An Empiric Antibiotic Protocol Using Risk Stratification Improves Antibiotic Selection and Timing in Critically Ill Children

Karsies, Todd; Sargel, Cheryl; Marquardt, David J.; Khan, Nadeem; Hall, Mark W.

doi:10.1513/annalsats.201408-389oc

Cited by 19 publications

(15 citation statements)

References 33 publications

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“…[19,28,31,35,51,60,63–66] Values for the percentage of compliance with guidelines are summarised in Table 5. CDS effects were measured as absolute percentage differences between CDS and intervention groups.…”

Section: Resultsmentioning

confidence: 99%

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

2017

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BackgroundInappropriate antimicrobial use has been shown to be an important determinant of the emergence of antimicrobial resistance (AMR). Health information technology (HIT) in the form of Computerised Decision Support (CDS) represents an option for improving antimicrobial prescribing and containing AMR.ObjectivesTo evaluate the evidence for CDS in improving quantitative and qualitative measures of antibiotic prescribing in inpatient hospital settings.MethodsA systematic literature search was conducted of articles published from inception to 20th December 2014 using eight electronic databases: MEDLINE, EMBASE, PUBMED, Web of Science, CINAHL, Cochrane Library, HMIC and PsychINFo. An updated systematic literature search was conducted from January 1st 2015 to October 1st 2016 using PUBMED. The search strategy used combinations of the following terms: (electronic prescribing) OR (clinical decision support) AND (antibiotic or antibacterial or antimicrobial) AND (hospital or secondary care or inpatient). Studies were evaluated for quality using a 10-point rating scale.ResultsEighty-one studies were identified matching the inclusion criteria. Seven outcome measures were evaluated: adequacy of antibiotic coverage, mortality, volume of antibiotic usage, length of stay, antibiotic cost, compliance with guidelines, antimicrobial resistance, and CDS implementation and uptake. Meta-analysis of pooled outcomes showed CDS significantly improved the adequacy of antibiotic coverage (n = 13; odds ratio [OR], 2.11 [95% CI, 1.67 to 2.66, p ≤ 0.00001]). Also, CDS was associated with marginally lowered mortality (n = 20; OR, 0.85 [CI, 0.75 to 0.96, p = 0.01]). CDS was associated with lower antibiotic utilisation, increased compliance with antibiotic guidelines and reductions in antimicrobial resistance. Conflicting effects of CDS on length of stay, antibiotic costs and system uptake were also noted.ConclusionsCDS has the potential to improve the adequacy of antibiotic coverage and marginally decrease mortality in hospital-related settings.

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Section: Resultsmentioning

confidence: 99%

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

2017

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“…For example, a number of studies have shown that weight-based pre-written orders for vancomycin improve vancomycin dosing [12,13]. Introduction of order sets [groups of pre-written orders] have also been shown to improve antimicrobial use for severe sepsis [14], improve antimicrobial use in critically ill children [15], and increase timely discontinuation of post-operative antimicrobials [16].…”

Section: Background and Significancementioning

confidence: 99%

Redesign of computerized decision support to improve antimicrobial prescribing

Baysari¹,

Gigante²,

Moran³

et al. 2017

Appl Clin Inform

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“…14 Similarly, there are protocols for the selection and administration of antibiotics, in both critically ill children and adults. 15,16 In each of these examples of a complex-accomplishing protocol, there is universal agreement that the condition should be treated and near-universal agreement on how that should be accomplished. Given that there is little equipoise on the issues (DKA should be treated with insulin, tailored antibiotics should be given for sepsis), the goal is not to standardize a difficult or controversial intervention.…”

Section: Protocol-based Medical Care: Advantages and Disadvantagesmentioning

confidence: 99%

Protocol-Based Care versus Individualized Management of Patients in the Intensive Care Unit

Siner

Connors

2015

Semin Respir Crit Care Med

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The delivery of evidence-based care in the high-acuity environment of the intensive care unit can be challenging. In an effort to help turn guidelines and standards of care into consistent and uniform practice, physicians and hospitals turn toward protocol-based medical care. A protocol can help guide a practitioner to make correct interventions, at the right time, and in the proper order when managing a given disease. But to be considered a success, a protocol must meet several standards. A protocol must facilitate consistent practice, guiding the practitioner to deliver care more consistently than without the protocol. A good protocol must also be in alignment with the provider's general practice and beliefs to assure wide adoption and complete penetrance. Finally, the protocol must deliver the most medically correct care-neither simplifying nor overcomplicating health care delivery. In addition to the care the protocol delivers, it must overcome other barriers to gain acceptance. These include concerns about protocol usage among medical trainees, physician concern regarding loss of autonomy, and the ceiling effect protocol-driven care places on expert practitioners, among other concerns. The aim of this article is to critically appraise what it means for a protocol to be considered successful with an aim toward improving protocol design and implementation in the future.

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An Empiric Antibiotic Protocol Using Risk Stratification Improves Antibiotic Selection and Timing in Critically Ill Children

Cited by 19 publications

References 33 publications

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

Redesign of computerized decision support to improve antimicrobial prescribing

Protocol-Based Care versus Individualized Management of Patients in the Intensive Care Unit

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