An electronic trigger tool to optimise intravenous to oral antibiotic switch: a controlled, interrupted time series study

Marvin A H Berrevoets,Anton S M Dofferhoff,Tom Sprong,Marrigje H Nabuurs-Franssen,Hanneke W H A Fleuren,Anne E Houterman,Bart-Jan Kullberg,Johannes L W Pot,Jeroen A Schouten

doi:10.1186/s13756-017-0239-3

Abstract

BackgroundTimely switch from intravenous (iv) antibiotics to oral therapy is a key component of antimicrobial stewardship programs in order to improve patient safety, promote early discharge and reduce costs. We have introduced a time-efficient and easily implementable intervention that relies on a computerized trigger tool, which identifies patients who are candidates for an iv to oral antibiotic switch.MethodsThe intervention was introduced on all internal medicine wards in a teaching hospital. Patients were automatically identified by an electronic trigger tool when parenteral antibiotics were used for >48 h and clinical or pharmacological data did not preclude switch therapy. A weekly educational session was introduced to alert the physicians on the intervention wards. The intervention wards were compared with control wards, which included all other hospital wards. An interrupted time-series analysis was performed to compare the pre-intervention period with the post-intervention period using ‘% of i.v. prescriptions >72 h’ and ‘median duration of iv therapy per prescription’ as outcomes. We performed a detailed prospective evaluation on a subset of 244 prescriptions to evaluate the efficacy and appropriateness of the intervention.ResultsThe number of intravenous prescriptions longer than 72 h was reduced by 19% in the intervention group (n = 1519) (p < 0.01) and the median duration of iv antibiotics was reduced with 0.8 days (p = <0.05). Compared to the control group (n = 4366) the intervention was responsible for an additional decrease of 13% (p < 0.05) in prolonged prescriptions.The detailed prospective evaluation of a subgroup of patients showed that adherence to the electronic reminder was 72%.ConclusionsAn electronic trigger tool combined with a weekly educational session was effective in reducing the duration of intravenous antimicrobial therapy.

Highlights

Switch from intravenous (iv) antibiotics to oral therapy is a key component of antimicrobial stewardship programs in order to improve patient safety, promote early discharge and reduce costs
When the patient clinically improves within 48 h and results from microbiology cultures and other tests become available these iv antibiotics may be switched to oral therapy, with the exception of certain clinical conditions that necessitate prolonged iv treatment (e.g. Staphylococcus aureus bacteremia, endocarditis, meningitis)
Previous research showed that introducing switch therapy into daily practice by a computerized trigger tool was effective in promoting iv to oral switch therapy [9, 10]

Summary

Introduction

Switch from intravenous (iv) antibiotics to oral therapy is a key component of antimicrobial stewardship programs in order to improve patient safety, promote early discharge and reduce costs. We have introduced a time-efficient and implementable intervention that relies on a computerized trigger tool, which identifies patients who are candidates for an iv to oral antibiotic switch. Previous research showed that introducing switch therapy into daily practice by a computerized trigger tool was effective in promoting iv to oral switch therapy [9, 10]. These reminders were produced with low specificity, were only performed for a limited number of antibiotics or had a low adherence rate

Objectives

Methods

Results

Conclusion