Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline

Chen, Justin R.; Tarver, Scott A.; Alvarez, Kristin; Wei, Wenjing; Khan, David A.

doi:10.1093/ofid/ofy106

Cited by 31 publications

(23 citation statements)

References 33 publications

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“…An overview of the characteristics of the included studies is listed in Table 2. Generally, twenty-two studies (81%) [5,[13][14][15][16]18,[20][21][22][23][24][25][28][29][30][31]32,[34][35][36][37][38] out of the included twenty-seven studies report cost savings after implementing an EHR based CDS intervention. Four studies (15%) [17,26,27,33] report a rise in cost expenditure.…”

Section: Resultsmentioning

confidence: 99%

“…In the majority of included studies the main cost outcome measures were related to laboratory test cost. [15][16][17]20,21,25,28,29,31,32,38] Exploration of different front-end CDS intervention categories According to the taxonomy by Wright et al [12], we identi ed ten (37%) studies [5,13,15,20,22,23,26,[36][37][38] which explored EHR based CDS interventions based on point-of-care alerts or reminders (category 3). Three interventions (11%) [17,27,34] were order facilitators (category 2).…”

Section: Resultsmentioning

confidence: 99%

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Economic impact of clinical decision support interventions based on electronic health records

Lewkowicz

Wohlbrandt

Boettinger

2020

Preprint

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Background Unnecessary healthcare utilization, non-adherence to current clinical guidelines, or insufficient personalized care are perpetual challenges and remain potential major cost-drivers for healthcare systems around the world. Implementing decision support systems into clinical care is promised to improve quality of care and thereby yield substantial effects on reducing healthcare expenditure. In this article, we evaluate the economic impact of clinical decision support (CDS) interventions based on electronic health records (EHR).Methods We searched for studies published after 2014 using MEDLINE, CENTRAL, WEB OF SCIENCE, EBSCO, and TUFTS CEA registry databases that encompass an economic evaluation or consider cost outcome measures of EHR based CDS interventions. Thereupon, we identified best practice application areas and categorized the investigated interventions according to an existing taxonomy of front-end CDS tools. Results and discussion Twenty-seven studies are investigated in this review. Of those, twenty-two studies indicate a reduction of healthcare expenditure after implementing an EHR based CDS system, especially towards prevalent application areas, such as unnecessary laboratory testing, duplicate order entry, efficient transfusion practice, or reduction of antibiotic prescriptions. On the contrary, order facilitators and undiscovered malfunctions revealed to be threats and could lead to new cost drivers in healthcare. While high upfront and maintenance costs of CDS systems are a worldwide implementation barrier, most studies do not consider implementation cost. Finally, four included economic evaluation studies report mixed monetary outcome results and thus highlight the importance of further high-quality economic evaluations for these CDS systems. Conclusion Current research studies lack consideration of comparative cost-outcome metrics as well as detailed cost components in their analyses. Nonetheless, the positive economic impact of EHR based CDS interventions is highly promising, especially with regard to reducing waste in healthcare.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Economic impact of clinical decision support interventions based on electronic health records

Lewkowicz

Wohlbrandt

Boettinger

2020

Preprint

View full text Add to dashboard Cite

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“…The most common single antibiotic targeted for reduction was aztreonam. 21,23,25,27,28,46,48 Other targeted antibiotics included carbapenems, vancomycin, linezolid, tigecycline, daptomycin, and moxifloxacin. 22,30,[32][33][34][35]46,49 Targeting Infections One PST-based pathway relied on reviews of each patient's infection and antibiotic data to select patients that would likely have a therapy change with a negative PST.…”

Section: Patient Selection Targeting Antibioticsmentioning

confidence: 99%

“…34,40 Some PST pathways excluded patients with recent type I reaction or anaphylaxis history. 38,48 Other PST-based pathway exclusions included cutaneous conditions, severe cardiac or pulmonary comorbidities, immunosuppression, pregnancy, altered mental status, and clinical instability. 31,37,48 Implementation Teams Implementation teams were often multidisciplinary with diverse perspectives and varied expertise.…”

Section: Targeting Patientsmentioning

confidence: 99%

Acute care beta-lactam allergy pathways: approaches and outcomes

Wolfson

Huebner

Blumenthal

2019

Annals of Allergy, Asthma & Immunology

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Acute care beta-lactam allergy pathways are coordinated allergy assessment programs for hospitalized patients as an antibiotic stewardship tool, which can be based on the allergy history alone, or use the allergy history to guide procedures such as drug challenges and/or penicillin skin testing. Pathways commonly targeted patients likely to benefit from acute care penicillin allergy evaluations: patients on specific broadspectrum antibiotics, referred from Infectious Diseases specialists, and/or patients with specific infections or bacterial culture results. Acute care beta-lactam pathways were safe and report decreased alternative antibiotic use and increased beta-lactam antibiotic use. Instructions Credit can now be obtained, free for a limited time, by reading the review article and completing all activity components. Please note the instructions listed below: Review the target audience, learning objectives and all disclosures. Complete the pre-test. Read the article and reflect on all content as to how it may be applicable to your practice. Complete the post-test/evaluation and claim credit earned. At this time, physicians will have earned up to 1.0 AMA PRA Category 1 Credit TM. Minimum passing score on the post-test is 70%. Overall Purpose Participants will be able to demonstrate increased knowledge of the clinical treatment of allergy/asthma/immunology and how new information can be applied to their own practices. Learning Objectives At the conclusion of this activity, participants should be able to: Identify the benefits of inpatient beta-lactam allergy assessments. Describe different approaches to beta-lactam allergy pathways including the methods used to identify patients.

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“…Several strategies have been developed and reported in the literature to attempt to decrease the inappropriate labeling of BL allergies and subsequent avoidance of BL therapy including penicillin skin testing, decision support tools for patients with documented penicillin allergies, and pharmacist-driven BL allergy interviews. [9][10][11][12][13][14] In a recent study, patients who received skin testing per hospital protocol and who were subsequently treated after provider utilization of a computerized guideline application with clinical decision support were 5.7 and 1.8 times more likely to receive a penicillin or cephalosporin, respectively. 14 A pilot-study of a standardized BL allergy questionnaire used by pharmacists found that 63% of assessed patients had previously tolerated a BL antibiotic resulting in BL prescriptions for 87.5% of the 24 patients deemed eligible for BL therapy.…”

mentioning

confidence: 99%

Pharmacy driven assessment of appropriate antibiotic selection in patients with reported beta‐lactam allergy

Holmes

Bennett

Berry

2019

J Am Coll Clin Pharm

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Background Reported beta‐lactam (BL) antibiotic allergies lead to the avoidance of BL antibiotics. Despite that less than 10% of patients reporting have a true allergy, the documentation often leads to an increased use of alternative antibiotics. These nonpreferred antibiotics (NPA) have a significant impact on cost, clinical outcomes, and antimicrobial resistance. Objective The primary objective of this study was to assess the impact of a pharmacy‐driven assessment on the prescribing frequency of penicillin or cephalosporin antibiotics in patients with a reported BL allergy. Methods This retrospective cohort analysis evaluated the effect of a best practice alert (BPA) and subsequent allergy assessment on BL use in patients with reported allergies at an integrated health system. The BPA notified pharmacy staff that a patient with a documented BL allergy was receiving a NPA. Pharmacy staff assessed previous BL tolerance and clarified reaction, severity, and timing of the documented allergy. Patients were identified for analysis if they had a documented BL allergy within the electronic medical record and received at least one antibiotic during the study period. Results A total of 418 patients were included in this analysis (180 preimplementation, 238 postimplementation). In the pharmacy‐driven assessment group, BL antibiotic use increased by 12.9% (P = .008) in patients with a previously documented BL allergy with the largest use increase in 3rd/4th generation cephalosporins (P = .045). Days of therapy for NPAs decreased in the postimplementation group, including aztreonam (P = .006) and vancomycin (P = .009). Conclusions Our data suggests that a pharmacy‐driven allergy assessment using a BPA can increase appropriate use of BL antibiotics for hospitalized patients.

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Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline

Cited by 31 publications

References 33 publications

Economic impact of clinical decision support interventions based on electronic health records

Economic impact of clinical decision support interventions based on electronic health records

Acute care beta-lactam allergy pathways: approaches and outcomes

Pharmacy driven assessment of appropriate antibiotic selection in patients with reported beta‐lactam allergy

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