Tiffany Kan1, Derrick Kwan2, Thomas Chan3, Pavani Das4, Sumit Raybardhan5. 1. , BScPhm, PharmD, BCPS, RPh, is with the Department of Pharmacy, North York General Hospital, and the Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario. 2. , BScPhm, ACPR, RPh, is with the Department of Clinical Informatics, North York General Hospital, Toronto, Ontario. 3. , BScPhm, MBA, RPh, was, at the time of this study, with the Department of Pharmacy, North York General Hospital, Toronto, Ontario. He is now with the Department of Pharmacy, Centre for Addiction and Mental Health, Toronto, Ontario. 4. , MD, is with the Division of Infectious Diseases, Department of Medicine, North York General Hospital, Toronto, Ontario. 5. , BScPhm, ACPR, MPH, RPh, is with the Department of Pharmacy, North York General Hospital, Toronto, Ontario.
Abstract
BACKGROUND: Antibiotic IV-to-oral (IV-PO) conversion is a key initiative of antimicrobial stewardship programs. Guidelines and education are commonly described interventions to promote IV-PO conversion; however, technological interventions may be more effective in changing practice. OBJECTIVE: To determine the impact of a clinical decision support (CDS) tool on the adoption and sustainability of an antibiotic IV-PO conversion program at a community academic hospital. METHODS: A quasi-experimental study consisting of 3 phases was conducted. During phase 1, the pre-intervention antibiotic IV-PO conversion rate was determined. During phase 2, the IV-PO conversion policy was updated, education was provided to pharmacists and physicians, and a post-intervention evaluation was conducted. During phase 3, a CDS tool was developed to generate real-time electronic alerts prompting pharmacists to assess antibiotic therapy, and post-intervention audits were performed 1 month, 3 months, and 15 months after implementation of the tool. Pantoprazole IV-PO conversion was assessed during each phase as a non-equivalent dependent variable. The primary outcome was the proportion of patients eligible for IV-PO conversion who were switched to oral therapy. RESULTS: Of 332 patients receiving targeted IV antibiotic therapy during the overall study period, 122 (37%) met the criteria for IV-PO conversion. The phase 2 IV-PO conversion rate of 35% (9/26) was comparable to the pre-intervention rate of 29% (10/35) (p = 0.61). Implementation of the CDS tool significantly increased the conversion rate to 78% (14/18), an increase that was sustained at 3 months (71% [17/24]) and 15 months (74% [14/19]) after implementation (p < 0.05 for all comparisons with phases 1 and 2). Pantoprazole conversion rates were similar across all phases. CONCLUSIONS: Implementation of the CDS tool was effective in improving and sustaining antibiotic IV-PO conversion rates and enhancing policy compliance beyond the effects of policy revision and education. Refinement of both the policy and the tool is warranted to maximize adoption of the IV-PO conversion program. 2019 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
BACKGROUND: Antibiotic IV-to-oral (IV-PO) conversion is a key initiative of antimicrobial stewardship programs. Guidelines and education are commonly described interventions to promote IV-PO conversion; however, technological interventions may be more effective in changing practice. OBJECTIVE: To determine the impact of a clinical decision support (CDS) tool on the adoption and sustainability of an antibiotic IV-PO conversion program at a community academic hospital. METHODS: A quasi-experimental study consisting of 3 phases was conducted. During phase 1, the pre-intervention antibiotic IV-PO conversion rate was determined. During phase 2, the IV-PO conversion policy was updated, education was provided to pharmacists and physicians, and a post-intervention evaluation was conducted. During phase 3, a CDS tool was developed to generate real-time electronic alerts prompting pharmacists to assess antibiotic therapy, and post-intervention audits were performed 1 month, 3 months, and 15 months after implementation of the tool. Pantoprazole IV-PO conversion was assessed during each phase as a non-equivalent dependent variable. The primary outcome was the proportion of patients eligible for IV-PO conversion who were switched to oral therapy. RESULTS: Of 332 patients receiving targeted IV antibiotic therapy during the overall study period, 122 (37%) met the criteria for IV-PO conversion. The phase 2 IV-PO conversion rate of 35% (9/26) was comparable to the pre-intervention rate of 29% (10/35) (p = 0.61). Implementation of the CDS tool significantly increased the conversion rate to 78% (14/18), an increase that was sustained at 3 months (71% [17/24]) and 15 months (74% [14/19]) after implementation (p < 0.05 for all comparisons with phases 1 and 2). Pantoprazole conversion rates were similar across all phases. CONCLUSIONS: Implementation of the CDS tool was effective in improving and sustaining antibiotic IV-PO conversion rates and enhancing policy compliance beyond the effects of policy revision and education. Refinement of both the policy and the tool is warranted to maximize adoption of the IV-PO conversion program. 2019 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
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