewees’ perspectives, are related to socioeconomic and cultural patterns. The violations were not seen or mentioned by the interviewees as violations, but as difficulties in accomplishing their tasks on time. Knowing these patterns and perspectives is important for implementing strategies to improve the safety of both patients and professionals involved in the medication process. It is suggested that the exploitation culture of junior doctors’ work be discouraged and that their training be improved and prioritized.

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Effectiveness of antimicrobial stewardship interventions on early switch from intravenous-to-oral antimicrobials in hospitalized adults: A systematic review

Garwan

Alsalloum

Thabit

et al. 2023

American Journal of Infection Control

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Assessment of an intervention aimed at early discontinuation of intravenous antimicrobial therapy in a Brazilian University hospital

Cited by 4 publications

References 30 publications

Antimicrobial stewardship using electronic prescribing systems in hospital settings: a scoping review of interventions and outcome measures

Antimicrobial stewardship using electronic prescribing systems in hospital settings: a scoping review of interventions and outcome measures

Prescribing errors in a Brazilian teaching hospital: Causes and underlying factors from the perspective of junior doctors

Effectiveness of antimicrobial stewardship interventions on early switch from intravenous-to-oral antimicrobials in hospitalized adults: A systematic review

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