Abstract
Background To maximize resources, the antimicrobial stewardship program at a pediatric tertiary
care hospital made pediatric dosing specific guidance within the electronic health
record available to all hospitals within the health system.
Objective The objective of this study was to compare the appropriateness of antibiotic dosing
before and after the implementation of an electronic intravenous (IV) antibiotic order
set.
Methods This was a retrospective cohort study evaluating orders from patients younger than
18 years who received cefepime, piperacillin–tazobactam, tobramycin, or gentamicin
at 12 health-system hospitals. Antibiotic dosing regimens and order set use were evaluated
in patients who received the specified antibiotics during the 6-month time frame prior
to and following electronic order set availability at each hospital.
Results In the before and after implementation periods, 360 and 387 total antibiotic orders
were included, respectively. Most orders were gentamicin (55.8% in the before implementation
period and 54.5% in the after implementation period) followed by piperacillin-tazobactam
(22.5% in the before period and 22.2% in the after period). Overall, 663 orders were
classified as appropriate (88.8%). Appropriateness was similar in the before or after
implementation periods (87.8 vs. 89.7%, p = 0.415). There was a significant difference in appropriateness if a blank order
versus the electronic IV antibiotic order set was used (82.8 vs. 90.5%; p = 0.024).
Conclusion No difference in antibiotic appropriateness overall was found in the before and after
implementation periods. However, when specifically compared with the appropriateness
of dosing when blank order forms were used, dosing was more appropriate when electronic
antibiotic order sets were used.
Keywords
antibiotic stewardship - clinical decision support - inpatient CPOE - order set -
pediatrics
