Effectiveness of clinical pathway for upper respiratory tract infections in emergency department

Madran, Bahar; Keske, Şiran; Uzun, Soner; Taymaz, Tolga; Bakir, Emine; Bozkurt, İsmail; Ergönül, Önder

doi:10.1016/j.ijid.2019.04.022

Cited by 9 publications

(7 citation statements)

References 21 publications

(22 reference statements)

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“…These results were similar to those of Jenkin et al, who reported an 11.2% relative reduction in antibiotic prescription for non-pneumonia respiratory infection and a 14.4% relative reduction in broad-spectrum antibiotic use during the intervention period [ 12 ]. In addition, Madran et al reported that the rate of antibiotic prescription decreased from 49% pre-implementation of an antibiotic stewardship program (ASP) to 29% post-implementation and that the application of a clinical pathway resulted in a rate of appropriate antibiotic use of 82% [ 13 ]. However, our application of the clinical pathway differed from those in the studies above in that, instead of providing a hard copy, we inserted clinical pathway pop-up windows into the electronic prescription system.…”

Section: Discussionmentioning

confidence: 99%

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Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection

et al. 2021

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Outpatient antibiotics are most frequently prescribed for upper respiratory tract infection (URI); however, most such prescriptions are inappropriate. We aimed to determine the effect of an electronic clinical pathway on the rates of overall and rational prescription of antibiotics in patients with URI. A pilot quasi-experimental study was conducted in a university hospital and two of its nearby primary care units (PCU) in northeast Thailand from June to September 2020. Clinical pathway pop-up windows were inserted into the hospital’s computer-based prescription system. Care providers were required to check the appropriate boxes before they were able to prescribe amoxicillin or co-amoxiclav. We examined a total of 675 visits to the outpatient department due to URI at three points in time: pre-intervention, immediately post-intervention, and 6 weeks post-intervention. Patients in the latter group tended to be younger and visits were more likely to be general practitioner-related and to the student PCU than in the other two groups. In addition, the rate of antibiotic prescription was significantly lower at 6 weeks after intervention than at either of the other time periods (32.0% vs 53.8% pre-intervention and 46.2% immediately post-intervention; p < 0.001), and the proportion of rational antibiotic prescriptions increased significantly after implementation. Antibiotic prescription rates were lower at the community primary care unit and higher when the physician was a resident or a family doctor. The deployment of an electronic clinical pathway reduced the rate of unnecessary antibiotic prescriptions. The effect was greater at 6 weeks post-implementation. However, discrepancy of patients’ baseline characteristics may have skewed the findings.

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Section: Discussionmentioning

confidence: 99%

“…The use of a clinical pathway has been shown to reduce antibiotic use in URI [ 12 , 13 , 14 ]. However, the method of implementation may depend on how medication is dispensed.…”

Section: Introductionmentioning

confidence: 99%

Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection

et al. 2021

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“…The commonly occurring URTI are common cold, tonsillitis, pharyngitis, laryngitis, rhino sinusitis and otitis media. 3 Lower respiratory tract structure includes larynx, vocal folds, trachea, bronchi, bronchioles and alveoli. The most commonly occurring respiratory tract infection are tracheitis, bronchiolitis and pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Bacteriological profile and their antibiogram from Endotracheal aspirate and Bronchoalveolar lavage fluid samples from intensive care unit patients

Chitrans

Sharma²,

Maqusood³

et al. 2021

IJMMTD

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Bacterial respiratory infections are most commonly causes of illness for all age group patients in ICU. Most of the patients suffer from urosepsis, postoperative disease and lower respiratory infection when admitted in ICU’s. The main purpose of this study is control in ICU’s infection & determine their antibiotic sensitivity pattern for better treatment of patients. Bacteriological profile and their antibiogram from endotracheal aspirate and bronchoalveolar lavage fluid samples from intensive care unit patients.We performed manual culture of Endotracheal aspirate & BAL fluid specimens collected from ICU’s patients. Samples were cultured on Blood agar and Mac-Conkey agar then incubated at 37C for 24 hours. Any growth were further confirmed by Gram stain and appropriate biochemical tests, and then Antibiotic sensitivity test was done. Among the 123 mechanically ventilated patients and 68 of them developed positive samples. In this study 55.3% (68) pathogenic isolates, 4.1% (5) were non pathogenic isolates and 40.6 (50) were no growth isolates in BAL and endotracheal aspirate samples. In which 67.6% (46) male and 32.4% (22) female patients. Older population falling in the 40-50 years of age group contributes the majority (27.64%) of the infection undergoing treatment for LRT infection in ICU’s patients in TMMC & RC, Moradabad, and in 70-80 years of age group (4.06%) was less contributes of this infection. Among the causative agents, were most common among gram negatives and was common among the gram positive isolates. In our study more resistance gram positive antibiotics were CIP, E, LE, and most sensitive antibiotics were VA, LZ, GEN and TEI. And gram negative bacteria most resistant antibiotics were OF, CPM, CAZ, CIP, CTR, MRP, LE, IPM, PIT and most sensitive antibiotics were AK, GEN, CL, TGC. In this study we conclude that Gram-negative bacilli were predominant in BAL fluid and endotracheal aspirates of ICU patients. Out of 68 multidrug resistance isolates, 1.47% were MRSA, 41.17% were ESBL and 57.36% were MBL isolates higher rate of ESBL production seen in spp., and higher rate of MBL production in spp.High incidence of VAP and the potential MDR pathogens are a real threat in our ICU’s. Combined approach of judicious antibiotic usage and training programs to health care personnel might be of help in combatting high incidence of antibiotic resistance in our institute.

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“…6,7 Inappropriate and high rates use of antibiotics can increase antibiotic resistance, healthcare cost, adverse events, and also poor treatment outcomes. [7][8][9] Antibiotic resistance is a growing problem worldwide and now becomes the most serious threat in the field of health. 9,10 Antibiotic consumption is still a concern in Asia-Pacific countries, prescribing at ambulatory care centers reaches 82%.…”

Section: Introductionmentioning

confidence: 99%

Quality of Antibiotic Prescribing for Respiratory Tract Disease in Primary Healthcare Centers in the District of Tegal, Central Java, Indonesia

Fakhrunnisa

Andrajadi

Radji

2020

ijcp

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The prescription of antibiotics for diagnosed upper respiratory tract infections (URTIs) is frequently practiced. Furthermore, inappropriate use has been implicated in numerous problems, including the onset of resistance. This study is, therefore, aimed to evaluate the antibiotic prescribing quality for respiratory tract disease diagnosed at the outpatients of primary healthcare centers in Tegal District, Central Java, Indonesia. In addition, cross-sectional evaluation was employed, using data obtained within the period of June–August, 2018 in six locations, and subsequently subjected to qualitative analysis. The prescribing quality was evaluated by comparing the drug selected, dosage, frequency, and duration of administration stated in the prescriptions, with the terms in the Clinical Practice Guidelines for Primary Healthcare Facilities, 2014. A total of 1453 samples were selected through purposive sampling, where 632 were diagnosed with respiratory tract diseases, with common cold as the most frequent diagnosis (87.2%). In addition, exactly 621 (98.3%) failed to fulfill the rational antibiotic prescribing criteria, evidenced by irrational drug selection (22.0%), dosage (9.5%), frequency (1.7%), and duration of administration (65.0%). The physicians tend to comply more with the national treatment guidelines (OR: 1.828, 95%CI: 0.486–6.874, p-value 0.365), and the less experience of prescribers (<12 years of service) was identified as a negative contributing factor (OR: 0.536, 95%CI: 0.143–2.016, p-value 0.349). Furthermore, irrational prescription was observed in a much larger proportion, influenced by the prescribers’ qualification and experience. This association is currently not significant, due to deficiency of influencing samples.Keywords: Antibiotic, appropriateness prescribing, national treatment guidelines, qualification prescribers, rationality Kualitas Peresepan Antibiotik pada Penyakit Saluran Pernafasan di Beberapa Puskesmas di Kabupaten Tegal, Jawa Tengah, IndonesiaAbstrakPeresepan antibiotik untuk diagnosis infeksi saluran pernafasan atas sering dilakukan. Peresepan antibiotik yang tidak tepat dapat menyebabkan banyak masalah, salah satunya resistensi antibiotik. Tujuan dari penelitian ini adalah mengevaluasi kualitas peresepan antibiotik pada diagnosis penyakit saluran pernafasan pasien rawat jalan di Puskesmas Kabupaten Tegal, Jawa Tengah, Indonesia. Penelitian potong lintang menggunakan data peresepan pasien rawat jalan periode Juni–Agustus 2018 di enam puskesmas di Kabupaten Tegal. Resep dengan diagnosis penyakit saluran pernafasan digunakan untuk analisis kualitatif. Kualitas peresepan dinilai dengan membandingkan pemilihan obat, dosis pemberian, frekuensi pemberian dan durasi pemberian antara yang tertulis pada resep dengan Panduan Praktik Klinis Fasilitas Kesehatan Primer 2014. Sebanyak 1453 resep diambil secara purposive sampling, 632 resep di antaranya dengan diagnosis penyakit saluran pernafasan. Diagnosis yang paling sering yaitu salesma (87,2%). Sebanyak 621 (98,3%) resep tidak memenuhi kriteria peresepan antibiotik yang rasional, meliputi ketidakrasionalan pemilihan antibiotik (22,0%), dosis pemberian (9,5%), frekuensi penggunaan (1,7%), dan durasi pemberian (65,0%). Peresepan antibiotik oleh dokter lebih sesuai dengan panduan pengobatan nasional (OR 1,828, 95% CI: 0,486–6,874, p-value 0,365). Pengalaman penulis resep yang lebih singkat (<12 tahun) juga menjadi faktor persepan tidak rasional (OR 0,536, 95% CI: 0,143–2,016, p-value 0,349). Sebagian besar peresepan antibiotik pada penyakit saluran pernafasan tidak rasional. Baik kualifikasi maupun pengalaman penulis resep pada penelitian ini memiliki memengaruhi rasionalitas resep, meskipun tidak (belum) signifikan karena kurangnya sampel terhadap kerasionalan.Kata kunci: Antibiotik, kerasionalan, kesesuaian peresepan, kualifikasi penulis resep, panduan pengobatan nasional

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Effectiveness of clinical pathway for upper respiratory tract infections in emergency department

Cited by 9 publications

References 21 publications

Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection

Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection

Bacteriological profile and their antibiogram from Endotracheal aspirate and Bronchoalveolar lavage fluid samples from intensive care unit patients

Quality of Antibiotic Prescribing for Respiratory Tract Disease in Primary Healthcare Centers in the District of Tegal, Central Java, Indonesia

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